Despite being offered at a reduced price, South Africa is unable to financially support the purchase of a new anti-HIV medication. This is due to budget constraints and limited resources.

The health department of South Africa reports that the cost of a new anti-HIV injection is still three times higher than their budget can cover.

ViiV Healthcare, a pharmaceutical company based in the UK, has reduced the cost of their medication from 729 rand per dose (£32) to a range of 540 to 570 rand (£23.66-£24.97).

The medication, taken every eight weeks, essentially eliminates someone’s chances of contracting HIV through sex. It contains an antiretroviral drug, cabotegravir, that is released over a two-month period. The treatment is called CAB-LA (short for long-acting cabotegravir).

In 2022, it was estimated that 164,200 individuals in South Africa were infected with HIV, making it the country with the highest number of people affected by the virus. Over 13% of the population is living with HIV in South Africa, making it the largest HIV epidemic globally.

The cost of CAB-LA at non-profit rates is significantly lower than in the US, where a single shot costs approximately $3,700 (£2,975). However, it is still four times the amount that South Africa’s health department pays for a monthly supply of a daily HIV prevention pill, which costs £2.85 per patient.

Khadija Jamaloodien, the chief director of procurement for the national health department, stated that in order for CAB-LA to be financially viable for the South African government, its price must be comparable to the cost of oral PrEP, which is currently 129 rand (£5.68) for a two-month supply. She also mentioned that the department is facing budget cuts and cannot afford to pay significantly more for the medication.

Jamaloodien added that in addition to this, ViiV’s non-profit price does not cover distribution expenses, resulting in an even higher cost compared to the current rate of 540 to 570 rand per vial.

To avoid the expensive cost of CAB-LA, a solution is to let donors, like the US government’s President’s Emergency Plan for AIDS Relief (PEPFAR), cover the expenses. PEPFAR is the largest contributor among government donors for antiretroviral medication in Africa and also supports oral PrEP in various African nations.

ViiV has already delivered supplies sponsored by Pepfar to Malawi, Zambia, and Zimbabwe. These supplies are expected to arrive in late November, according to Mitchell Warren from the Coalition to Accelerate Access to Long-Acting PrEP. From 2023 to 2025, Malawi is projected to receive 10,000 doses, Zimbabwe between 10,000 and 12,000, and Zambia between 8,000 and 10,000 doses.

Warren and a group of HIV researchers in South Africa have been informed by Pepfar that the country will receive donations in early 2024. However, this has not been officially confirmed by Pepfar.

The health department is still considering whether or not to accept donations from CAB-LA. Jamaloodien stated that it is important for the country to have sustainable programs and relying solely on donations could result in the rollout being discontinued if the funding runs out. In terms of HIV treatment, South Africa covers the cost of its own antiretroviral drugs.

Jamaloodien stated that while we are not completely opposed to it, we must also consider its long-term viability.

In March, ViiV granted licenses to three Indian pharmaceutical companies to manufacture more affordable, generic forms of CAB-LA in partnership with the Medicines Patent Pool, an organization supported by the UN that aids developing nations in obtaining medication. Cipla, one of the companies, intends to produce the drug at their plant in Durban.

Man in full biosecurity suit in a pharmaceutical plant fiddling with a screen while a production line of medicines operates around him.

However, before Cipla can proceed, it must establish the necessary technology, construct facilities, and conduct trials to demonstrate that its product functions similarly to the branded version.

According to Warren, generic versions will not be accessible until at least 2027.

Warren stated that ViiV has mentioned a potential decrease in price as their sales increase and they receive orders from major buyers such as Pepfar, the Global Fund, and governments like South Africa. He believes that within the next few years, the branded product could be priced at around $100 or $120 for an annual supply of injections, rather than the current price of $175.

However, even at that price, it would still be more than twice the cost of the daily HIV prevention pill that the South African government pays for. The department stated that this would make it unaffordable and not cost-effective.

  • This is a revised edition of an article originally written for the Bhekisisa Centre for Health Journalism.


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