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. 2025 Jul 1;16(1):5760.
doi: 10.1038/s41467-025-60752-y.

Potential impact and cost-effectiveness of long-acting injectable lenacapavir plus cabotegravir as HIV treatment in Africa

Andrew Phillips  1 , Jennifer Smith  2 , Loveleen Bansi-Matharu  2 , Kenly Sikwese  3 , Cissy Kityo  4 , Charles Flexner  5 , Marco Vitoria  6 , Nathan Ford  6 , Meg Doherty  6 , Zack Panos  7 , David Ripin  8 , Matthew Hickey  9 , Diane Havlir  9 , Monica Gandhi  9 , Michael Reid  9   10 , Paul Revill  11
Affiliations

Potential impact and cost-effectiveness of long-acting injectable lenacapavir plus cabotegravir as HIV treatment in Africa

Andrew Phillips et al. Nat Commun. .

Abstract

Although viral suppression is attained for most adults living with diagnosed HIV in East, Central, Southern and West Africa (ECSWA), challenges remain with sustained adherence to daily oral pill taking for some in the population. Here, we evaluate the potential effectiveness and cost-effectiveness of introduction of a new combination of long-acting injectable drugs of lenacapavir + cabotegravir to increase levels of sustained viral suppression. We find there is potential for a significant impact on HIV deaths and disability adjusted life years, including due to a decrease in mother to child transmission. If lenacapavir + cabotegravir can be sourced at a cost of around $ 80 per year or less, our analysis suggests there is potential for a policy to introduce it to be cost-effective in settings in ECSWA. Recognising the limitations of a modelling study, we suggest that implementation studies be conducted to confirm the viability of these approaches.

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Conflict of interest statement

Competing interests: D.H.: for the NIH funded SEARCH study, ViiV provided cabotegravir for the study. C.F. served as an expert witness for a law firm representing Gilead in a patent dispute in 2023. Payments came from the law firm and not from Gilead, and the payments were not contingent on outcome. The remaining authors declare no competing interests.

Figures

Fig. 1
Fig. 1. Effects over time of introduction of lenacapavir + cabotegravir.
a Of PWH, percentage on ART (b) Of PWH on ART, percentage on lenacapavir + cabotegravir (c) Of PWH with diagnosed HIV, percentage with viral load >1000 cps/mL (d) HIV incidence in women aged 15−49 (e) HIV incidence in men aged 15−49 (f) Number of HIV-related deaths in women ^ (g) Number of HIV-related deaths in men (in the context of a setting with population size of 1 million adults aged 15+ in 2024) (h) Number of children newly infected with HIV per year (in the context of a setting with population size of 1 million adults aged 15+ in 2024).
Fig. 2
Fig. 2. Incremental cost-effectiveness ratio for lenacapavir + cabotegravir introduction according to the percentage of diagnosed PWH with viral load >1000 copies/mL and HIV incidence age 15−49.
Also shown is the incremental cost-effectiveness ratio for lenacapavir + cabotegravir introduction in subgroups defined by age and sex. Both are also shown according to cost of lenacapavir + cabotegravir.
See this image and copyright information in PMC

References

    1. UNAIDS. 2024 Gobal AIDS Report — The Urgency of Now: AIDS at a Crossroads. https://www.unaids.org/en/resources/documents/2024/global-aids-update-2024 (2024).
    1. Rodger, A. J. et al. Sexual activity without condoms and risk of HIV transmission in sero-different couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA316, 171–181 (2016). - PubMed
    1. Nachega, J. B. et al. Long-acting antiretrovirals and HIV treatment adherence. Lancet HIV10, e332–e342 (2023). - PMC - PubMed
    1. Toska, E. et al. Factors associated with preferences for long-acting injectable antiretroviral therapy among adolescents and young people living with HIV in South Africa. AIDS Behav.27, 2163–2175 (2023). - PMC - PubMed
    1. Murray, M. et al. Identifying appropriate candidates for long-acting antiretroviral therapy: findings from a survey of health care providers in the ATLAS-2M trial. HIV Res. Clin. Pract.21, 105–113 (2020). - PubMed

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