WHO recommends long-acting cabotegravir for HIV prevention

Kampala, Uganda | THE INDEPENDENT | The World Health Organization-WHO on Thursday released new guidelines giving countries a green light to use long-acting injectable cabotegravir (CAB-LA) as pre-exposure prophylaxis (PrEP) for HIV.

The guidelines that were released ahead of the annual International AIDS Conference will support countries as they plan for CAB-LA introduction as part of a comprehensive approach to HIV prevention and will facilitate urgently needed operational research.

The guidelines were launched just a day after UNAIDS released a global report showing a high 1.5 million people getting newly infected with HIV in 2021. This means there were 4000 new infections every day in 2021, with key populations such as sex workers, men who have sex with men, people who inject drugs, people in prisons and transgender people and their sexual partners accounting for 70% of HIV infections globally.

“Long-acting cabotegravir is a safe and highly effective HIV prevention tool, but isn’t yet available outside study settings,” said Dr. Meg Doherty, Director of WHO’s Global HIV, Hepatitis and Sexually Transmitted Infections Programmes.

“We hope these new guidelines will help accelerate country efforts to start to plan and deliver CAB-LA alongside other HIV prevention options, including oral PrEP and the dapivirine vaginal ring.”

CAB-LA is an intramuscular injectable, long-acting form of PrEP, with the first 2 injections administered 4 weeks apart, followed thereafter by an injection every 8 weeks.

CAB-LA was shown to be safe and highly effective among cisgender women, cisgender men who have sex with men, and transgender women who have sex with men in two randomized controlled trials. Together, these studies found that the use of CAB-LA resulted in a 79% relative reduction in HIV risk compared with oral PrEP, where adherence to taking daily oral medication was often a challenge.

Long-acting injectable products have also been found to be acceptable and sometimes preferred in studies examining community PrEP preferences.

“To achieve UN prevention goals, we must push for rapid, equitable access to all effective prevention tools, including long-acting PrEP,” said Rachel Baggaley, Lead of the Testing, Prevention and Populations Team at Global HIV, Hepatitis and STI Programmes at WHO. “That means overcoming critical barriers in low- and middle-income countries, including implementation challenges and costs.”

However, the new injection comes after WHO long approved the use of oral PrEP although many countries especially in Africa are still struggling to make it available for everyone that needs it.

But, WHO says CAB-LA increases the options available and should always be offered alongside oral PrEP. Some people may continue to choose oral PrEP and CAB-LA will likely be preferred by people who find it difficult to take tablets or do not want to do so.

The guidelines also note that young people and key populations often experience challenges in accessing current PrEP services. Communities must be involved in developing and delivering HIV prevention services that are effective, acceptable and support choice.

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