Unitaid and Fiocruz are going to implement injectable PrEp against HIV in Brazil

Unitaid, the global health agency connected to the WHO, will be financing the implementation of the project for Injectable Pre-Exposure Prophylaxy in Brazil, using long-acting Cabotegravir. With only six injections per year, the method has proven to be more effective than daily oral PrEP in terms of reducing the risk of infection by the virus. The project will be coordinated by the Evandro Chagas National Infectiology Institute (INI/Fiocruz) in a partnership with the Ministry of Health and was announced during the seminar Brazil and Unitaid - current partnerships and future perspectives, at the auditorium of the Immunobiological Technology Institute (Bio-Manguinhos/Fiocruz) last Friday (18/3). The initiative will also involve South Africa.

The project was announced during the seminar Brazil and Unitaid - current partnerships and future perspectives (Image: Peter Ilicciev)

In Brazil, the project will target the groups at highest vulnerability to HIV: men who have sex with men as well as trans women, from 18 to 30 years old. Long-acting Cabotegravir provides eight weeks of continual protection against HIV infections, with a single intramuscular shot. This method is an alternative to oral PrEP, which may reduce the risk of infection by HIV by 99%, but only when taken as prescribed: once a day or before and after sex using the PrEP 2+1+1 scheme (in this case, for cisgender men only).

In South Africa, the target will be teenage girls and young women, who have been infected at disproportionally high rates. In Sub-Saharian Africa, six out of every seven cases of infection amongst teenagers involve girls, and young women have double the contamination rates than that of young men.

Integration with the public health system

In both countries, the idea is to integrate Cabotegravir into the national health program, generating data that will support its global implantation, says Mauricio Cysne, director of Foreign Relations and Communication of Unitaid, during the seminar. Carmen Pérez Casas, senior technical manager of the Unitaid Strategies Department, highlighted the need to maintain sustainable prevention against HIV. The Organization warns that it is necessary to ensure wide access to long-acting Cabotegravir, so as to reach the WHO’s goal of reaching 95% of people at risk of infection by 2025.

"PrEP with CAB-LA is a new and powerful strategy that can really make a difference in controlling the HIV/Aids epidemic", emphasized Beatriz Grinsztejn, chief of the STDs and Aids Clinical Research Laboratory of the Evandro Chagas National Infectiology Institute (INI/Fiocruz).

Injectable PrEP can also be a solution for the challenges faced by users regarding taking pills on a regular basis, which reduces the impact of oral PrEP. The new method also helps mitigate the fear that the pills are interpreted as HIV treatment, causing users to be stigmatized, discriminated against, or to suffer violence by sexual partners as a result. In spite of the high protection that oral PrEP can provide, absorption has been slow.

Fiocruz president, Nísia Trindade Lima, mentioned Brazil’s participation in the creation of Unitaid and emphasized that the new project is a continuation of a series of HIV prevention actions that have been developed. “These 10 million dollars that will be invested will have a huge impact in Brazil and in South Africa”, she said.

The Ministry of Health, Marcelo Queiroga, emphasized that “thanks to Unitaid investments, communities in Brazil with disproportionally high rates of HIV will be among the first in the world to benefit from this new preventive treatment.”

Joint projects

The seminar presented ongoing projects and future perspectives in what was defined by Marco Krieger, vice-president of Production and Innovation in Health, and by Cysne as “a mature relationship”. Created 15 years ago, Unitaid finances eight projects in Brazil, two of which with Fiocruz: the CUIDA Chagas and the Project for the Implementation of HIV Pre-Exposure Prophylaxy in Brazil, in Mexico, and in Peru (ImPrEP), whose extension was now signed. Both projects are connected to INI.

Brenda Hoagland, the coordinator of ImPrEP, mentioned an online survey with the target public, showing that in Brazil interest in an injectable medicine to prevent HIV rose from 42% in 2018 to 75% in 2021, which may facilitate adherence to Cabotegravir. ImPrEP relies on a total budget of 26 million.

As for CUIDA Chagas, the main researcher of the project, Andrea Silvestre, has defined the infirmity as a neglected disease that hits the most vulnerable populations and that gets mixed up with the history of Fiocruz itself. She emphasized the need to prevent the congenital transmission of Chagas disease, mentioning the difficulties in terms of access to diagnosis and treatment.

CUIDA Chagas involves four countries: Brazil, Bolivia, Paraguay, and Colombia. Unitaid finances 15 million dollars, while the Brazilian Ministry of Health pitches in with 4 million dollars. The goal is to speed up diagnosis, making treatment easier. The target public is women of child-bearing age, their children, and their families. The project involves 32 municipalities in the four countries. “In these countries, the implementation of the program should end up saving about 15 million dollars”, she said.

Krieger, on the other hand, reminded the public that new partnerships may appear after Fiocruz was selected as a hub for the mRNA platform, in which the same base can be used for various diseases. He believes that new collaboration proposals may be presented soon.

For Cysne, “there has been an evolution in the partnership” with Fiocruz, anchored to the Ministry of Health. He mentioned that six years ago some collaborations were facing difficulties due to the country’s dependence on imports. “Today we have a different scenario, in terms of COVID-19 as well as other elements. It is very important that Brazil maintain this global health leadership, as in the case of PrEP”, said Cysne, mentioning that projects that are successful here can then be replicated in other nations.

In addition to Lima, Krieger, Cysne, and Casas at the table, the seminar was attended by former minister of Health José Gomes Temporão and by Jorge Bermudez, researcher of the Sérgio Arouca National School of Public Health (Ensp/Fiocruz) and former director of Unitaid, among other Fiocruz members.