Bekker emphasized the necessity of strong demand for generic companies to find it worthwhile to produce. She expressed hope that governments across sub-Saharan Africa would incorporate the generic product into their future budgets. Currently, many regions depend on donor funding. Even South Africa, with its robust GDP that covers 80% of its HIV response, annually purchases antiretrovirals for 6 million people. Bekker noted that it might take several years for such countries to allocate funds for lenacapavir.
There is concern among clinicians, like Nomathemba Chandiwana from the Desmond Tutu Health Foundation in South Africa, about an increase in HIV infection rates. This concern arises from PEPFAR’s apparent focus on treating existing patients rather than on prevention, which could significantly affect public health in Africa and beyond.
Chandiwana, speaking at the NCD Alliance Forum in Kigali, explained that new HIV infections bear consequences beyond the virus. Research indicates that long-term HIV infections, even when controlled by antiretroviral treatment, increase the risk of metabolic conditions such as hypertension, obesity, and type 2 diabetes. These conditions are already on the rise in sub-Saharan Africa. Chandiwana pointed out that HIV and many antiretrovirals disrupt metabolism, leading to chronic diseases manifesting earlier and more aggressively in people with HIV compared to the general population.
There is a need for new HIV treatments, and one proposed approach involves using lenacapavir as a foundation for future combination therapies for people already living with the virus. This could potentially reduce metabolic side effects and develop treatment protocols that don’t require daily medication.
Bekker has mooted various ideas, such as combining bimonthly cabotegravir with a six-monthly lenacapavir injection for viral suppression, limiting visits to six per year. Additionally, there is consideration of combining a weekly antiretroviral pill with a six-monthly injectable, which could reduce the stigma of daily medication.
However, many studies face uncertainty due to anticipated reliance on US-based funding. Bekker expressed concern about restrictions on research funding from sources such as the National Institutes of Health, which could hinder innovation and progress.
Ngure mentioned hope for other donors to support The Global Fund in procuring lenacapavir. Meanwhile, Bekker is exploring funding from European agencies and potential donors in Scandinavia, Japan, and Australia. She emphasized the importance of African countries developing the capability to fund preventative efforts independently.
Bekker stressed the need for Africa to contribute more to the fight against HIV, stating it is crucial for the continent to increase its involvement in research and development.
She expressed concern that without US resources, the opportunity presented by lenacapavir could be missed. Bekker remarked on the timing of this setback, indicating it could significantly delay progress and increase public health spending. She underscored the importance of quickly controlling the epidemic to save money and lives in the long term.