HIV Injections Outperform Daily Pills in African Teen Trial

According to researchers behind the study, a trial published in The Lancet showed that an injectable HIV drug administered once every eight weeks did a better job of controlling the virus than daily pills among 476 teenagers aged 12 to 19 treated at five clinics in Kenya, South Africa, Uganda and Zimbabwe.¹⁵²

Trial design and results

The LATA trial randomly assigned adolescents who had already spent more than a year on tablet treatment with fully suppressed HIV to either continue daily antiretroviral tablets or switch to injections of cabotegravir and rilpivirine every eight weeks. Almost all participants had acquired HIV at birth, according to the dossier sources.⁵³⁴¹

The study found that by the 96-week mark, just 1% of those on injections experienced a confirmed return of detectable virus, versus 6% of participants taking daily tablets. Researchers reported that 94% of the teens getting shots described the eight-week regimen as far simpler than swallowing pills every day.²³⁴⁵

Sarah Pett, chief investigator at the UCL Innovative Clinical Trials Unit, said the results were notable in comparison with earlier trials in adults. "The benefits of this form of treatment for adolescents are stronger than we have seen for adults," she said.²

Why daily pills are harder for teenagers

Sources cited in the dossier note that teenagers often struggle with daily pill regimens due to social stigma, being teased by peers, and difficulty sticking to a consistent schedule. Pett said adolescents with HIV have historically fared worse on antiretrovirals than adults, adding that injectable treatment "can help young people to lead a more normal life," according to her comments to researchers.⁵³

Dossier sources indicate that HIV affects roughly 1.6 million young people between 10 and 19 worldwide, with nine in ten of those cases concentrated on the African continent. Pett noted that despite this concentration of cases, the treatment remains largely inaccessible on the continent: "Nine out of 10 adolescents with HIV live in Africa yet currently this treatment is not accessible to them," she said.²³⁴¹

Access and cost barriers

Per the sources, the World Health Organization already endorses the injectable option for adults and teens whose HIV is suppressed and who lack active hepatitis B, and it is being used in wealthier regions such as the U.S. and Europe for patients 12 and up.²⁵³⁴

In Africa, however, injectable treatment is not accessible except at a small number of clinics, according to researchers. Mutsa Bwakura-Dangarembizi, a trial physician and principal investigator at the Harare site in Zimbabwe, said: "But we have a major problem right now in Africa and other low- and middle-income settings, where these long-acting injectables are simply not available for use."²³¹

Researchers attributed the limited availability to cost, since the injectable drugs remain under patent and are more expensive than tablets, with no agreement yet reached on a generic version, according to the dossier. Sources added that rilpivirine must be kept cold throughout distribution and storage, and trained nurses are required to give the shots every eight weeks—both factors that strain healthcare infrastructure.²⁵³⁴

Deborah Ford, corresponding author on the trial paper from the UCL Innovative Clinical Trials Unit, said: "The lack of availability of injectable treatments in Africa risks increasing inequalities in HIV care, leaving most people living with HIV without access to treatments that are available in high-income settings."²³