Despite a discounted offer, South Africa is unable to finance the cost of a new medication for HIV due to financial constraints.

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

ViiV Healthcare, a pharmaceutical company in the UK, has reduced the cost of their shots from 729 rand to a range of 540-570 rand, equivalent to £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 affected by HIV, making it the country with the highest HIV epidemic globally. More than 13% of the population has been diagnosed with the virus.

The cost of CAB-LA in non-profit organizations is significantly lower compared to the US. In the US, a single shot costs around $3,700 (£2,975), while in South Africa, the health department only pays £2.85 for a month’s supply of a daily HIV prevention pill for each patient. This is four times less than the cost of CAB-LA.

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 that of oral PrEP (the daily pill), which costs 129 rand (£5.68) for a two-month supply. With budget cuts affecting our department, we cannot afford to pay significantly more for CAB-LA.

Jamaloodien added, “Additionally, ViiV’s non-profit price does not cover distribution expenses, resulting in a further increase from the already stated 540 to 570 rand per vial.”

A strategy for circumventing the expensive cost of CAB-LA is to permit contributions from donors like the US government’s President’s Emergency Plan for Aids Relief (Pepfar). Pepfar has been the top contributor among government donors for antiretroviral treatment in Africa and also supports oral PrEP in various African nations.

ViiV has already delivered supplies sponsored by Pepfar to Malawi, Zambia, and Zimbabwe, with an estimated arrival in late November. According to Mitchell Warren from the Coalition to Accelerate Access to Long-Acting PrEP, Malawi is expected to receive 10,000 doses between 2023 and 2025, while Zimbabwe is expected to receive between 10,000 and 12,000 doses and Zambia between 8,000 and 10,000 doses.

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

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 on donations could result in the discontinuation of the rollout if the funding runs out. In regards to HIV treatment, South Africa covers the cost of its own antiretroviral medication.

Jamaloodien stated that while they will not outright reject it, they must also consider its sustainability.

In March, ViiV granted licenses to three Indian pharmaceutical companies to manufacture affordable, generic forms of CAB-LA in partnership with the Medicines Patent Pool, a United Nations-supported group that aids developing nations in obtaining medication. Cipla, one of the companies involved, intends to produce the drug at its Durban facility.

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

However, Cipla must first establish the necessary technology, construct facilities, and conduct trials to demonstrate that their product functions similarly to the branded version.

Warren stated that generic versions will not be accessible before 2027, at the soonest.

Warren stated that ViiV predicts a potential decrease in price as volume increases and they receive orders from major purchasers like Pepfar, the Global Fund, and the South African government. They anticipate the branded product to cost around $100 or $120 for a year’s worth of injections in the next few years, compared to its current price of $175.

The department stated that the proposed price would be more than twice the cost of the daily HIV prevention pill, making it unaffordable for the South African government and not considered cost-effective.

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