Cabotegravir-Global Access to Long-Acting Pre-exposure Prophylaxis for HIV

Abstract

A novel injectable pre-exposure prophylaxis, cabotegravir, has greater efficacy and acceptability than oral tenofovir/emtricitabine for prevention of HIV infection. Cabotegravir is currently priced at $22 200 per year, >185 times higher than the $60-$119 estimated cost-effectiveness threshold for middle-income countries (MICs). Following civil society pressure, ViiV provided access to generic versions in 90 countries with the Medicines Patent Pool (MPP), including all African nations. However, several MICs outside Africa have rapidly growing HIV epidemics. We analyzed the ViiV-MPP deal to assess population covered and gross domestic product (GDP) per capita. There were 38 countries excluded from the ViiV-MPP deal despite having a GDP per capita lower than the highest-earning African country. These countries include 2.4 billion people (30% global population), with an incidence of 122 000 (8%). For cabotegravir to have a significant impact on HIV infections, millions will need to be treated at affordable prices in a wide range of countries.

Keywords: HIV; PrEP; access; cabotegravir.

Figure 1.

Choropleth maps comparing the countries currently included in the ViiV-MPP deal (Figure 1a—top) and the proposed countries that would be included in a deal based on GDP per capita of Mauritius (Figure 1b—middle), and Seychelles (Figure 1c—bottom) as the definitive metric for inclusion. On all maps countries in green are included and countries in red are excluded.