Dr Githinji Gitahi, Group CEO of Amref Health Africa: “In the short term, international partners such as the Global Fund are playing a key role in supporting the introduction and early financing.”
With the anti-HIV injection Lenacapavir now launched in Kenya, attention is
turning to what it will take to ensure equitable access and sustainable
delivery. DR GITHINJI GITAHI, Group CEO of Amref Health Africa, reflects on
what this innovation means not only for individuals at risk of HIV but also for
Africa’s health systems and the future of prevention financing.
Q: Beyond the science, why is this moment significant for
Africa?
A: For many years, prevention relied on daily oral PrEP
tablets. Later, we saw long-acting options requiring injections every two
months. Now, we have an injection that can protect for up to six
months at a time. That shift, from daily dosing to twice-yearly administration,
has the potential to significantly improve adherence and convenience for people
at substantial risk of HIV.
Clinical trials have demonstrated very high efficacy, making
this one of the most promising prevention tools we have seen in decades.
But beyond the science, this moment is significant because
of equity.
Historically, new medical innovations have taken years,
sometimes up to a decade, to become accessible in low- and middle-income
countries after being launched in wealthier markets. In this case, long-acting
HIV prevention is reaching African countries at roughly the same time as
high-income countries.
Pricing has also been a defining issue. While costs in
high-income markets have been significantly higher at about $40,000 per person
per year, negotiated agreements supported by the Global Fund, working in
partnership with governments such as Kenya, have enabled access for eligible
countries at approximately $40.
That represents meaningful progress toward global health
equity. This is not only a scientific breakthrough, it is also a moment of
global health solidarity.
Who is eligible for this injectable HIV prevention option,
and what should they consider?
This intervention is designed for individuals who are
HIV-negative and at substantial risk of HIV exposure due to their
circumstances, environment, or social vulnerabilities.
Groups that may particularly benefit include adolescent
girls and young women, especially those under 24, as well as men who have sex
with men, transgender individuals, and other key populations. It may also be
appropriate for people in sero-discordant relationships, where one partner is
living with HIV and the other is not.
Eligibility will follow national guidelines and requires
appropriate HIV testing and screening before initiation.
It is important to emphasise that this intervention is
preventive. It is not a treatment for people living with HIV, and it does not
replace antiretroviral therapy for those already diagnosed.
Additionally, while it offers highly effective protection,
it complements rather than replaces other prevention strategies. Safe sexual
practices, including correct and consistent condom use, remain important
components of comprehensive HIV prevention.
What concerns should communities be aware of? Are there side
effects?
Clinical trials have shown Lenacapavir to be generally well-tolerated. The most commonly reported side effects are mild injection-site
reactions, such as temporary pain or swelling.
As with any medical intervention, individuals will receive
proper HIV testing and eligibility assessment prior to initiation and will be
supported through follow-up visits in line with national protocols.
Another important concern is misinformation. When a new
health intervention is introduced, communities often ask understandable
questions: Is this a vaccine? Will I need it for life? Is it safe? Who
qualifies?
Without clear, trusted information, even highly effective
innovations can face hesitation. This is why communication and community
engagement will be critical to success.
What role do Primary Health Care and Community Health
Workers play in delivery?
Primary Health Care (PHC) systems will be central to the
successful rollout of long-acting HIV prevention.
The injection is stable at standard room temperatures,
making it suitable for delivery in many PHC settings without complex cold-chain
infrastructure. This increases its feasibility in rural and
resource-constrained environments.
However, successful delivery will depend far more on trust
and awareness than on storage logistics.
Community Health Workers (CHWs) will be foundational.
They serve as the trusted link between health systems and
communities. In the context of this rollout, CHWs will provide accurate, accessible
information; address misconceptions and fears; help identify individuals who
may be eligible; support referrals to health facilities; and remind clients to
return for follow-up injections.
Awareness is one of the biggest determinants of success. If
people do not understand the intervention, they will not use it. If they do not
trust it, uptake will stall.
Strong community systems are therefore essential for the
success of such interventions.
Is this intervention sustainable?
In the short term, international partners such as the Global
Fund are playing a key role in supporting the introduction and early financing.
At approximately $40 per person per year under negotiated
agreements, the intervention is relatively affordable compared to many other
specialised health technologies. Importantly, this is not a universal vaccine
targeting entire populations. It is focused on individuals at substantial risk,
which makes forecasting, budgeting, and targeting more manageable.
However, sustainability cannot rely solely on external
funding.
African governments must begin integrating financing for
long-acting prevention into domestic health budgets over time. That requires
forward planning, strong procurement systems, reliable forecasting, and
continued investment in PHC delivery platforms.