Botswana introduces injectable anti-retroviral (ARV) drugs for HIV treatment

BOTSWANABotswana has approved the use of injectable anti-retroviral (ARV) drugs to improve adherence to HIV treatment.

With the world’s fourth largest prevalence of HIV infections, Botswana becomes the second country in Africa, after South Africa, to adopt the use of the injectable ARV drug.

Minister of Health Edwin Dikoloti said that the injections, given every two months, are more convenient than daily pills, which patients sometimes skip. The use of injectable ARV medication will start next year, after the recent approval of the drug.

“The government is working on introducing the injectable anti-retroviral medication soon,” said Dikoloti.

Botswana has, through the professional guidance of the clinical guidelines committee, adopted the use of injectable antiretroviral medicines given every two months, for both prevention and treatment.”

Minister Dikoloti said the move will help alleviate concerns that patients are skipping their daily oral dose.

“The injectable ARVs, for both prevention and treatment, will no doubt improve adherence to the HIV treatment in our country,” said Dikoloti.

“The injectable ARV medication formula comprises cabotegravir and rilpivirine. The cabotegravir injection has already been registered by the Botswana Medicines Regulatory Authority while rilpivirine is still undergoing the registration process.”

According to HIV activist Bonosi Bino Segadimo, the introduction of injectable medication will not only help with compliance but could reduce the stigma associated with the virus that causes AIDS.

“I believe the injectable ARVs will help a lot of people in terms of adherence because a lot of defaulting is caused by taking a pill every day,” he said.

“Some say the bottles (for oral pills) cause a lot of attention when they are in public from their appointments (at health facilities). It’s not that everyone on (ARV) treatment has accepted their status. It is a relief for those who find it hard going around a bottle of medication.”

In 2019, the Botswana Harvard AIDS Institute conducted clinical trials to determine the efficacy of the injectable drug. The study proved the drug is safe and highly effective for HIV prevention.

“We are so excited as activists that HIV medication has actually evolved to this level. Who knows, in the near future this will be taken twice a year. This could also encourage people to test because people have this phobia for daily pills,” said Kennedy Mupeli, a programs officer at Center of Youth for Hope, a non-governmental organization that targets young people living with HIV in Botswana.

SAPHRA to approve HIV prevention shot

The South African Health Products Regulatory Authority (SAHPRA) is expected to approve the HIV prevention shot for use in the country in early 2023. This after drugmaker ViiV Healthcare submitted its application for regulatory approval in late November 2021.

SAHPRA’s approval will spell out who can receive the HIV prevention shot and who can administer it, depending on how SAHPRA schedules or classifies the injection. In particular, many will be watching to see whether the injection will be made available to pregnant and breastfeeding people, who remain at high risk for contracting HIV in South Africa.

Truvada, the once-daily HIV prevention pill, is already available at more than 2,000 public sector sites nationwide. When taken correctly, it can reduce a person’s risk of contracting HIV by almost 99%.

The Wits Reproductive Health and HIV Institute (Wits RHI) and the national health department are expected to begin providing the injections of the long-acting formulation of the antiretroviral cabotegravir to young women.

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