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Preventing HIV in Kenya with an Injection

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

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DREAMS Fights Against AIDS

DREAMS Fights Against AIDS
Today, approximately 36.9 million people are living with HIV globally and 25 percent of that number do not even know their status. Of those millions, HIV infects about 1,000 young girls and women each day and accounts for 74 percent of new HIV infections among adolescents in sub-Saharan Africa. HIV/AIDS continues to be at the forefront of global public health issues in the world today and appears to be most prevalent in low and middle-income countries. However, the organization DREAMS fights against AIDS and initiatives like the United States President’s Emergency Plan for AIDS Relief (PEPFAR) is helping it accomplish its goals.

What is PEPFAR?

PEPFAR emerged in 2003 and has received strong support ever since, resulting in the United States becoming a global leader in the response to the HIV/AIDS epidemic and PEPFAR being a model for development programs around the world. PEPFAR has helped transform the response to HIV/AIDS by working with over 50 countries, as well as causing a significant decline in new HIV diagnoses among young girls and women through the DREAMS partnership.

The DREAMS Partnership

DREAMS is a public-private partnership between PEPFAR, the Bill and Melinda Gates Foundation, Girl Effect, Johnson & Johnson, Gilead Sciences and ViiV Healthcare to implement an ambitious HIV/AIDS reduction program. This initiative launched in 2014 on World AIDS Day and targets 10 African countries in which 65 percent have extremely high HIV rates, especially among young girls and women. This movement aims to support affected women, as well as prevent any further spreading of HIV/AIDS. It has resulted in the integration of DREAMS activities into the plans of the involved countries.

The DREAMS Impact

The DREAMS organization fights against AIDS in 10 countries including Kenya, Lesotho, Malawi, Mozambique, South Africa, Swaziland, Tanzania, Uganda, Zambia and Zimbabwe. These countries’ populations account for more than half of all new HIV infections that occurred in young girls and women globally in 2015.

DREAMS’ plan consists of multiple solutions surrounding the main problem of the HIV/AIDS epidemic in the world. It delivers a package that combines evidence-based approaches addressing structural drivers that directly and indirectly increase the risk of HIV in girls, such as poverty, gender inequality, sexual violence and a lack of education. More specifically, this comprehensive package of interventions has four focus groups including educating girls and young women through a range of activities to prevent their risk of HIV and violence, targeting men and boys within the community for treatments, strengthening families through social protection programs and the implementation of parenting programs related to adolescent HIV risk and shifting norms to mobilize communities and change to prevent violence and the further spread of HIV/AIDS.

Currently, 80 percent of young girls and women ranging from 15 to 24 years old and living with HIV are in sub-Saharan Africa. By the end of 2016, new HIV incident recordings in young girls and women decreased by 25 percent in the hardest-hit countries and further reduced by 40 percent by the end of 2017.

The DREAMS Innovation Challenge

While DREAMS has made significant progress since its formation, HIV/AIDS is still infecting an alarming number of young girls and women every day. Fifty-five organizations won the DREAMS Innovation Challenge and are now implementing solutions in six main focus areas such as strengthening leadership and capacity of community-based organizations (such as nonprofit or grassroots organizations) to support the expansion of intervention, ensuring girls’ access and smooth transition into secondary school, creating new methods to engage men in HIV testing and counseling and treatments, supporting pre-exposure interventions, providing employment opportunities to young women to decrease their risk of exposure to HIV and increasing the availability and use of data to inform, increasing impact and further producing innovative solutions.

Selected solutions resulting from this challenge were those that introduced new innovations in the 10 countries where DREAMS fights against AIDS. It also offers sustainable, long-lasting solutions and countries can implement them rapidly within two years. More than 60 percent of the challenge winners are small, community-based organizations that not only received funding but also became new PEPFAR partners.

Continuing on its innovative path to preventing and reducing the spread of HIV/AIDS, PEPFAR recently announced its investment of nearly $2 billion to empower and support women and girls, with it channeling nearly $200 million through the DREAMS partnership. This will allow more girls to avoid contracting HIV at birth, keep more adolescents HIV free and support vulnerable women and children while treating HIV positive women. Additionally, the partnership has recently grown to provide more than $800 million to 15 African and Caribbean countries since its founding in 2015. PEPFAR has helped 2.4 million babies to be born HIV free from HIV-positive mothers and has saved about 17 million lives through its efforts as DREAMS fights against AIDS. Thankfully, this organization shows no sign of slowing down in the fight against HIV/AIDS for young girls and women around the world.

– Adya Khosla
Photo: Flickr