An injection of lenacapavir offers six months of protection against HIV infection for HIV-negative individuals. This new drug is approved for pre-exposure prophylaxis (PrEP), providing a more efficient approach compared to daily pills.
The Impact of Lenacapavir
Lenacapavir promises major advancements in HIV prevention. Irene, a 22-year-old Ugandan woman part of a significant HIV trial, shares her story. Motivated by her HIV-positive uncle’s experiences, she participated in the trial for lenacapavir. With the drug’s protection, she and her soon-to-be-born child face less risk from HIV, affecting 13% of her district’s population.
The drug addresses two critical barriers in HIV prevention: adherence and efficacy. It’s administered twice a year via injection, replacing daily PrEP pills. This cutting-edge approach was proven effective in the PURPOSE 1 and 2 trials.
The PURPOSE 1 trial showed remarkable results with nearly 4,200 women remaining HIV-negative. The adherence rate was over 96%, reflecting the drug’s feasibility. Dr. Flavia Matovu Kiweewa, who led the trial in Uganda, notes that results like these are unprecedented in the history of HIV prevention.
Challenges in Rollout
Despite its promise, lenacapavir’s rollout has faced obstacles. After U.S. Food and Drug Administration approval, the distribution met with mixed results. Uganda received its first doses, yet some areas, like Kalangala, were initially excluded from the plans.
Health officials, aiming to target high-risk areas, find the rollout fraught with scheduling and supply issues. Nurse Amiri Kabuye, working in Kasensero’s health clinic, reports that only 60 individuals received the drug so far, despite the town’s significant HIV rates.
Concerns over long-term supply and funding persisted among health officials and participants. Additionally, the pricing of lenacapavir, currently at $28,000 for two doses, significantly outpaces oral PrEP’s annual cost, prompting criticism.
Price and Distribution Concerns
The high cost of lenacapavir has drawn criticism. Gilead, the company behind both oral PrEP and lenacapavir, has faced scrutiny over distribution methods. Doctors Without Borders expressed frustration over blocked direct purchases for their programs.
Gilead states that cooperations with the Global Fund aim to optimize distribution and prevent fragmentation. It plans to extend availability to 24 low- and middle-income countries by 2026. Meanwhile, Gilead pledges to sell lenacapavir at no profit until generic versions, expected by 2027, become available.
Long-term Considerations
Challenges in HIV prevention extend beyond lenacapavir. The U.S. cutbacks in foreign aid in 2025 have hampered Uganda’s HIV programs, reducing staffing and disrupting trusted services.
Despite receiving lenacapavir, Uganda’s ability to distribute the drug effectively remains constrained by workforce shortages. Kabuye’s clinic experienced a significant delay in receiving doses.
While the U.S. State Department pledges greater global access, including thousands of doses for Uganda by 2028, the demand far exceeds the supply. Estimates suggest 20 million people could benefit from the drug, highlighting the urgent need for more resources.
Until then, oral PrEP remains the central preventive measure. Despite promising results from lenacapavir trials, the distribution and associated challenges reveal the importance of continued innovative approaches to HIV prevention in Uganda and beyond.