Improving preparedness for introducing and scaling up long-acting HIV pre-exposure prophylaxis in Asia

Benjamin R. Bavinton; Heather-Marie A. Schmidt; Stephen Mills; Nittaya Phanuphak

doi:10.1071/SH23192

RESEARCH ARTICLE (Open Access)

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Improving preparedness for introducing and scaling up long-acting HIV pre-exposure prophylaxis in Asia

Benjamin R. Bavinton

^A ^* , Heather-Marie A. Schmidt ^B ^C , Stephen Mills ^D and Nittaya Phanuphak

^E

+ Author Affiliations

- Author Affiliations

^A Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.

^B UNAIDS Regional Office for Asia and the Pacific, Bangkok, Thailand.

^C Global HIV, Hepatitis and STIs Programme, World Health Organization, Geneva, Switzerland.

^D FHI 360, Bangkok, Thailand.

^E Institute of HIV Research and Innovation, Bangkok, Thailand.

^* Correspondence to: bbavinton@kirby.unsw.edu.au

Handling Editor: Darren Russell

Sexual Health 21, SH23192 https://doi.org/10.1071/SH23192

Submitted: 29 November 2023 Accepted: 13 May 2024 Published: 4 June 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Long-acting injectable PrEP, particularly cabotegravir (CAB-LA), has the potential to enhance HIV prevention in Asia, and was the topic of a roundtable held in Singapore in June 2023. Despite proven efficacy, CAB-LA’s impact in Asia is hindered by regulatory, manufacturing, and cost barriers. There is an urgent need to address these challenges to expedite CAB-LA’s introduction and scale-up, including collaborative research, streamlined regulatory processes, and increased manufacturing capacity. We call for better preparedness in long-acting PrEP in research and implementation science, product licensing and accessibility, and capacity readiness for scale-up, to meet the significant demand among key populations in Asia.

Keywords: Asia, cabotegravir, HIV, injectable, long-acting, pre-exposure prophylaxis, PrEP, prevention.

References

1 Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med 2010; 363(27): 2587-99.
| Crossref | Google Scholar | PubMed |

2 Grulich AE, Jin F, Bavinton BR, Yeung B, Hammoud MA, Amin J, et al. Long-term protection from HIV infection with oral HIV pre-exposure prophylaxis in gay and bisexual men: findings from the expanded and extended EPIC-NSW prospective implementation study. Lancet HIV 2021; 8(8): e486-e94.
| Crossref | Google Scholar | PubMed |

3 Bavinton BR, Grulich AE. HIV pre-exposure prophylaxis: scaling up for impact now and in the future. Lancet Pub Health 2021; 6(7): e528-e33.
| Crossref | Google Scholar |

4 Schaefer R, Schmidt H-MA, Ravasi G, Mozalevskis A, Rewari BB, Lule F, et al. Adoption of guidelines on and use of oral pre-exposure prophylaxis: a global summary and forecasting study. Lancet HIV 2021; 8(8): e502-e10.
| Crossref | Google Scholar | PubMed |

5 Mayer KH, Allan-Blitz L-T. PrEP 1.0 and beyond: optimizing a biobehavioral intervention. J Acq Immun Def Synd 2019; 82(2): S113-S7.
| Crossref | Google Scholar |

6 Agrahari V, Anderson SM, Peet MM, Wong AP, Singh ON, Doncel GF, et al. Long-acting HIV pre-exposure prophylaxis (PrEP) approaches: recent advances, emerging technologies, and development challenges. Expert Opin Drug Deliv 2022; 19(10): 1365-80.
| Crossref | Google Scholar | PubMed |

7 Landovitz RJ, Donnell D, Clement ME, Hanscom B, Cottle L, Coelho L, et al. Cabotegravir for HIV prevention in cisgender men and transgender women. N Engl J Med 2021; 385(7): 595-608.
| Crossref | Google Scholar | PubMed |

8 Delany-Moretlwe S, Hughes JP, Bock P, Ouma SG, Hunidzarira P, Kalonji D, et al. Cabotegravir for the prevention of HIV-1 in women: results from HPTN 084, a phase 3, randomised clinical trial. Lancet 2022; 399(10337): 1779-89.
| Crossref | Google Scholar | PubMed |

9 World Health Organization. Guidelines on long-acting injectable cabotegravir for HIV prevention. Geneva: World Health Organization; 2022.

10 Bavinton BR, Bushby B, Murphy D, Cornelisse V, Philpot S, Chan C, et al. Discussion paper: research priorities for implementing long-acting injectable Cabotegravir for PrEP in Australia. Sydney: Kirby Institute, UNSW; 2022.

11 Green KE, Chan C, Cassell MM, Ong JJ, Fraser D, Zhang L, et al. Just how far off target are we? Measuring unmet pre-exposure prophylaxis (PrEP) need among men who have sex with men (MSM) and transgender women (TGW) in Asia. In: 12th International AIDS Society Conference on HIV Science; 23–26 July; Brisbane, Australia; 2023.

12 Chan C, Fraser D, Schmidt H-MA, Green KE, Cassell MM, Ong JJ, et al. PrEP product awareness, preferences, and past experiences among transgender women and men who have sex with men in Asia and Australia: the PrEP APPEAL study report. Sydney: Kirby Institute, UNSW Sydney; 2023.

13 UNAIDS. The Path That Ends AIDS: 2023 UNAIDS Global AIDS Update. Geneva: UNAIDS; 2023.

14 Schmidt H-MA, Rodolph M, Schaefer R, Baggaley R, Doherty M. Long-acting injectable cabotegravir: implementation science needed to advance this additional HIV prevention choice. J Int AIDS Soc 2022; 25(7): e25963.
| Crossref | Google Scholar | PubMed |

15 Warren M, Nyagah W, Verde Hashim C, Rodolph M, Schaefer R, Schmidt H-MA, et al. Shaping and coordinating the implementation science agenda for injectable cabotegravir for PrEP: the role of the Biomedical Prevention Implementation Collaborative (BioPIC). J Int AIDS Soc 2023; 26: e26094.
| Crossref | Google Scholar | PubMed |

16 Zhao R, Fairley CK, Cook AR, Phanuphak N, He S, Tieosapjaroen W, et al. Optimising HIV pre-exposure prophylaxis and testing strategies in men who have sex with men in Australia, Thailand, and China: a modelling study and cost-effectiveness analysis. Lancet Global Health 2024; 12: E243-E56.
| Crossref | Google Scholar | PubMed |

17 Medicines Patent Pool. Cabotegravir long-acting (LA) for HIV pre-exposure prophylaxis (PrEP); 2022. Available at https://medicinespatentpool.org/licence-post/cabotegravir-long-acting-la-for-hiv-pre-exposure-prophylaxis-prep

18 Henderson M, Schmidt H-MA, Chitembo L, Peralta H, Alaama AS, Johnson C, et al. The future of pre-exposure prophylaxis (PrEP) for HIV prevention: a global qualitative consultation on provider perspectives on new products and differentiated service delivery. AIDS Behav 2023; 27: 3755-66.
| Crossref | Google Scholar | PubMed |

19 Lertpiriyasuwat C, Jiamsiri S, Tiramwichanon R, Langkafah F, Prommali P, Srikhamjean Y, et al. Thailand national PrEP program: moving towards sustainability. In: 24th International AIDS Conference; 2 August; Montreal, Canada; 2022.

20 Phanuphak N, Ramautarsing R, Chinbunchorn T, Janamnuaysook R, Pengnonyang S, Termvanich K, et al. Implementing a status-neutral approach to HIV in the Asia-Pacific. Curr HIV-AIDS Rep 2020; 17: 422-30.
| Crossref | Google Scholar | PubMed |