Abstract:
Sub-Saharan Africa carries the highest burden of HIV-1 and AIDS. About 39% of all new
infections in the world in 2020 were in this region. Oral PrEP was found to be very effective in
reducing the risk of HIV-1 transmission. However, its effectiveness is highly dependent on users
adhering to the drugs. The availability of long-acting injectable PrEP that eliminates the need for a
daily pill may increase PrEP uptake and adherence in people who struggle to adhere to oral PrEP. The
USA’s FDA approved long-acting cabotegravir (CAB-LA) for PrEP of HIV-1 in December 2021. In this
review, we discussed the implementation challenges to the successful roll-out of CAB-LA in Africa
and measures to address these implementation challenges. Some health system-level challenges
include the cost of the drug, its refrigeration requirement, and the shortage of healthcare providers
trained to administer parenteral medicines. In contrast, client challenges include lack of knowledge,
accessibility of the drug, side effects, stigma, and lack of family and community support. These
challenges can be addressed by several measures emanating from lessons learned from the successful
implementation of ART, oral PrEP, and immunization in the continent. Some steps include advocating
for waiving of CAB-LA patent licence, conducting demonstration projects in Africa, promoting the
use of renewable energy sources such as solar energy, healthcare provider training, task shifting,
community engagement, client education, and implementing adherence promotion strategies.
