The problem

Despite progress in HIV prevention, new infections continue in Zambia, particularly among adolescent girls and young women and other highly affected populations. While public health facilities play a central role in service delivery, many people face barriers such as distance, stigma, limited clinic hours and concerns about privacy that pose challenges to accessing facility-based prevention. The introduction of lenacapavir, a highly effective twice-yearly injectable, is an opportunity to expand prevention choice, but its impact will depend on evidence-based strategies to deliver services safely and equitably beyond facility settings.

Our response

This project will support Zambia to expand access to lenacapavir by strengthening decentralized delivery alongside national rollout through public health facilities. Led by the University Teaching Hospital/ Ministry of Health, in collaboration with national and international partners, the project will implement a hub-and-spoke model in 10 high-burden districts, linking facilities with community-based delivery points.

Implemented in close collaboration with community partners, lenacapavir will be offered through pharmacies, community health posts, drop-in centers and trained community health workers, and complemented by digital tools to support demand generation and follow up. By bringing prevention closer to where people live and work, the project aims to reach populations who may not otherwise access services, including adolescent girls and young women, pregnant and breastfeeding women, sex workers, men who have sex with men, transgender persons and people who use drugs.

The project will generate practical evidence on task-shifting to community health workers and the cost-effectiveness and impact of a range of delivery approaches to inform national scale-up and support other countries introducing long-acting HIV prevention, helping ensure lenacapavir reaches those who need it most.