England and Wales are set to introduce a new, long-acting injectable for HIV prevention on the NHS, marking a significant advance in public health policy and aligning with Scotland’s existing provision. The injection, cabotegravir (CAB-LA), is designed to be an alternative to the daily oral pre-exposure prophylaxis (PrEP) pills currently used to prevent HIV infection. Administered either six times a year or every other month, the shot offers a discreet and convenient option aimed particularly at individuals for whom daily oral PrEP is impractical or difficult.

The introduction of this injection reflects the UK government's broader goal of eradicating new HIV infections by 2030. Wes Streeting, the Secretary of State for Health and Social Care, described the approval of the cabotegravir jab as "game-changing," emphasising its potential to save lives and improve access for vulnerable populations who struggle with traditional pill regimens due to factors such as stigma, housing instability, or fear of disclosure. According to government officials, around 1,000 adults and adolescents at high risk of sexually acquired HIV, with a healthy weight and who have difficulty with oral PrEP, will be offered the injection through NHS sexual health clinics in the coming months.

Cabotegravir must be used alongside safe sex practices, including condom use, to maximise protection. The NHS has secured a confidential discount for the treatment, although its list price is approximately £7,000 per patient annually. NICE’s guidelines focus on addressing inequalities in access to HIV prevention, with advocates urging that rollout should be rapid and expand beyond traditional sexual health clinics to reach marginalised groups more effectively. Richard Angell of the Terrence Higgins Trust highlighted the injection's transformative potential and called for its delivery in diverse healthcare settings to better serve populations currently underserved by oral PrEP services.

The UK Medicines and Healthcare products Regulatory Agency (MHRA) has approved two formulations of cabotegravir: a 30 mg oral tablet and a 600 mg long-acting injection administered every two months. The injection is notable as the first of its kind approved for HIV-1 prevention in the UK. Patients must test HIV-negative before starting treatment, with healthcare professionals responsible for administering the jab.

Globally, the World Health Organization (WHO) has embraced similar strategies, recommending long-acting injectable PrEP options such as cabotegravir and the even longer-acting lenacapavir. Lenacapavir, which can be administered twice yearly, has shown promising results in clinical studies. Data involving over 2,000 participants demonstrated that lenacapavir injections caused a 96% reduction in HIV incidence compared to background rates and were 89% more effective than daily oral PrEP. These developments hint at a future where annual HIV prevention injections could become a reality, potentially transforming the landscape of HIV prevention worldwide, especially for those facing daily pill adherence challenges or stigma.

The WHO's endorsement of these injectable options, announced most recently at the International AIDS Society Conference in Kigali, Rwanda, illustrates a significant shift in the global response to HIV prevention. It emphasises expanding accessible, user-friendly, and discreet options for people at risk, particularly those who struggle with conventional daily medication or face barriers in healthcare access.

This new injectable option in England and Wales, therefore, stands as a critical step forward not only for the UK’s HIV elimination ambitions but also in alignment with emerging international models for effective and inclusive HIV prevention.

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Source: Noah Wire Services