PrEPd and Loving It!
PrEPd and Loving It!
…Meet Zimbabwe’s First injectable PrEP recipient
By Michael Gwarisa
In June 2022, the World Health Organisation (WHO) released guidelines for the use of long-acting injectable cabotegravir (CAB-LA) as pre-exposure prophylaxis (PrEP) for HIV, and called for countries to consider this prevention option for people at substantial risk of HIV infection.
A few months after the WHO announcement, Zimbabwe approved CAB-LA as an HIV prevention tool, following the approval of the Medicines Control Authority of Zimbabwe (MCAZ) The country received its first consignment of CAB-LA doses in April 2024, and the HIV prevention injection is being administered in 15 demonstration sites in Zimbabwe. The sites are located in Harare, Mutare, and Bulawayo. The pilot study targets mainly groups at high risk of HIV, namely Female Sex Workers (FSW), Adolescent Girls and Young Women (AGYW) and Men who have Sex with other Men (MSM).
For Rumbidzai Mhlanga (38), a long-time Pre-Exposure Prophylaxes (PrEP) user, long-acting injectable cabotegravir couldn’t have come at any better time.
“I wasted no time and said let me switch to this injection because of the many advantages it possesses,” said an elated Rumbidzai during an exclusive interview with this publication.
Rumbi works as a PrEP champion in partnership with the Population Solution Solutions for Health (PSH) in Harare where she constantly engages HIV key and vulnerable groups regarding available HIV prevention measures such as PrEP in all its forms.
Rumbidzai’s PrEP Journey
Zimbabwe has a strong history of PrEP use in Southern Africa and the rest of the region. Oral PrEP was introduced in Zimbabwe in 2015 as a strategy to reduce HIV incidence among adolescent girls and young women.
In 2021, Zimbabwe through the MCAZ also announced the use of the Dapivirine or Vaginal Ring, as a tool to expand HIV prevention options in Zimbabwe.
The injectable or CAB-LA is the latest prevention tool to be used in Zimbabwe.
“As for me, I started using PrEP in 2017 and from there. I was using oral PrEP. From there, I moved to the PrEP ring or Dapivirine or Vaginal Ring. I have now moved to the CAB-LA or the injection. I have used these products for a long time to know that they are effective in preventing HIV infection. I have used all PrEP products available in Zimbabwe,” added Rumbidzai.
CAB-LA is an intramuscular injectable, long-acting form of PrEP, with the first two injections administered 4 weeks apart, followed thereafter by an injection every eight weeks. CAB-LA was shown to be safe and highly effective among cisgender women, cisgender men who have sex with men, and transgender women who have sex with men in two randomised controlled trials, HPTN 083 and HPTN 084.
Together, these landmark studies found that the use of CAB-LA resulted in a 79 percent relative reduction in HIV risk compared with oral PrEP, where adherence to taking daily oral medication was often a challenge. Long-acting injectable products have also been found to be acceptable and sometimes preferred in studies examining community PrEP preferences.
Why Rumbidzai prefers the injectable PrEP?
PrEP is about giving users choice. However, choosing the right PrEP product can be challenging for others, and many people might be wondering which PrEP option they should settle for. The answer to that question depends on one’s preferences. As the saying goes, the best medicine for you is the one you’ll take, and for Rumbidzai, it seems the injectable PrEP has struck the right cord.
“When the injectable was introduced I was very happy. I knew there and then that some of the challenges and problems I experienced back then were now a thing of the past. Before the injection, I was on oral PrEP. I am not saying oral PrEP is bad but sometimes I would forget to take the pills. At times, I would travel and forget the pills at home. Now with the injection, I know I get my shot every two months, and for those two months I will be okay,” said Rumbidzai.
She also recalls how at one point her then-boyfriend physically attacked her when he found Oral PrEP tablets in her handbag.
“I once carried Oral PrEP tablets to my boyfriend’s place. He somehow found them and he hit me very hard. He thought I was HIV positive and had concealed my status from him. He accused me of not telling him that I was on medication. He mistook the drugs for Antiretroviral Therapy (ART) medications. I later explained to him but it was too late, he had already beaten me. I was bruised badly.”
Apart from dealing with the pill burden and other challenges oral PrEP exposed her, Rumbi also said she took the injectable PrEP to motivate these communities to take up the HIV prevention tool and also protect herself from getting infected.
Data from PSH shows that a sizable number of PrEP users in Zimbabwe were transitioning from oral PrEP to CAB-LA, citing reduced pill burden. The switch to CAB-LA has addressed concerns related to oral PrEP, including pill fatigue, discreteness and convenience, thereby improving the overall experience and outcomes for individuals at risk of HIV infection.
The (CAB-LA) for HIV prevention has seen more users returning to get the second dose post their first jab, with data showing that the injectable drug has recorded a continuity rate over 90 percent since April 2024.
PARTING SHORT
Rumbidzai believes the injectable PrEP or CAB -LA is a game changer and could leapfrog Zimbabwe towards attaining an HIV-free generation.
“It is my wish that every HIV-negative person gets an opportunity to get the CAB-LA and to be informed and educated enough about this beautiful tool. That way, we are assured of preventing new HIV infections and end the HIV cycle,” she said.
Rumbi says she has not experienced any adverse events or side effects since getting the injectable. She has been jabbed three times since the introduction of CAB-LA in demonstration sites in Zimbabwe. She added that everyone including married people, was at risk of infection and no one should feel a false sense of immunity.