Online Reporter
Rumbidzayi Zinyuke in ACCRA, Ghana
AFRICAN governments have been urged to strengthen health systems, financing mechanisms and regulatory pathways to support the introduction of next-generation antiretroviral therapy, as the continent edges closer to adopting long-acting HIV treatment options.
This call came at the ongoing ICASA (International Conference on AIDS and STIs in Africa) 2025 in Accra, where advocates, global health agencies and pharmaceutical manufacturers highlighted how long-acting formulations, such as cabotegravir and rilpivirine injections administered every two months, as well as emerging once-weekly oral combinations, could significantly change the daily realities of millions of people living with HIV.
Stakeholders agreed that if countries prioritised equitable roll-out, long-acting therapies could accelerate Africa’s progress towards the 95-95-95 targets.
According to Ms Maurine Murenga, founder of the Lean on Me Foundation, long-acting therapies offer far more than convenience.
“I speak not just as an advocate but as a woman who has lived with HIV for over two decades,” she said.
“We cannot prevent new infections if people living with HIV are not virally suppressed. And we cannot achieve viral suppression when daily pills feel like a constant reminder of our status.”
She emphasised that long-acting options could reduce stigma, protect privacy and help young people and mothers stay on treatment without fear of being exposed.
“For a mother who has to hide her HIV status, an injection every two months means she doesn’t have to hide a pill in her home,” she added.
For adolescents who want to go on a school trip without medication that might reveal their status, this is freedom. When we simplify treatment, we restore humanity.”
Ms Murenga, however, indicated that communities must be educated and prepared before roll-out begins, stressing that affordability must be prioritised from the start.
“I refuse to live in a world where long-lasting treatments become another privilege gap,” she said.
Pharmaceutical partners outlined progress on voluntary licences aimed at speeding up access to generic long-acting treatment across low- and middle-income countries.
Ms Anna Hare, strategic director for access to medicines at ViiV Healthcare, said voluntary licences through the Medicines Patent Pool had already enabled more than 23 million people to access dolutegravir-based regimens.
“These licences have now expanded beyond oral tablets into long-acting injectables. The aim is affordable, accessible versions of long-acting cabotegravir for both treatment and prevention in 133 countries,” she said.
Generic manufacturers said some long-acting products were moving closer to approval.
Mr Jijo Jose, senior general manager at Aurobindo, said his company had completed key development work and would begin stability studies in January 2026.
“We expect our first approvals in early 2028, but accelerated pathways could bring this forward by six months,” he said.
The company, he added, had built initial capacity for five to six million doses a year, equivalent to about one million patients, with the potential to scale production as demand increases.
Mr Sushil Kumar Mishra, associate vice president (commercial) at Viatris, said success would depend on more than manufacturing alone.
“Long-acting injectables require a different delivery approach. Policy adoption, sustainable financing, partner support and strong health system readiness from trained providers to supply chain logistics will all determine whether these therapies deliver real benefit,” he said.
Dr Tereza Kasaeva, director of WHO’s HIV, TB, Hepatitis and STIs department, said the world was living in a period of remarkable innovation, with the first-ever injectable combinations now approved and more in development.
But she cautioned that countries must take a measured approach to implementation.
“These new recommendations will guide you on how to use these options for people already on treatment with adherence challenges,” she said.
“Long-acting therapies can improve quality of life and minimise stigma, but they also bring programmatic implications that should not be underestimated,” she said.
She underscored the need for improved storage capacity, protocols to manage treatment interruptions and systems to prevent drug resistance.
“Oral pills work very well, but that is not a reason to ignore new options. If we show no interest in uptake, further innovation may stall,” Ms Kasaeva added.
She said the WHO would continue updating global guidelines and supporting countries with adaptation, stressing that community leadership must remain central to any future roll-out.
