Long-acting injectable HIV treatment as effective as daily oral pill — study

An injectable antiretroviral drug: Long-acting Cabotegravir and rilpivirine (LA-CAB/RPV) is effective in treating HIV, New Vision Online has learnt.

According to the CARES study, the first trial evaluating Long-Acting Antiretroviral (ART) drugs in sub-Saharan Africa has shown that the injectable ARVs drug, which is given once every two months instead of taking a pill every day, works as effectively as the daily oral pill.

The same study discovered that people who have problems with swallowing the daily pill, for instance, those who get tired of taking tablets, are stigmatised and have to hide somewhere to take the pills, people who may travel and forget to take pills can now adhere to their treatment by taking the long-acting injectable antiretroviral therapy.

Joint Clinical Research Centre (JCRC) executive director and lead investigator Dr Cissy Kityo Mutuluuza says during the study, people were asked their preferences for injectable drugs or oral tablets, and 99% of the people who were switched to the injectable ARVs, preferred to stay on injectable ARVs instead of going back to the oral tablets. Consequently, showing a very high level of preference.

 The final results of the CARES study on the long-acting injectable antiretroviral therapy in Africa were presented at the Conference on Retroviruses and Opportunistic Infections (CROI) in San Francisco in March of this year.

For Uganda, the results were disseminated to participants of the study in Fort Portal on Friday, August 1, 2025.

Funded by Janssen Pharmaceuticals and co-ordinated by JCRC here in Uganda, the 24 months CARES Study that kicked off in 2021 enrolled 512 participants from eight sites in Kenya with 162 (31.6%) participants, South Africa enrolling 106 (20.7%) participants and Uganda with 244 (47.7%) participants who were drawn from JCRC Lubowa, JCRC Fort Portal and Infectious Disease Institute (IDI).

Impact

According to Kityo, this first study in sub-Saharan Africa has contributed to the available evidence of how well the injectable drugs work better to the World Health Organisation (WHO).

As such, in the recent International AIDS meeting that happened in Kigali, Rwanda from  July 13 to 17, 2025, WHO presented their revised guidelines, which included using this modality of treatment.

The guidelines stipulate that individuals who are already on oral ARVs and are virally suppressed can switch to injectable because it is equivalent, Kityo said.

Once WHO endorses guidelines, then local ministries adopt and look at ways in which to implement, Kityo added.

Jotham Mubangizi, the UNAIDS strategic information advisor. (Credit: Agnes Kyotalengerire)

She further noted that what may delay them is the generic manufacturers, considering that the drugs will only be available in cheaper generic formulations in 2027.

“Considering that the WHO guidelines are available, the only obstacle lies in translating them into local guidelines, which is dependent on the availability of generic drugs, which will be available in 2027,” Dr Kityo said.

Long-acting injectable ART (LA-CAB/RPV) has already been approved for use in all parts of the UK and is already in use in Scotland.

What does this mean for HIV fight?

According to Kityo, when you have a treatment that is preferred by people, has the convenience of dosing, it means this will translate into better treatment outcomes, including viral suppression.

“If you have better viral suppression in the community, it means there is improved quality of life of patients. In addition to reduced HIV transmission to other people in the community,” Kityo said.

Not to mention the drugs provide convenience, varied choice, they are very efficacious, they can cause viral suppression and contribute to epidemic control.

UNAIDS strategic information advisor Jotham Mubangizi said it is a great milestone, as it pushes and reinforces the continued quest for a long-term solution that is affordable, easy for administration, but also offers the best effect.

“Once an individual receives the injection, then the rest of the two months, there is assurance of viral suppression compared to if somebody is swallowing the pill every day,” Mubangizi said.

 Highlighting the need for Government implementation and readiness to take on the injectable drug, Mubangizi said health workers should be trained to move from a study setting into a real program implementation.

“There will be refinement of the tools, to be able to collect appropriate data for monitoring and relevant preparation of those facilities that will be able to roll it out,” he noted.

Clinical geneticist, Immunologist, and Virologist at Makerere University College of Health Sciences Dr Misaki Wayegera said the social context of having to take this medicine in public is a little bit stigmatising. In addition, someone could forget their ARVs at home, therefore the introduction of the long-acting injectable ARVs is one of the greatest development in the area of treatment in the area of HIV treatment.

 “It will increase compliance and remove the burden of  swallowing drugs every day,” Dr Misaki said.

He called for the need to ensure the virus does not acquire resistance against the new injectable ARV drug.

“The enrolment should have mechanisms for follow-up. Otherwise, if let resistance emerge against the drug, then we shall lose it, which takes us back to the zero-drawing board,” Misaki said.

Additionally, research should be done to uncover new ways of turning other drugs into injectable solutions. According to Misaki, this will create other options in case resistance emerges against this injectable option.  

 The HIV burden

The national HIV prevalence has dropped to 4.9% from 5.1%, according to the 2025 national HIV estimates report.

The same report shows that Uganda has registered a 61% reduction, which translates into 37,000 new HIV infections per year, compared to 15 years ago where over 97,000 new HIV infections were registered.

Of the 37,000 new HIV infections recorded, about14, 000 were young people aged 15 to 24, with majority about 70% being adolescent girls and young women.  Only 17% of the new HIV infections occurred among young boys and men who are not circumcised but still engaging in unsafe sexual practices.

A total of 4700 children acquire HIV from their infected mothers. Sadly, in 2024, a total of 20,000 Ugandans succumbed to AIDS related conditions.