CAB-LA Roll-Out Promises Major Boost to HIV Prevention in Zimbabwe

Clive Tatenda Makumbe in Zimbabwe

Zimbabwe’s fight against HIV is set to gain a new ally as Doctors Without Borders/Médecins Sans Frontières (MSF) prepares to introduce the long-acting injectable pre-exposure prophylaxis (PrEP) drug, cabotegravir (CAB-LA), before the end of the year.

The intervention, anticipated by experts to revolutionise HIV prevention, comes as recent data continue to show significant but uneven progress in reducing new infections.

Zimbabwe joins a cohort of four African nations—Zimbabwe, Malawi, Zambia, and eSwatini—that introduced CAB-LA in 2024.

This novel prevention tool is administered as an injection every two months, offering a discreet and convenient alternative to once-daily oral PrEP. Such discretion, health experts say, holds particular promise for populations at higher risk, including adolescent girls and young women, men who have sex with men, and sex workers, many of whom face stigma or barriers to consistent HIV prevention.

According to the Zimbabwe National AIDS Council (NAC), the country has made remarkable strides in its HIV response over the last two decades.

National data indicate that Zimbabwe reduced new HIV infections by nearly 79% between 2010 and 2020, a feat widely attributed to the government’s robust prevention and treatment programmes, supported by international partners. UNAIDS figures from 2021 estimate that approximately 1.3 million people in Zimbabwe are living with HIV, reflecting both the scale of the challenge and the urgency to adopt innovative prevention tools.

“My excitement stems from the fact that CAB-LA, administered every two months, has been shown to be more effective than oral PrEP in reducing new HIV infections,” said Dr. Antonio Flores, an MSF HIV/TB advisor based in South Africa.

“With no HIV vaccine or cure in sight, CAB-LA and other long-acting formulations can be game-changers in curbing the epidemic if scaled up globally, especially in low- and middle-income countries, including Zimbabwe.”

In July 2022, the World Health Organization (WHO) recommended CAB-LA as an additional HIV prevention choice, underscoring its potential to bolster global efforts to end AIDS as a public health threat by 2030.

WHO’s guidance aligns with Zimbabwe’s National HIV and AIDS Strategic Plan (ZNASP), which emphasises combination prevention strategies and aims to sustain the country’s positive trajectory in combating HIV.

Zimbabwe’s upcoming rollout is supported by a limited number of doses secured by MSF, as well as an allocation through the US President’s Emergency Plan for AIDS Relief (PEPFAR).

Part of a 231,000-dose donation, these initial doses will be distributed to countries in need before year-end, with further allocations to follow over the next two years. According to PEPFAR’s latest data, high-impact interventions like CAB-LA can play a key role in reducing infections among underserved populations and help maintain the gains achieved in recent years.

“The launch of CAB-LA will be a great benefit to our patients and the people of Zimbabwe,” said Dr. Gerald Hangaika from MSF’s Mbare project.

“In addition to offering better protection than oral PrEP, the injection reduces the burden of adherence and eliminates the need to store a container of tablets. This triad of privacy, convenience, and effectiveness will likely increase PrEP uptake and adherence, especially among vulnerable groups.”

Yet, experts warn that for CAB-LA’s full potential to be realised, global manufacturers and pharmaceutical firms must ensure adequate supply and affordable pricing for low- and middle-income countries.

A July 2023 report by the Medicines Patent Pool and UNAIDS noted that timely, affordable access to new prevention technologies is critical in regions most affected by HIV.

In 2023, ViiV Healthcare—CAB-LA’s sole manufacturer—distributed enough of the formulation to cover only about 13,000 people, nearly 70% of whom were in high-income countries.

To ensure the effective rollout, MSF recently hosted a four-day training for clinicians, nurses, and frontline workers in Zimbabwe and neighbouring countries.

The training covered critical topics including clinical eligibility, side-effect management, and patient counselling. These efforts reflect MSF’s longstanding commitment to HIV care since the mid-1990s, when the organisation began pioneering community-based treatment models and advocating for more affordable and accessible antiretroviral therapy.

UNAIDS estimates that 1.3 million new HIV infections occur worldwide each year, underscoring the urgent need for prevention breakthroughs. While Zimbabwe has led the way in testing, treatment, and care—nearing the UNAIDS 95-95-95 targets—new infections persist, particularly among adolescent girls and young women in sub-Saharan Africa.

WHO data show that effective, easy-to-use prevention tools like CAB-LA can help address these disparities and accelerate progress.

As CAB-LA prepares to debut in the Zimbabwean health system, public health officials, community activists, and international partners remain hopeful.

If scaled up effectively and matched with adequate resources, this long-acting PrEP approach could mark a pivotal turning point in Zimbabwe’s efforts to prevent HIV infections and continue on the path toward a generation free of AIDS.