By Elizabeth Sitotombe
ZIMBABWE had its first recipient of the HIV prevention injection this month — a more convenient alternative to the daily regimen.
The long-acting Cabotegravir PrEP medication (also known as CAB-LA) is an injectable pre-exposure prophylaxis (PrEP) drug that was recently added to the local HIV prevention regimen.
CAB-LA is administered every two months.
PrEP reduces the risk of getting HIV from sexual intercourse by more than 90 percent. It works by preventing HIV from taking hold and spreading throughout the body. It is highly effective for inhibiting HIV if used as prescribed. However, its efficacy rate is limited to an individual’s adherence in taking the medication and the risk of getting infected quickly reverts once PrEP is stopped.
CAB-LA is intended to subdue any infection as it occurs and is the third PrEP product to be introduced after the Medicines Control Authority of Zimbabwe (MCAZ) approved the use of the Dapivirine vaginal ring in 2021.
The Dapirivine vaginal ring is a flexible silicone ring that is inserted in the vagina while oral PrEP (pills) were also used.
The MCAZ gave the thumbs-up to CAB-LA in 2022.
CAB-LA can only be used by HIV negative people who have a high risk of getting infected with HIV, that is serodiscordant couples. This is where one partner is infected with HIV and the other is not. Serodiscordancy contributes to the spread of HIV/AIDS, particularly in sub-Saharan nations.
According to the World Health Organisation (WHO), the CAB-LA injections were safe, well-tolerated and highly effective in reducing the risk of one getting infected with HIV, based on research studies carried out previously. WHO endorsed the injection as an additional HIV prevention option in 2022.
The US approved the drug in December 2021, while Australia gave it its green light in August 2022.
CAB-LA cannot be used for treatment of HIV and is not yet regularly accessible and according to the Ministry of Health and Child Care officer, Dr Idah Moyo, it is presently undergoing evaluation at selected demonstration sites.
Zimbabwe has introduced PrEP medication to over 200 000 Zimbabweans over the past eight years.
According to one general practitioner, Dr Misheck Ruwende: “Injection site reactions are the most common side effects among people receiving the injection (82 percent of cases). These reactions last on average eight days and decrease in severity with each subsequent injection. These side effects include local pain, swelling, redness and bruising. Taking over-the-counter pain relievers before (or immediately after) the injection can significantly ease injection site reactions.”
PrEP reduces HIV by up to 90 percent compared with placebo when taken correctly; the actual efficacy achieved depends on adherence, according to UNAIDS (2015).
The UN body also adds that no evidence indicates PrEP will undermine the use of condoms and other safer sex behaviour and have indicated that it, in fact, reduces individual anxiety about HIV, allowing them more ownership of their safer sex behaviour. Ongoing follow-up with regular HIV testing is required. Sex-workers, prisoners, youths, adolescent girls and young women as well as mobile workers are among the groups with high risk of exposure.
In 2020 alone, 1,5 million new HIV infections were recorded. According to statistics, around 5 000 young women (15-24 years) were newly infected, globally, with HIV every week.
But, as we all know, sexually transmitted infections (STIs) are very common among people who are sexually active. Anyone who indulges in sex is at risk. Even if one is taking PrEP, it will not prevent infection from STIs, such as syphilis, chlamydia or gonorrhoea. Abstinence is the most effective way of not contracting STIs, as well as reducing the number of sexual partners and condomising.
The National Library of Medicine says the use of PrEP raises concerns about STI incidence because of decreased condom use. Individuals tend to engage in riskier sexual practices, increasing their chances of getting infected with STIs.
A study of individuals between the ages of 34-36 years of PrEP users was conducted at Montreal’s Clinique Medicale l’Actuel. Seventy-one percent of these had attained a university level education. Most of them reported having multiple sexual partners — on average, one stable partner and 20 occasional partners. Within 12 months prior to PrEP initiation, all PreP users received an initial prescription of daily PrEP. By the end of the year, 25 percent had stopped using PrEP and, among those remaining, 6,1 percent were not consistent in taking it.
Overall, 83,5 STI cases per 100 person-years were detected during the year following PrEP prescription compared to 48,6 per 100 person-years cases prior to PrEP; 30 percent of PrEP users contracted one STI; 12 percent contracted two STIs and nine percent contracted three or more STIs.
While the use of PrEP is definitely a game-changer in the fight against HIV, STIs are still a cause for concern.