Long-acting injections for HIV prevention among women in sub-Saharan Africa

• Published in: The Lancet (British edition) Vol. 399; no. 10337; pp. 1754 - 1755
• Main Authors: Mudzingwa, Emily Krogstad, Parker, Ivana K
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 07.05.2022; Elsevier Limited
• Subjects: Acquired Immunodeficiency Syndrome; Africa South of the Sahara - epidemiology; Antiretroviral drugs; Clinical trials; Disease prevention; Female; Gays & lesbians; Gels; HIV; HIV Infections - epidemiology; HIV Infections - prevention & control; Human immunodeficiency virus; Humans; Infections; Men; Mens health; Prophylaxis; Risk management; Sexually transmitted diseases; STD; Tenofovir; Vagina; Women; Womens health; Africa South of the Sahara; Sub-Saharan Africa; Africa
• ISSN: 0140-6736; 1474-547X; 1474-547X
• DOI: 10.1016/S0140-6736(22)00613-4

Tenofovir vaginal gels showed initial promise with a 39% overall reduction in HIV infection,2 but later trials showed no evidence of protection.3 Two clinical trials of dapivirine vaginal rings showed an overall 27–31% risk reduction.4,5 Daily oral pills containing tenofovir disoproxil fumarate are currently the standard for pre-exposure prophylaxis (PrEP).6 Although oral PrEP is effective if taken regularly,7 clinical trials in women in sub-Saharan Africa show variable protection ranging from 0% to 75%.8,9 All of these studies highlight poor adherence as a primary driver of low protection, supported by clear adherence–efficacy associations. Delany-Moretlwe and colleagues observed 40 incident infections over 3898 person-years, with four in the cabotegravir group and 36 in the TDF-FTC group, which corresponds to an 88% lower risk of HIV infection for women in the cabotegravir group relative to the TDF-FTC group. Comparatively, HPTN 083, the sister clinical trial among men who have sex with men and transgender women in the USA, Latin America, Asia, and Africa reported a higher TDF-FTC adherence (72% as measured by TFV-DP) and a lower risk reduction (66%) for cabotegravir versus TDF-FTC than did the present study.11 These differences highlight the potentially greater barriers that sub-Saharan African women face in taking pills, and suggest that, relative to daily oral PrEP, cabotegravir injections might have an even greater impact on reducing HIV in women in this context.