Preventing HIV in KenyaA new, injectable antiretroviral drug, cabotegravir (CAB LA), may have significant potential for preventing HIV among sub-Saharan African women. In November 2020, the World Health Organization (WHO) reported trial results of the HIV Prevention Trials Network Study (HPTN 084), testing the use and effectiveness of CAB LA in preventing HIV among more than 3,200 HIV-negative, sexually active women across east and southern Africa. This drug could significantly lower prevalence rates and help in preventing HIV in Kenya, which has one of the largest HIV/AIDS epidemics in the world.

Cabotegravir or CAB LA

CAB LA, a long-acting pre-exposure prophylaxis (PrEP) regimen, requires an injection only every eight weeks and has been shown to be 89% more effective in preventing HIV than taking a daily oral antiretroviral PrEP, a generic pill currently marketed as Truvada.

Kenya’s HIV Epidemic

The first case of HIV in Kenya appeared in 1984. By 1990, HIV was one of the leading causes of illness in the country. At its highest point, more than three million Kenyans lived with AIDS. Since then, the government of Kenya decreased the prevalence of HIV from its 10.5% peak in 1996 to 5.6% in 2012. By 2019, the prevalence rate was 4.5% in adults aged 15-49. However, certain vulnerable populations within Kenya are more at risk of getting HIV, such as women. Males have an estimated prevalence rate of 4.5% while the rate for females is 5.2%. Among youth aged between 15 and 24 years old, boys have a prevalence rate of 1.34% compared to girls at 2.61%.

The only option for preventing HIV in Kenya is a daily PrEP pill called Truvada. The government of Kenya first approved oral PrEP for country-wide distribution in 2015, and since 2017, has scaled up the distribution throughout Kenya. However, of the 1.5 million Kenyans living with HIV, only 26,098 (1.7%) are currently on PrEP.

Though 72% of the population had been tested for HIV, only 70% had been tested more than once. Frequent testing, at least once a year if sexually active or at least every six months if part of a particularly vulnerable population, is vital to giving care and treatment for at-risk groups.

The Potential of CAB LA for Preventing HIV in Kenya

  1. The HPTN study reported that CAB LA is nine times more effective in preventing HIV in Kenya than the Truvada pill, the current form of PrEP. The PrEP pill is only effective if taken daily and is not a standalone prevention method for other STIs or unplanned pregnancies. The new drug also does not require other forms of protection, such as condoms.
  2. This drug gives vulnerable populations more HIV options for preventing HIV in Kenya. Vulnerable populations include sex workers, men who have sex with men, people who inject drugs, youth and women. These vulnerable populations face stigma, which affects their ability to access PrEP pills. Because the injection is needed only once every two months, the increased discretion and ease of the infrequent injection may increase its use and thus increase the protection of those who need it.
  3. Discretion in use of the drug may be able to reach more women specifically. In combination with the stigma attached to HIV, women in Kenya face discrimination in terms of access to education, employment and healthcare. As a result, men often dominate sexual relationships, with women not always able to practice safer sex, even when they know they should. For example, in 2014, 35% of adult women (aged 15-49) who were or had been married had experienced spousal violence and 14% had experienced sexual violence. Women in Kenya find it especially difficult to take a daily pill, which significantly reduces the effectiveness of the medicine. Only 68% of Kenyan women have access to antiretroviral pills.

Though not yet approved by the U.S. Food and Drug Administration (FDA), the developer of the drug, ViiV Healthcare, expects cabotegravir to be ready for the market by early 2021.

– Charlotte Ehlers
Photo: Flickr

A new HIV treatment has recently been introduced to the public. The treatment, known as Pre-Exposure Prophylaxis (PrEP) and sold under the brand name Truvada, “involves taking a pill once a day to prevent HIV infections in populations that are at high risk.”

The World Health Organization (WHO) has recently recommended that people who have a high risk of getting HIV should be taking the pill. In an interview with Michael Martin of NPR, Dr. Anthony Fauci, who attended the 20th annual International Aids Conference (IAC) that took place in Melbourne, Australia, seeks to explain the recommendation by the WHO and the sudden interest in the Truvada treatment. He told Martin that it is taken both as a treatment and as a precautionary and prevention drug.

Fauci explained that the WHO is now extremely interested in PrEp because “the clinical trials have incontrovertibly shown that if used properly and if people take the pill—and this is a pill that has two drugs in it, that are highly effective against HIV.”

He also commented that for people who do take the pill consistently, “the efficacy is greater than 90 percent,” and that because of this level of success, “the (WHO) and our own Centers for Disease Control and Prevention here in the United States are recommending that people in a few subcategories who are at particularly high risk should seriously consider taking this pre-exposure prophylaxis.”

Dr. Robert Grant, who also attended the 20th annual IAC, commented on the success of the drug’s implementation. He said that a daily dose was necessary because it keeps people in the habit of taking the medicine. He explained to Medscape that “daily dosing creates the highest drug levels, which provides somewhat of a cushion in case people miss a few doses,” and helps to ensure and maximize the effective nature of the treatment.

While the drug is now being used more regularly and shows promise for future HIV research, it is important to remember that Truvada serves only as a treatment and as prevention method and not as an actual cure for HIV.

– Jordyn Horowitz

Sources: NPR, Truvada
Photo: SheKnows