Western Cape rolls out six-month HIV prevention injection in high-burden communities

Fear of side effects, stigma and the challenge of taking a daily pill have long discouraged many adolescent girls and young women from using oral pre-exposure prophylaxis (PrEP), despite its effectiveness in preventing HIV infection.

Health authorities and researchers are hoping that the rollout of Lenacapavir, a long-acting HIV prevention injection administered just twice a year, could help change that.

On Monday, the Western Cape department of health and wellness began the phased rollout of Lenacapavir at 22 healthcare facilities located in communities with the highest HIV burden in the province. The launch follows the national rollout announced by President Cyril Ramaphosa and health minister Dr Aaron Motsoaledi in Mpumalanga last week.

The rollout marks a milestone in South Africa’s HIV prevention efforts, offering people at risk of HIV infection an alternative to daily oral PrEP.

Professor Linda-Gail Bekker, director of the Desmond Tutu HIV Centre at the University of Cape Town, said the selected communities have experienced high HIV transmission rates for many years.

“HIV has been circulating in these communities for a long time. There comes a point where, unless you have highly effective prevention and treatment interventions, the virus continues to circulate within sexual networks,” she said.

Bekker said a range of social and economic factors contribute to the continued spread of HIV.

“There are very definite social determinants that play a role in the HIV epidemic. We see increased infection rates among young women who are unemployed and economically vulnerable. They may have to rely on male partners for their well-being and may not always be able to negotiate safe sex. Some may find themselves in transactional relationships.”

She said other factors linked to poverty also contribute to higher infection rates.

“For instance, high alcohol use can contribute to HIV transmission. Having said that, HIV is not only a disease of poverty. It is an infectious disease that can affect all groups in society. However, these communities have a high density of infections, and, because this is a public-sector programme, this is where we want to introduce donated Lenacapavir. Otherwise, access may not be possible for many people living in these communities.”

Bekker described Lenacapavir as one of the most promising HIV prevention tools currently available.

“There is no doubt that it holds great promise as an HIV prevention tool,” she said.

The facilities participating in the first phase of the rollout include Khayelitsha Site B Community Health Centre, Phumlani Clinic, Weltevreden Valley Clinic, Vuyani Clinic, Delft South Clinic, Matthew Goniwe Community Day Centre, Gugulethu Clinic, Nolungile Community Day Centre, Symphony Way Community Day Centre, Town 2 Community Day Centre, Delft Community Health Centre, Gugulethu Community Health Centre, Mzamomhle Clinic, Dr Abdurahman Community Day Centre, Mfuleni Community Day Centre, Luvuyo Community Day Centre, Michael Mapongwana Community Day Centre, Nyanga Community Day Centre, Kuyasa Clinic, Ikhwezi Clinic, Dr Ivan Toms Clinic and Nomzamo Community Day Centre.

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The rollout comes as concerns remain about HIV prevalence in the province. According to the Sixth South African National HIV Prevalence Survey conducted by the Human Sciences Research Council (HSRC), HIV prevalence among children, adolescents and people aged 50 and older increased in the Western Cape between 2017 and 2022.

Though the province still has the lowest HIV prevalence rate in the country, an estimated 540,000 people are living with HIV.

In December last year, the Western Cape department of health and wellness revealed that about 111,000 people living with HIV had not accessed care in the previous two years, a gap that threatens progress towards the global 95-95-95 targets. These targets aim for 95% of people living with HIV to know their status, 95% of those diagnosed to be on treatment and 95% of those on treatment to achieve viral suppression.

The department said the Lenacapavir rollout forms part of a broader HIV prevention strategy that includes testing services, treatment programmes, condom distribution and oral PrEP.

Provincial Council on Aids and TB co-chairperson Amelia Mfiki welcomed the introduction of Lenacapavir, describing it as a major step forward in HIV prevention.

“Different people require different prevention options. For some, a six-monthly injection may be easier to manage than taking a daily pill. What matters most is that people are empowered to make informed decisions about their health and have access to prevention choices that suit their lives,” she said.

“Lenacapavir is another valuable tool in our collective effort to reduce new HIV infections and protect the health of our communities.”

Mfiki said strong partnerships between researchers, communities and government would be critical to the programme’s success.

“When researchers work in partnership with communities, supported by strong government leadership, it creates the foundation for a successful public health programme. Continued support for community-based organisations remains essential to ensuring the effectiveness and sustainability of HIV programmes on the ground.”

She also called on funders and sponsors to continue investing in clinical research and demand-creation campaigns to ensure scientific breakthroughs translate into real-world impact.

Western Cape health and wellness minister Mireille Wenger said the introduction of Lenacapavir represented one of the most significant advances in HIV prevention in recent years.

“The rollout of Lenacapavir represents a major scientific breakthrough in HIV prevention and gives us another opportunity to strengthen HIV prevention in our communities,” she said.

“It expands the choices available to people who may benefit from a long-acting prevention option and brings us one step closer to a future with fewer new infections.”

Wenger said South Africa’s progress against HIV has demonstrated the value of collaboration between communities, healthcare workers, researchers and government.

“While treatment has transformed millions of lives, preventing new infections remains one of our most important priorities.”

Bekker emphasised that while the injection offers long-lasting protection, people must return for their follow-up doses to maintain its effectiveness.

“For a long period, people can be adequately protected, but it remains important that they return for refills,” she said.

“We also need educational interventions to ensure people know what prevention tools are available to them and how best to protect themselves. Accessibility to high-quality prevention services remains critical if we are to reduce the burden of HIV infection.”