The problem
New HIV infections remain high in South Africa, particularly among adolescent girls and young women and key populations such as sex workers, men who have sex with men and transgender women. While highly effective prevention tools exist, many people at greatest risk face barriers to uptake and effective use. The burden of daily pill-taking associated with oral pre-exposure prophylaxis (PrEP) poses challenges for many individuals. The emergence of long-acting PrEP offers additional choices to address such challenges, however individuals may also face barriers to accessing facility-based services, including stigma, long distances, limited clinic hours and concerns about privacy.
Lenacapavir – a twice-yearly injectable shown in clinical trials to be safe and nearly 100% effective – offers great potential to help turn the tide on new infections. However, ensuring equitable and timely access beyond traditional facilities is essential to maximize its prevention impact.
Our response
This project will support South Africa to expand access to lenacapavir through innovative, community-based delivery and demand-generation approaches that complement national rollout through public health facilities. Designed in close collaboration with government and community partners, the project aims to bring prevention services closer to people’s everyday lives while strengthening prevention choice and uptake among populations at highest risk.
Led by the Africa Health Research Institute and a consortium of local partners, the project focuses on adolescent girls and young women and key populations including sex workers, men who have sex with men, transgender persons and people who use drugs in KwaZulu-Natal and Gauteng. Lenacapavir is delivered through a mix of decentralized settings, including pharmacies, mobile clinics, hair salons and safe spaces for key populations, alongside peer-led prevention literacy, stigma reduction and community-driven demand creation.
The project will generate real-world evidence on the feasibility, cost-effectiveness and impact of these delivery models, including their effect on HIV incidence. By sharing lessons in real time, it will help inform national scale-up and guide other countries rolling out long-acting HIV prevention.
