Long-acting PrEP: what measures should be taken to encourage its implementation and access?

Basile Berberat, GSN

The arrival of long-acting PrEP over the next decade has the potential to transform HIV prevention and drastically reduce new infections. Over and above the challenges associated with access to these treatments, there are many new tools available to achieve the objectives of reducing the number of infections. But for this to be effective, millions of people would need to be on treatment, and the question is how can this be achieved?

Access to treatment is one of the sinews of war, and this involves a number of players at different levels. From a global point of view (business, pharma), work must focus on affordable prices, a distribution timetable in line with the realities on the ground and, of course, products that meet the needs of users. There are a number of different methods of distributing treatment, and it is important to multiply these in order to respond to individual problems (discrimination due to taking the drug, geographical access/distance from treatment centres, sexual behaviour, beliefs, etc.).

Secondly, the country has a major impact on the way in which treatment is accessed. Legislation relating to treatment, access to it, the target population or public health policy and its priorities. All these factors either facilitate or can block the implementation of an effective treatment dissemination strategy.

At local level, which raises the question of infrastructure within communities. Here, the public and private sectors are directly involved in developing treatment distribution platforms.

Finally, the individual level is of enormous importance. What are individuals prepared to do to access treatment and prevention? If people are not prepared to invest, it becomes difficult to be effective despite the strong implications at other levels. One way of reaching individuals is through peer educators and multipliers, who take messages to the communities concerned. They play an essential role within communities, thanks to their understanding of people's preferences, beliefs and motivations.

Obviously, the question of costs is central, and we need to work with the industry to ensure that prices are competitive. We must not neglect the approach of companies, which do not all have the same cursors when it comes to social objectives, profits or the fight against the epidemic. However, during the presentation of case studies involving high-prevalence populations (African-American women, young people aged 18-24 in Zambia), it became clear that the challenge was more to reach the community than the treatment itself.

There is no single lever for promoting access to and the development of long-acting PrEP, but it is by supporting a range of individualised actions that the impact will be felt. For those players who can, this means encouraging the development of generics, developing partnerships to benefit users, and building on existing infrastructures that are trusted by local players and the general public.

Making these treatments accessible means pooling resources in order to act as effective ambassadors for the most severely affected populations, thereby stemming new infections and achieving the 2030 targets.

Abstract based on: Taking action on long-acting PrEP: Towards access and implementation

• Accelerating access to long-acting PrEP: Partnerships, pitfalls and possibilities, Shirley Chen
• Implementation of LAI CAB among Black women in the United States: What we know and what we need, Yolanda Lawson
• Opportunities and challenges related to long-acting PrEP scale up in the context of sustaining the HIV response and lessons from Zambia, Adamson Ndhlovu
•  Innovation models for implementation, Anne-Isabelle Cameron