By Charmaine Ndlela
A total of 95.5% of young people who switched from daily human immunodeficiency virus (HIV) tablets to long-acting injectable treatment maintained viral suppression after 48 weeks, according to findings from the AFINAty study conducted in South Africa.
The study, involving 134 adolescents and young adults aged 12 to 24 who had already achieved viral suppression on oral medication, provides encouraging evidence that long-acting HIV treatment can be successfully administered in community-based settings, offering an alternative to daily antiretroviral medication.
The participants switched from daily tablets to a combination of two antiretroviral injections, cabotegravir and rilpivirine, administered every eight weeks following initial dosing. Researchers found no confirmed cases of sustained loss of viral control during the 48-week study period.
The Desmond Tutu Health Foundation, which provided the findings, said the results were significant because young people often face challenges with daily HIV treatment, including stigma, treatment fatigue and concerns about disclosing their HIV status.
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The foundation said that all 132 participants who completed the final study visit chose to continue with the injectable treatment.
It said that long-acting treatment could help reduce some of these challenges while giving young people greater choice in managing their HIV.
The study also recorded a participant retention rate of 98.5%, while 97.5% of injections were administered on schedule.
Despite being registered in South Africa, the foundation noted that injectable treatment is not yet routinely available through the public healthcare system.
The foundation said the findings provide important local evidence that should encourage government, policymakers and pharmaceutical partners to prioritise affordable access and explore ways of integrating long-acting treatment into routine HIV services.
It said the next challenge was ensuring that these advances reached the young people who stood to benefit from them.
The foundation also highlighted progress in HIV prevention through lenacapavir, a long-acting injectable medicine administered once every six months to prevent HIV infection in people who are HIV-negative, noting its ongoing involvement in multiple clinical studies.
Unlike daily oral pre-exposure prophylaxis (PrEP), the foundation said that lenacapavir offers prolonged protection without requiring people to remember to take a tablet every day, potentially making HIV prevention more convenient, discreet and easier to incorporate into their daily lives.
The Desmond Tutu Health Foundation was involved in the landmark PURPOSE 1 and PURPOSE 2 clinical trials, which demonstrated the effectiveness of lenacapavir in preventing HIV infection.
According to the foundation, participants responded positively to the prevention option, appreciating its convenience, privacy and the reassurance of long-lasting protection.
More than 95% of eligible PURPOSE 1 participants chose to receive lenacapavir when given the opportunity during the study’s extension phase.
Building on the findings, the foundation said it is conducting the ALIGN study in Cape Town to investigate how young people choose between different HIV prevention options, including daily oral PrEP and long-acting injectable methods.
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The study is also examining how these prevention methods can be delivered through public healthcare facilities and mobile community services, as well as the factors that influence whether people continue using their chosen prevention method over time.
The foundation said further research was planned as access to lenacapavir expanded.
South Africa began introducing lenacapavir into the public healthcare system in June. According to the Department of Health, more than 55,123 people had received the HIV prevention medicine through 360 public healthcare facilities across 24 districts in six provinces by 7 September.
However, the rollout has yet to reach all public healthcare facilities, limiting wider availability.
The foundation said the scientific breakthrough was significant, but its public health impact would depend on ensuring that people who could benefit from it were able to access it.
It called for affordable and equitable access to be prioritised to ensure that advances in HIV prevention and treatment translated into meaningful improvements for communities across the country.
