Christopher Akolo

HIV will remain a public health challenge if individuals who could benefit from PrEP continue to be left behind. The introduction of dapivirine ring and CAB-LA provide choices and address some barriers to daily oral PrEP. To realize the full potential of PrEP, services must be accessible to all.

Beatriz GRINSZTEJN, with Fiocruz/INI, Brazil, presented on two long-acting PrEP formulations that are now available for countries to adopt; the dapivirine ring that could reduction new HIV infections by 50% with long term use and injectable cabotegravir that showed 88% reduction in new infections. More rapid development of implementation science studies will be vital in understanding barriers to roll-out of these technologies as well as address questions on how best to integrate these products into health systems globally. Other critical elements needed for introduction include having multiple quality-assured suppliers for affordable pricing and adequate supply, ensuring a person-centered approach and availability of choices for all potential users. An advocate from GNP+, Annah Sango, welcomed these developments and emphasized how young girls and women, and key populations need more choices as they continue to be disproportionately affected by HIV. She highlighted how product development should include human-centered design and involvement of the communities in planning and design. We must also ensure HIV prevention choice is enshrined in all programs for women and girls. She concluded with a call to action for governments and donors to invest in the roll out and delivery of long-acting PrEP and address structural barriers and inequalities.

While long-acting PrEP will help address some of the challenges associated with oral PrEP, the issue of pricing, the risk of resistance and potential need for molecular testing at initiation may present challenges. Efforts to accelerate implementation are needed; timely registration of new products; updating national guidelines, capacity building for providers, and engaging communities for demand creation. The efficacy of PrEP will rely on the ability of people at risk to choose a method that works best for them. Access and equity will require policies around drug pricing and patents and allowing for generics to ensure affordability, availability, and sustainability.