The Global Prevention Agenda -GPA

LONG POST ALERT!!! but its informative.

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About PrEP
Over a decade has passed since Oral Pre-exposure prophylaxis (PrEP) for HIV was first shown to be safe for use and effective and since the antiretroviral received regulatory approval by WHO.Lesotho now has over 9 years since the government launched oral PrEP and adopted it into the HIV/AIDS treatment and care guidelines to be used by all people at substantial risk of HIV acquisition.Globally,there has been an upwards of 3,800,000 reported oral PrEP initiations as of December of 2022,of that Number, 27,235 cases were from Lesotho for the same year,while there were 82,147 cases since the country's first oral PrEP launch in 2016.Eversince, Lesotho's HIV prevention programming has moved towards being pro-choice expansion to make it possible to reach the country's targets on overall PrEP initiations by tailoring the response to suit everyone's needs and contexts.

Currently, Lesotho's oral PrEP is sub-optimal relative to its performance in other countries.Just closer to home,South Africa had reported a staggering 422,239 oral PrEP initiations in 2022 alone and 792,434 since its first launch in 2015.Biomedical research and development have set the stage through the introduction of innovative PrEP options like DVR,CAB for PrEP and Lenacapavir.Dapivirine Vaginal Ring(DVR) is a flexible silicon ring that a woman inserts into her va**na for monthly protection against HIV infection.DVR(PrEP ring) is the first long acting woman-centered product that empowers women because the decision to use that ring is entirely their choice.Secondly there is cabotegravir long acting injectable(CAB-LA) which is a form of injectable administered every eight weeks,the injection can be used by different populations including men who sleep with other men,transgender women and cisgeder women.There is also Lenacapavir commonly known as LEN,as another longer acting form of PrEP administered twice a year and soon to be availed on the market for use.

The inclusion of the latest long acting PrEP technologies into Lesotho's HIV treatment and care guidelines has addressed some of the concerns raised by end users around adhering to repetitive doses of oral PrEP.Listed among the reasons for low uptake were; drug packaging,pill size and HIV related stigma among others.It is equally important for good advocacy to be backed by good political will and support from the government because while uptake and continued use are influenced by individual,interpersonal and structural factors,the availability of products that prove safe and effective depends on national regulatory approval and guideline processes.having these array of HIV prevention options has increased the number of people initiated and staying on PrEP and will ultimately help the country reach the Global goal of having zero new infections by 2030.Comparatively,in the United States,the cumulative number of of oral PrEP initiations as at 30th May 2023 was 381,784 and 2,695 was for injectable PrEP.Considering the fact at the time the data was reported the injectable PrEP had recently been approved and introduced for use in America,the number shows that CAB was well received by end users.

The new technologies present a great opportunity for HIV prevention and PrEP uptake in Lesotho because for the first time,the discretion to use either the ring or an injection lies with the client at risk.Secondly; the three options are all long acting and that removes the need to adhere to the routine dosing schedules of oral PrEP.The options are also discrete and do not require having consent of sexual partners,especially with DVR,as women do not have ask permission to use the ring from their intimate partners.The merits that come with the PrEP options present a gain for Lesotho's PrEP performances as they make PrEP attractive and enticing to eligible populations with susceptibility to infection.One of the challenges of oral PrEP was the users' concern and fear for HIV related stigma so PrEP ring,CAB for PrEP and soon to be launched Lenacapavir are a step in the right direction towards increasing overall PrEP uptake and ending the country's challenges around sub-optimal drug uptake.
There is a Ray of hope after all.

CREDITS
AVAC PrEPwatch UNAIDS TCA The Lesotho midterm review NHASP 2018-2023

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