Dr Githinji Gitahi: Why Kenya can't rely on Lenacapavir donations for long

Dr Githinji Gitahi, Group CEO of Amref Health Africa: "In the short term, international partners such as the Global Fund are playing a key role in supporting the introduction and early financing."

Q: Beyond the science, why is this moment significant for Africa?

A: For many years, prevention relied on daily oral PrEP tablets. Later, we saw long-acting options requiring injections every two months. Now, we have an injection that can protect for up to six months at a time. That shift, from daily dosing to twice-yearly administration, has the potential to significantly improve adherence and convenience for people at substantial risk of HIV.

Clinical trials have demonstrated very high efficacy, making this one of the most promising prevention tools we have seen in decades.

But beyond the science, this moment is significant because of equity.

Historically, new medical innovations have taken years, sometimes up to a decade, to become accessible in low- and middle-income countries after being launched in wealthier markets. In this case, long-acting HIV prevention is reaching African countries at roughly the same time as high-income countries.

Pricing has also been a defining issue. While costs in high-income markets have been significantly higher at about $40,000 per person per year, negotiated agreements supported by the Global Fund, working in partnership with governments such as Kenya, have enabled access for eligible countries at approximately $40.

That represents meaningful progress toward global health equity. This is not only a scientific breakthrough, it is also a moment of global health solidarity.

Who is eligible for this injectable HIV prevention option, and what should they consider?

This intervention is designed for individuals who are HIV-negative and at substantial risk of HIV exposure due to their circumstances, environment, or social vulnerabilities.

Groups that may particularly benefit include adolescent girls and young women, especially those under 24, as well as men who have sex with men, transgender individuals, and other key populations. It may also be appropriate for people in sero-discordant relationships, where one partner is living with HIV and the other is not.

Eligibility will follow national guidelines and requires appropriate HIV testing and screening before initiation.

It is important to emphasise that this intervention is preventive. It is not a treatment for people living with HIV, and it does not replace antiretroviral therapy for those already diagnosed.

Additionally, while it offers highly effective protection, it complements rather than replaces other prevention strategies. Safe sexual practices, including correct and consistent condom use, remain important components of comprehensive HIV prevention.

What concerns should communities be aware of? Are there side effects?

Clinical trials have shown Lenacapavir to be generally well-tolerated. The most commonly reported side effects are mild injection-site reactions, such as temporary pain or swelling.

As with any medical intervention, individuals will receive proper HIV testing and eligibility assessment prior to initiation and will be supported through follow-up visits in line with national protocols.

Another important concern is misinformation. When a new health intervention is introduced, communities often ask understandable questions: Is this a vaccine? Will I need it for life? Is it safe? Who qualifies?

Without clear, trusted information, even highly effective innovations can face hesitation. This is why communication and community engagement will be critical to success.

What role do Primary Health Care and Community Health Workers play in delivery?

Primary Health Care (PHC) systems will be central to the successful rollout of long-acting HIV prevention.

The injection is stable at standard room temperatures, making it suitable for delivery in many PHC settings without complex cold-chain infrastructure. This increases its feasibility in rural and resource-constrained environments.

However, successful delivery will depend far more on trust and awareness than on storage logistics.

Community Health Workers (CHWs) will be foundational.

They serve as the trusted link between health systems and communities. In the context of this rollout, CHWs will provide accurate, accessible information; address misconceptions and fears; help identify individuals who may be eligible; support referrals to health facilities; and remind clients to return for follow-up injections.

Awareness is one of the biggest determinants of success. If people do not understand the intervention, they will not use it. If they do not trust it, uptake will stall.

Strong community systems are therefore essential for the success of such interventions.

Is this intervention sustainable?

In the short term, international partners such as the Global Fund are playing a key role in supporting the introduction and early financing.

At approximately $40 per person per year under negotiated agreements, the intervention is relatively affordable compared to many other specialised health technologies. Importantly, this is not a universal vaccine targeting entire populations. It is focused on individuals at substantial risk, which makes forecasting, budgeting, and targeting more manageable.

However, sustainability cannot rely solely on external funding.

African governments must begin integrating financing for long-acting prevention into domestic health budgets over time. That requires forward planning, strong procurement systems, reliable forecasting, and continued investment in PHC delivery platforms.