Long acting injectables: opportunities and realities Injectable therapies for treatment and prevention Andrew Mujugira, MBChB, MSc, MPH, PhD Senior Research Scientist, Makerere University Infectious Diseases Institute Affiliate Assistant
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Long acting injectables: opportunities and realities Injectable therapies for treatment and prevention Andrew Mujugira, MBChB, MSc, MPH, PhD
Senior Research Scientist, Makerere University Infectious Diseases Institute
Affiliate Assistant Professor of Global Health, University of Washington<br>
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Differentiated service delivery Socio-ecological model of PrEP adherence barriers Sources: WHO 2022; Haberer Lancet HIV 2023<br>
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Differentiated delivery of oral ART or PrEP<br>
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Differentiated delivery of oral ART or PrEP<br>
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The moon moves slowly, but it crosses the town Sources: ViiV Healthcare; Johnson and Johnson; Haberer Lancet HIV 2023<br>
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Pharmacy delivered oral PrEP with high continuation (Kenya) 6 Ortblad JIAS 2023<br>
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Pharmacy delivered CAB PrEP (South Africa) AXIS study (PI: Venter)
Acceptability and feasibility of injectable cabotegravir PrEP versus oral PrEP in routine care up to 15 months in private pharmacies in South Africa (AXIS)
Population: Young women and men (N=200)
Status: Not yet enrolling Choice of CAB-LA, oral PrEP (TDF/FTC[3TC]), or PrEP deferment Option to switch for up to 15 months Baseline/1 year and exit interviews<br>
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Feasibility and acceptability of a pharmacist-managed cabotegravir long acting injectable for PrEP program in a community pharmacy One-Step PrEP® - Kelly Ross Pharmacy, Seattle, WA
First pharmacy-led PrEP clinic in USA (2015)
Implementation and Delivery of Cabotegravir Long Acting Injection for PrEP in a Community Pharmacy Setting (ClinicalTrials.gov, NCT05867212)
Design: Observational
Sample size: 50
Follow up: 12 months
Duration: 2023-2025
Status: Enrolling<br>
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CAB PrEP - Provider perspectives Source: Henderson, AIDS Behav 2023<br>
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CAB LA for ART or PrEP - Client Perspectives Sources: Kerrigan 2018; Mujugira (unpublished)<br>
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CAB-LA PrEP Research Source: AVAC PrEPWatch<br>
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Long Acting Injectables: Promise vs Reality Promise of long acting injectables tempered by:
Slow pace of regulatory approvals
No national programs delivering injectables
Cost, USA (~$3,700 per injection; 6 injections annually)
Insurance barriers, USA (prior authorization)
Remedicalization of PrEP delivery
Supply chain limitations
Health equity - challenges delivering injectables to those who need it most
Punitive legislation driving people back into the closet
Large implementation studies needed to evaluate delivery of injectables at scale Sources: Patel IDSA 2023; Nguyen IAPAC 2023; Rodríguez-Díaz IAPAC 2023<br>
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Summary and Conclusions Long acting injectables are revolutionary game changing products
Implementation studies needed earlier in the product cycle
History repeats herself
Great science produced COVID vaccines (and injectables), but implementation challenges dampened initial promise
Global health inequities exposed by COVID-19 persist for injectables
“Follow the science, center the community, and lead with equity” – Mitchell Warren<br>
