After successfully piloting a study that showed an oral drug taken by HIV negative persons can reduce their risk of infection before exposure, Uganda will experiment with an injectable version of the same drug.

The initial pilot trial of the long-lasting injectable pre-exposure prophylaxis (PrEP) was conducted in several countries, including South Africa, Malawi, Brazil and the USA.

In Uganda, the experimental study on the injectable PrEP medication, Truvada, will be carried out by Makerere University-Johns Hopkins University research collaboration centre and Baylor Uganda, researchers said.

“Studies conducted in the United States and other countries show the injection is safe and well tolerated. We are going to replicate it here in Uganda,” said Dr Matovu of the University collaboration centre.

“A country with a high HIV infection rate like Uganda needs to have a wide range of HIV prevention interventions that people can choose from,” she added.

Preliminary results from Uganda’s recently released Population HIV Impact Assessment Survey shows about 1.3 million people are living with HIV/Aids.

The study on injectable PrEP is expected to start before the end of this year and will run for four years.

It will enroll an estimated 500 participants from groups considered to be at high risk of HIV infection, including sex workers and people who have multiple sexual partners will participate.

Problem of adherence

The drug is for people who are HIV negative, but at high risk of becoming positive to take a daily medication that helps lower their chances of being infected.

But like most medications, one of the challenges faced by people using the drug has been poor adherence to taking the daily pill.

Options such as long lasting injectable PrEP can, therefore, help people who are unable to adhere to daily oral pills to take the medication as required.

“In places where PrEP is being given, adherence to the regimen has been poor. An injection every two months would go a long way in ensuring people adhere to the medication,” Dr Matovu added. 

Kenya and South Africa are the two countries in Africa where oral PrEP has been rolled out as one of the prevention interventions for HIV negative people who are at high risk of infection.

Even though Uganda is one of the countries on the continent that pioneered research to demonstrate the effectiveness of oral PrEP in HIV prevention, the country has been slow in rolling it out.

Dr Joshua Musinguzi, the head of the Aids control programme at the Ministry of Health said the country will roll out the oral PrEP soon, staring with few selected sites, before expanding it to cover all those who need it.

“We are moving slowly because we have several interests and this is an expensive programme to roll out. We want to make sure we maximise all other prevention interventions,” he said.

WHO guidelines emphasise that PrEP should be given to people considered at substantial risk of HIV infection.

These include discordant couples, people with multiple sexual partners, sex workers and men who have sex with men.

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