By Tatiana Mhararira
In a proactive response to rising HIV infection rates Masvingo City Council through its Runyararo clinic launched Cabotegravir Long-Acting (CAB-LA), an innovative option for pre-exposure prophylaxis (PrEP).
This new injectable treatment, administered every two months aims to enhance HIV prevention efforts for individuals at significant risk providing them with a more effective, discreet and user-friendly alternative addressing critical barriers to adherence and stigma associated with daily oral PrEP pills.
In an interview with City Council Director of Health Services Suzanne Madamombe said the purpose of introducing CAB-LA injection for HIV prevention was part of a broader programme in Zimbabwe which was introduced to address several key challenges in HIV prevention.
“The CAB-LA was introduced offer choice which is to expand the “basket of HIV prevention tools available, allowing people to choose the method that best fits their lifestyle and needs.CAB-LA improve adherence since it is an injection administered every two months (after initial doses one month apart), which is a significant advantage over the daily oral PrEP pill, where forgetting doses can reduce effectiveness.
“The CAB-LA increases efficacy as clinical trials have shown that CAB-LA is more effective at reducing HIV risk compared to oral PrEP, largely due to improved adherence with the long-acting format. The injection enhances discretion and reduces stigma since the injectable format offers more privacy and discretion than daily pills, which helps individuals, particularly those who may face stigma or have partners who do not know about their PrEP use, to protect themselves without fear of discovery,” said Madamombe.
Madamombe said the eligibility criteria for individuals to receive CAB-LA injection includes HIV-negative status, significant risk of HIV acquisition, weight requirement, adherence capability and have no contraindicated medications.
“For one to be eligible to access the CAB-LA injection the individual must have a confirmed negative HIV-1 test result (preferably using an antigen/antibody and HIV RNA test) before starting the injection and before every subsequent injection. Using CAB-LA with undiagnosed HIV can lead to the development of drug-resistant HIV strains. The individual must be at substantial ongoing risk of acquiring HIV through sexual behavior (e.g., has an HIV-positive partner with an unknown or detectable viral load, does not consistently use condoms, or has had an STI diagnosis in the past 6 months). The person must be an adult or adolescent weighing at least 35 kilograms
“The individual should be willing and able to adhere to the required injection schedule, which starts with two injections a month apart, followed by one injection every two months. The individual must not be taking certain medications that can interact negatively with cabotegravir, including carbamazepine, oxcarbazepine, phenobarbital, phenytoin, rifampin, or rifapentine,” said Madamombe.
She also said CAB-LA injection differs from daily PrEP tablets because it is long acting hence reduces dose frequency that is twice per month compared to daily dosage which may cause pill burden and poor adherence resulting in ineffective protection.
The benefits of using the CAB LA injection are that the injection is discrete and private, it is more effective than Oral PrEP by 90%, has good adherence and reduced dosing frequency.
Madamombe said several measures were in place to ensure the safe and effective administration of CAB-LA.
“The following measures will be used to ensure good administration of the injection on job training of staff on injection administration, on job mentorship and routine supervision of staff, proper storage of medicine to ensure patient receive potent medicine, checking of expiry dates and if there are any discoloration before administration.
“The Runyararo clinic will manage follow up appointments or monitoring for patients receiving the CAB-LA injection through the following ways booking system for easy identification of missed appointment and also use of PrEP champions to follow up missed appointments and defaulters,” said Madamombe.
She said group health education sessions and individualized health sessions are the educational and counselling services provided for patients receiving the CAB-LA injection citing that the main challenge to be faced by the administration of the injection is defaulting and there will be defaulter tracking through community cadres who are being supported by Pangea Zimbabwe AIDS Trust (PZAT).
The Runyararo Clinic service hours are Monday to Friday from 0700hours to 1600hours for more information and scheduling of appointments since it is the only health facility initiating clients on CAB-LA injection.
Runyararo Clinic is one of the sites under the Maximizing Options to Advance Informed Choice for HIV Prevention (MOSAIC) consortium’s program launched by PZAT to this program is helping inform the national scale-up of the CAB-LA injection method across the country.
