Govt rolls out Science study of the implementation of Long Acting Injectable PrEP against HIV

The Malawi Government has started the Science study of the implementation of the the Long Acting injectable Pre Exposure Prophylaxis (PrEP) against Human Immunodeficiency Virus (HIV).

In a press statement dated March 24, 2024 signed by the Secretary for Health, Dr Samson Mndolo, the PrEP against HIV will be administered in two districts, Blantyre and Lilongwe.

In the Commercial City, Blantyre, three health facilities namely Chilomoni Health Centre, Limbe MACRO and Naperi Dropin Centre will be administering the drugs while in Lilongwe the drugs will be available in three health facilities namely, Area 25 Health Centre, Bwaila Hospital and Area 47 Drop in Centre.

The move has been made to curb further HIV infection in Malawi.

Dr Mndolo said the introduction of PrEP is part of the implementation study “Path to Scale implementation Science Study on Long Acting Injectable Pre-Exposure Prophylaxis” which was launched in Lilongwe, in partnership with the U.S. President’s Emergency Plan for AIDS Relief, Bill and Melinda Gates Foundation and Center for Innovation in Global Health at Georgetown University.

The findings from the initial implementation study in the mentioned six health facilities will provide the most practical, efficient, equitable and effective strategies of delivering the injectable PrEP before scaling up to additional 41 selected health facilities across the country.

“Malawi has made significant progress in the HIV response as demonstrated by the overall reduction by half of HIV incidence from 0.40% in 2015/16 to 0.20%in 2020/2021, according to the Malawi Population Based HIV Assessment Survey (MPHIA),” said Mndolo.

The Ministry of Health and implementing partners have been delivering HIV combination prevention interventions in public, private and CHAM health facilities across the country. These include Oral Pre-exposure Prophylaxis (PrEP), condoms, Post-Exposure prophylaxis (PEP, Voluntary Medical Male circumcision and prevention of mother to child transmission.

Recently Malawi adopted the use of Long Acting Injectable PrEP as one of the tools to accelerate elimination of HIV as a public health threat by 2030.

“However, new HIV infections are still being reported in some high risk and priority populations such as female sex workers, adolescent girls and young women, pregnant and breast feeding women, hence a need for more preventive strategies to further reduce the HIV transmission in the country.

“The public has to be informed that long acting injectable PrEP can be used by anyone who has reached 15 years and is at substantial risk of contracting HIV as screened by the health care provider,” adds Mndolo.

World Health Organization (WHO) in 2022 recommended the use of cabotegravir (CAB-LA) as pre-exposure prophylaxis (PrEP) for HIV and called for countries to consider this safe and highly effective prevention option for people at substantial risk of HIV infection.

WHO released guidelines that were launched at a critical moment, as HIV prevention efforts have stalled with 1.5 million new HIV infections in 2021 – the same as 2020. There were 4000 new infections every day in 2021, with key populations (sex workers, men who have sex with men, people who inject drugs, people in prisons and transgender people) and their sexual partners accounting for 70% of HIV infections globally.

“Long-acting cabotegravir is a safe and highly effective HIV prevention tool, but isn’t yet available outside study settings,” said Dr Meg Doherty, Director of WHO’s Global HIV, Hepatitis and Sexually Transmitted Infections Programmes. “We hope these new guidelines will help accelerate country efforts to start to plan and deliver CAB-LA alongside other HIV prevention options, including oral PrEP and the dapivirine vaginal ring.”

Acting Executive Director for National Association for People Living With HIV and AIDs in Malawi (NAPHAM) promised to call back when asked for interviews on the matter but in a short response, he commended the government for the effort.
“I am driving currently, I will call you back after 20 minutes but what I can shortly say is that the drug will help to reduce the issues I’d defaulters among people who are on Anti retrovirus Treatment,” he said.

Malawi engaged an extra gear in the fight against HIV and AIDS on 1st September 2023, by launching the implementation science for long-acting injectable PrEPwhich added to the country’s comprehensive combination prevention package for HIV.

Long acting injectable PrEP can be used by anyone who has reached 15 years and is at substantial risk of contracting HIV as screened by the health care provider. PrEPis not a vaccine against HIV and does not offer protection to individuals if they have been exposed to HIV. PrEPdoes not prevent Sexually Transmitted Infections.

The most critical advantage of injectable PrEP relative to oral PrEP its periodic, rather than daily, administration. Some individuals forget to take their PrEP medication and would benefit from taking PrEP less often. For others, PrEP adherence is complicated by multifaceted and intersecting factors, including underestimation of personal HIV risk and behavioral health challenges, particularly depression and substance use.
According to WFB 2022, Malawi is one of the countries that havw high prevalence of HIV, sitting 8th among 118 Countries that have experienced the rising of the Pandemic.
With President’s Emergency Plan for AIDS Relief (PEPFAR) resources, USAID has been able to invest in high-impact HIV prevention, treatment, and care activities with the goal of controlling the HIV epidemic. USAID’s HIV investments mitigate the social and economic impact of the disease, especially among orphans and vulnerable children.

Similarly, USAID supports health systems strengthening efforts that directly contribute to reducing new HIV infections and saving lives. These efforts support national and district governance structures, capacity building interventions for civil society and public sector institutions, commodity availability and supply chain functionality, and use of quality data for decision making.