In a bold step towards tackling the HIV epidemic, the Ministry of Health and Wellness is now considering a pilot programme for the first US Food and Drug Administration-approved injectable HIV prevention drug, lenacapavir.

The drug has been described by former United States President Bill Clinton as “a genuine chance to end” the global epidemic.

Jamaica’s decision to embark on the pilot was revealed by Dr Nicola Skyers, senior medical officer of the National HIV/STI programme in the Ministry of Health, who explained that there are also plans for the roll-out of cabotegravir, another injectable form of pre-exposure prophylaxis (PrEP), taken once every two months for the prevention of HIV.

According to Dr Skyers, lenacapavir, which is to be administered twice a year, will be available free of cost in the public health system. That was confirmed by Health and Wellness Minister Dr Christopher Tufton.

“The current thought is to do that, but a lot depends on what turns out in the pilot, and how it evolves over time, but the thought is have it free in the public health system because we’re targeting vulnerable groups and that represents a particular segment of the population,” Tufton, who is on assignment overseas, told the Jamaica Observer.

Dr Skyers noted that the ministry’s push for the pilot comes even as it accepts that the cost of the injectable antiretrovirals (ARVs) “is quite prohibitive at this point”.

“We have injectables for prevention, and we have injectables for treatment, two different target groups, and we are exploring both,” she told the Observer on Monday.

“In terms of prevention, yes, the pilot will be done. That is cabotegravir. Lenacapavir is more of a treatment-based one, but for both injectables in general, we are looking at pilots. We would focus on persons who are most at risk for use, and then certainly, as the pricing becomes within our budget, we can scale up the use,” she said.

According to the World Health Organization (WHO), lenacapavir offers a highly effective, long-acting alternative to daily oral pills and other shorter-acting options.

Dr Skyers noted that the injectable HIV prevention and treatment drugs will be particularly impactful as Jamaica is “not a pill-taking country”.

“I definitely see that [lenacapavir] as a benefit, but we don’t like needles either, so we have to also create that balance, but I believe that overall it can have a significant impact if we get more persons on it, especially for younger persons who might not be as adherent to the pills,” she said.

“For older persons, they are quite comfortable; they have been taking [pills] for diabetes, taking them for hypertension. So we do find that our older persons are actually doing better because they are more cultured towards taking pills, so they tend to do well,” Dr Skyers said.

“So, really, the injectables would be addressing the issues we have around adherence [because] you’re taking an injection every three or six months, depending on which medication we are talking about. And it covers you for that period, so certainly it will address some of the issues that we’re having with adherence,” Dr Skyers added.

Lenacapavir is set to be rolled out at the end of this year in the United States at a cost of US$28,000 per person annually.

However, 120 low- and middle-income countries will have access to the groundbreaking HIV treatment and prevention drug in 2027 at a reduced cost of US$40 per person each year.

This follows an agreement reached between the Clinton Health Access Initiative co-founded by the former US president, the Gates Foundation, and Wits RHI to partner with Indian manufacturers to scale up the production and distribution of lenacapavir.

Last year, 1.3 million new HIV infections were recorded worldwide and experts have said that lenacapavir could have a transformative effect on that figure as it almost completely prevented new cases of HIV in clinical trials.

In July, the WHO recommended it as a preventive drug or PrEP, with the WHO Director General Dr Tedros Adhanom Ghebreyesus describing it as “the next best thing” to an HIV vaccine.

On Monday, two young Jamaicans with whom the Observer spoke said they would be willing to take lenacapavir as an added HIV protection measure if made available at a reduced cost rather than the daily oral pill.

“I would choose the injection because it is only twice per year as compared to the pill, which you have to take daily. Sometimes you may forget, and not everybody likes swallowing pills,” said a University of the West Indies (UWI) student who gave her name as Angel.

While noting that she may not be able to afford the pill at the initially announced cost of US$28,000, Angel shared that if the cost is reduced, then she would choose the injectable.

“The young people would opt to take it because I am pretty sure nobody wants to contract HIV. It’s not something that goes away; it is a lifetime disease, so I think the young people would want to take the necessary precautions so as not to get this disease,” Angel added.

Anishka, another UWI student, said that she would consider taking the injectable HIV prevention drug as it would be more convenient than oral PrEP pills.

“It would be something that I would consider because the disease, in general, is very detrimental, and I think taking the proper precaution and step as a young adult is very necessary for the benefit of my health and my future generations to come… Seeing that you would have to take [oral] PrEP more often than the injection, I would be more open to injectable drugs than having to remember to take this pill every day,” she said.

In Jamaica, there are about 26,000 HIV/AIDS-positive individuals, according to the joint United Nations Programme on HIV/AIDS (UNAIDS) 2023 report.

SKYERS… I believe that overall it can have a significant impact if we get more persons on it

In July, World Health Organization Director General Dr Tedros Adhanom Ghebreyesus described lenacapavir as “the next best thing” to an HIV vaccine.