Taking injectable PrEP to scale: Optimising the value of lenacapavir for South Africa’s HIV response

作者：Lise Jamieson, Leigh F. Johnson, Jeffrey W. Eaton, Hasina Subedar, Linda‐Gail Bekker, Gesine Meyer‐Rath · 发表于：medRxiv · 年份：2025 · DOI：10.64898/2025.12.14.25342211 · 被引用次数：2 · 研究领域：HIV/AIDS Research and Interventions、HIV/AIDS drug development and treatment、HIV Research and Treatment

Abstract Background South Africa accounts for 20% of the global HIV infections and has one of the highest HIV incidence rates in the world. Six-monthly injectable lenacapavir (LEN) for HIV pre-exposure prophylaxis (PrEP) has superior efficacy to oral tenofovir disoproxil fumarate/emtricitabine (TDF/FTC), and similar efficacy to 2-monthly injectable cabotegravir (CAB). With LEN’s recent regulatory approval and the newly negotiated generic price of $40 per person per year, South Africa faces critical implementation decisions amid constrained domestic resources and reduced international funding. We evaluated the epidemiological impact on HIV infections and life years lost, cost-effectiveness, and optimal populations for LEN roll-out in South Africa. Methods and Findings Using Thembisa v4.8, a deterministic compartmental HIV transmission model of the South African HIV epidemic, we simulated the impact of LEN scale-up, expanded oral TDF/FTC, and CAB scale-up, compared to a baseline of current TDF/FTC provision over 20 years (2026-2045). We scaled PrEP among adolescent girls and young women (AGYW), female sex workers (FSW), pregnant and breastfeeding women (PBFW), men who have sex with men (MSM), and heterosexual men. For TDF/FTC scale-up, we doubled baseline initiation rates. For LEN and CAB, conservative and optimistic scenarios assumed initiation rates similar to or double those under TDF/FTC scale-up, respectively. Duration of use varied by subpopulation under TDF/FTC (3-6 mont...