Africa (Commonwealth Union) _ Seven months after Rwanda rolled out the world’s first injectable HIV prevention drug, health officials say the initiative is picking up steam, albeit for now in just two clinics in the capital, Kigali.
The two-monthly long-acting pre-exposure prophylaxis (PrEP) injection, cabotegravir, is administered and was rolled out last January as one of the country’s high-risk HIV prevention measures. It is only being distributed in Busanza and Gikondo health centers, both in Kicukiro District.
Dr Zephanie Nzeyimana, the Rwanda Biomedical Centre (RBC) HIV Key Population Strategic Officer, explained the limited release is intentional. “Enrollment has been slow because services are available at only two sites, and we’re still in the evaluation phase,” he said. The pilot will run for one year, during which uptake, adherence, and side effects are monitored to decide whether to expand the program nationwide or keep it as a complementary option to oral PrEP.
To date, 90 individuals have been administered the injection, and the reaction has been positive in the majority. Most say it is much easier to take a dose every two months compared to a daily pill. Priority populations are men who have sex with men, female sex workers, adolescent girls, young women, and HIV-negative partners of individuals living with HIV.
At the national level, 15,525 people were taking oral PrEP as of June 30. Its adoption has been inconsistent owing to challenges such as stigma, lack of awareness, and spotty access to medical care often associated with drug use or homelessness. The injectable form attempts to overcome these barriers through a less conspicuous and less burdensome alternative.
Distance is a problem. While the injection is accessible to everyone, travelling from rural areas to Kigali to receive treatment is not possible. Authorities believe that making the services more accessible in more local facilities will greatly improve uptake.
Side effects have been minimal in Rwanda, and most users have experienced only minor pain at the injection site for three days, acceptable with painkillers. One person has discontinued the injection because of discomfort, and a few have gone back to oral PrEP.
The Ministry of Health will roll out the service to other facilities within one to three months, scaling up incrementally to ensure sustainability.
Rwanda has been successful in the fight against HIV, with new infections decreasing by 76% in the past 15 years and achieving the UNAIDS 95-95-95 goals. However, with around 5,400 new adult cases annually, expanding preventive options like injectable PrEP might be a necessary next move to sustain these advances.
