SOUTH AFRICA – Medicines manufacturer Aspen Pharmacare recommends that African companies be given licenses to manufacture HIV prevention drugs so as to be more accessible and affordable.

An HIV prevention technique that involves HIV-negative people at high risk of infection getting an injection every two months has been found to be successful in a clinical trial.

But over two years, later it remains unaffordable and out-of-reach in countries with large HIV epidemics.

In 2020, pharmaceutical company ViiV Healthcare announced that a bimonthly injection of its new drug, cabotegravir, prevents HIV infection. More than two years later, the drug is still unaffordable in countries where HIV is highly prevalent.

Although the World Health Organisation has recommended cabotegravir for PrEP, it is unaffordable, especially in developing countries where HIV is most prevalent.

Cabotegravir can be used to prevent HIV infection. This is known as Pre-Exposure Prophylaxis, or PreP. Currently, PrEP is only available in pill form and has to be taken daily.

The Clinton Health Access Initiative (CHAI) has estimated that cabotegravir could be manufactured for just over US$65 (R1,100) a year.

ViiV’s not-for-profit price for cabotegravir is estimated to be US$240-US$270 (R4,059-R4,567) for a full year’s supply for one patient.

But in the United States, a full year’s supply for one person of cabotegravir is sold for more than US$22,000 (R370,000). In the UK a year’s supply is US$9,275.

In comparison, oral PrEP costs about R686 for a full year’s supply for one patient in South Africa. Cabotegravir is not yet approved by the South African Health Products Regulatory Authority.

Stavros Nicolaou, group senior executive strategic trade at Aspen Pharmacare, says that there is local capability to manufacture cabotegravir but licences have not yet been granted.

The company invested heavily in sterile equipment, needed to produce injections, during the Covid-19 pandemic. This can be used to produce cabotegravir.

Aspen is the biggest producer of antiretrovirals (ARVs) in Africa. Nicolaou says that giving licences to African producers is crucial to ensuring the equitable supply of medication.

ViiV has committed to allowing generic versions of the drug to be manufactured but has said that the process is complicated. Cabotegravir is currently only manufactured at one site in the UK.

ViiV has come to an agreement with the Medicines Patent Pool (MPP), a nonprofit organisation that will facilitate the process of awarding licences to manufacturers.

Globally, 1.5-million people are infected with HIV and about 650,000 people die of AIDS every year. UNAIDS’s target of reducing annual infections to fewer than 500,000 by 2020 was not reached.

It is widely accepted among experts that prevention, as well as treatment, is necessary to end the epidemic.

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