ViiV must urgently help get more people on lifesaving HIV prevention medicine

ViiV must also do more to provide access to the drug for people in low- and middle-income countries (LMICs) with high HIV incidences, where it’s currently largely inaccessible but could have the biggest impact on preventing HIV infections, said MSF.

There are an estimated 1.3 million new HIV infections per year, yet ViiV distributed only enough CAB-LA for prevention for approximately 13,000 people in 2023—almost 70 percent of which was sold in high-income countries. For governments and countries to be able to roll out this lifesaving intervention at the scale needed, ViiV must extend its access price to all middle-income countries and register CAB-LA for PrEP in many more countries, especially those with a high burden of new HIV infections.

“In many middle-income countries in which we are providing HIV care, we are seeing a worrying increase in HIV cases that we want to help curb through the introduction of CAB-LA for HIV prevention,” said Dr. Antonio Flores, senior HIV/TB advisor at MSF. “However, with ViiV unwilling to provide access or publicly share pricing information on CAB-LA for middle-income countries, we cannot introduce CAB-LA for HIV prevention in these settings. It’s disheartening that there is a very effective drug that could dramatically reduce HIV infections, but countries with high rates of HIV infection in vulnerable populations are not able to access it because ViiV is prioritizing selling the drug in countries where they can make much more profit.”

CAB-LA is a crucial medicine for HIV prevention and could contribute significantly to turning the tide against the HIV/AIDS epidemic if distributed optimally. However, according to MSF’s analysis of IQVIA MIDAS® annual sales data licensed by MSF and publicly available non-commercial procurement data, global distribution of CAB-LA by ViiV in 2023 was not enough to meet the needs of even 13,000 people—with most of the supply going to the US, where ViiV charges $22,000 per patient per year.

In addition, ViiV has not made the price publicly available for CAB-LA for PrEP for middle-income countries and continues to press procurers for secrecy and non-disclosure on the price for countries that fall outside of low-income countries, least-developed countries, and countries in sub-Saharan Africa that qualify for its access pricing. As of January 2024, ViiV had filed or registered CAB-LA in only 23 LMICs, versus 34 high-income countries, including the European Economic Area bloc.

Prioritizing commercial markets and profits at the expense of meeting public health needs in LMICs is a far cry from the “tailored approach which is country-specific and informed by local epidemics and national economic status” that ViiV espouses in its access policy.

“We have been negotiating with ViiV to access CAB-LA for PrEP since January 2022 and, after two long years, were finally able to order limited amounts of the drug for a handful of MSF projects and share the price of GBP£ 23.50 [about $30] per vial transparently,” said Jessica Burry, HIV/HCV pharmacist with MSF’s Access Campaign. “While it’s good news that we can soon start using CAB-LA for PrEP in four countries in which we work—all of which are already included in ViiV’s 'access price territory'—we need to address the bigger picture of ViiV’s distribution plan. What we’re seeing is ViiV prioritizing sales of CAB-LA for PrEP at higher prices to high-income markets instead of at affordable prices to middle-income countries. This is unacceptable, and ViiV must address the current limited and unequal access to CAB-LA for PrEP by ensuring manufacturing capacity, speeding up registration and availability for every country with high rates of new infections, and by ensuring the limited supply it has now reaches the countries and people who need it most.”

CAB-LA, administered as an injection every two months, is more discreet than the once-daily oral PrEP pill and could encourage adherence to this form of prevention. Discretion can be especially important for key and vulnerable populations at risk of HIV, like girls and women, sex workers, and men who have sex with men. CAB-LA was recommended for HIV prevention by the World Health Organization WHO in July 2022.