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More good news on lenacapavir, and community groups are left out of new bilateral health deals.
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I’ll admit to experiencing a bit of cognitive dissonance at this year’s International AIDS Conference.
The stunning conference center is strewn with posters from pharmaceutical manufacturers, including Gilead, who are key sponsors of the gathering. And Gilead’s six-month injectable version of preexposure prophylaxis — lenacapavir — is easily the star of the entire show. At the same time, Latin American leaders are accusing the pharmaceutical company of restricting their countries’ access to lenacapavir. That includes Brazil, which is hosting South America’s first IAC and which was part of the clinical trials for lenacapavir. Gilead has struck deals with generic manufacturers to produce and distribute low-cost versions of its prevention tool. But they have limited which countries have access to those generics, and much of Latin America didn’t make the list. The reasoning is that the countries are considered middle-income and can afford to purchase their own medicines. But officials argue that the costs will either overwhelm their budgets or get passed down to communities that are in no position to shoulder them. As activists stormed the stage at the opening night’s ceremony, they called out Gilead by name. “For two years Gilead has forced this region to wait; this approach will needlessly prolong the pandemic,” Health GAP’s Asia Russell tells me. “Brazil should stop waiting and break the patents instead — it’s good public health policy.” Just minutes before activists took the stage, Brazilian Minister of Health Alexandre Padilha announced that his country was on the brink of gaining access to at least one new prevention tool: cabotegravir, or CAB-LA. Manufactured by Viiv, the injectable preexposure prophylaxis, or PrEP, offers protection from HIV for two months. Padilha told reporters he’ll be talking to Brazilian officials next week about integrating CAB-LA into the country’s health system. Despite the challenges in gaining access, he said he remains hopeful “still this year we’ll have that in the arms of people in Brazil who want to use this medication and have the prescription for having the prolonged prophylaxis.” And the next day, Merck confirmed that it was also in discussions with Fiocruz, a manufacturer linked to the Brazilian government, to potentially produce and distribute a generic version of its emerging monthly oral HIV prevention tool, alimatravir. But Merck officials told me that, with clinical trials still ongoing, any generics are still months, if not years, away. Read: Why is Latin America still waiting for long-acting prevention?  For more content like this, sign up to Devex CheckUp — our free semiweekly newsletter that delivers more insights on global health straight to your inbox.
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In demand
For Latin American officials, their frustrations have been exacerbated by new research being unveiled at IAC that seems to indicate just how eager communities are to access emerging forms of prevention, including lenacapavir.
Saiqa Mullick, who directs implementation science at Wits RHI, has enrolled more than 1,500 people in a study in South Africa to try to figure out how lenacapavir can be integrated into prevention services. On a panel Monday, she said there has been outsized interest in lenacapavir — with 88% of participants choosing that option — and that interest in the injectable is actually drawing new people to try PrEP. Of the people who are selecting lenacapavir, she said 57% had never before used PrEP. “It’s not only appealing to previous PrEP users, [but] it’s also creating an entry point for people who might not have previously used PrEP,” she said. At the same time, some challenges are emerging. Eswatini was the first African country to roll out lenacapavir, alongside Zambia, and by the end of June had initiated people on the injectable more than 4,200 times, according to data presented Monday by Sindy Nana Matse, director of the country’s national HIV/AIDS program. But the system is only retaining 64% of people who have started on lenacapavir — below the national target of 75%. Matse said that pointed to the need to come up with more effective strategies to keep people coming back. Background: In ongoing trials, twice-yearly HIV prevention drug saw just one case |
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Left out
At the start of this year’s IAC, U.S. government officials offered some long-awaited insights into their plans for ongoing funding of the HIV response, as my colleague Sara Jerving has detailed. At the center of those efforts are the bilateral health deals that partner countries have struck with governments to maintain some support for HIV programs and other health services. We’ve only had patchy insight into those deals through memoranda of understanding that have leaked or been released. But this week, I’ve spoken to officials from partner governments who told me that implementation of those agreements is set to begin on Oct. 1 in many places. And they say efforts are being guided by implementation plans that were drafted — or are still being drafted — in a collaborative process between U.S. and domestic officials. Not in the room? Representatives from civil society or community groups. “We’ve been going to the communities, consultation with the communities, but not having the community as partners of that. They are not that much involved in what is happening in the MoU development,” Bongani Zakhele Masango, from Eswatini’s National Emergency Response Council on HIV and AIDS, tells me. “We might find problems because you might find that some of the things that we want to take to the community, they won’t be maybe accepting them.” A Ugandan civil society leader I spoke to says community organizations have also largely been locked out of the implementation planning process. The groups have been told they can bid to implement some of the programs funded under the plan, but it represents only a small portion of the overall budget. Talk about cognitive dissonance. Session after session at this IAC has extolled the importance of not just engaging communities, but involving them from the outset of any efforts to build and sustain the HIV response. ICYMI: State Dept health lead says the public misunderstands bilateral deals 
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Thank you for reading this special edition of the Newswire, edited by Rumbi Chakamba, copy edited by Nicole Tablizo, and produced by Yula Mediavillo. Have a news tip? Email [email protected].
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