Nadia Sam-Agudu

Long-acting ART and PrEP are newly available HIV therapeutic interventions. Questions arise on how to scale up these agents to ensure population-level effectiveness. Speakers share data and experiences, including lessons learnt from the scale-up of other long-acting formulations. Challenges are reviewed from implementation and economic perspectives while highlighting potential solutions.

Dr. Ruanne Barnabas, US infectious disease clinician, starts the session with the following take-home points: co-creation and equitable partnerships, client-centered treatment and prevention, and testing and implementing evidence-based interventions are critical for taking evidence on long-acting ARVs from clinical trial sites to community-based sites. Dr. Lise Jamieson, health economist from South Africa, presents a modelling study on cost-effectiveness of long-acting ARVs, concluding that CAB-LA (long-acting cabotegravir) will contribute an estimated 3-to-5-fold increase in infections and deaths averted over 20 yrs compared to oral PrEP, and that cost of CAB-LA needs to be $9-$15 per injection for it to be similarly or more cost effective than oral PrEP in South Africa. Dr. Cordelia Katureebe, National Coordinator for HIV Care and Treatment at the Uganda Ministry of Health, speaks next. She shares lessons learned from the scale up of long-acting contraceptives that would be useful for scaling up long-acting antiretrovirals. She calls for co-formulation and integration of contraception and ART into facility and community-based differentiated service delivery, and notes that self-injection and/or community healthcare worker administration is important, and that long-acting formulations should NOT require cold chain management and should NOT increase frequency of facility or community visits.

While there were several presentations on LA ARVs at IAS 2023, this session strongly helps to consolidate the argument for scaling up LA ARVs for both prevention and treatment. Speakers provide their experience and expertise on equitable and sustainable approaches to LA ARV scale-up, with respect to clinic-to-community evidence translation and implementation, integration and differentiated service delivery models for long-acting contraception and HIV treatment, and the economic cost of implementation and scale up in a high HIV burden setting. Added experience from a patient on LA ARV PrEP or treatment, or a community/non-clinical site implementer could have provided more insight.