When aiming to lower the yearly number of infections with HIV, access to different HIV prevention options has been highlighted as making a crucial difference. 

For many decades, and in many countries, the choice was mostly limited to condoms before effective medication was introduced, mainly in Western regions. However, while transmission rates have lessened in countries with access to treatment and education on U=U (Undetectable = Untransmittable), HIV has remained an issue in regions without this privilege.

To combat this, it has now been announced that a generic form of the groundbreaking HIV-prevention drug CAB-LA will be produced in South Africa, hopefully giving the country and continent better access to HIV prevention measures.

CAB-LA is short for ‘long-acting cabotegravir’, which is a form of pre-exposure-prophylaxis (PrEP) that can be injected every two months instead of having to take it every day. 

The pharmaceutical prevents the virus from entering a person’s cells. This reduces the chance of getting infected with HIV through sex to almost zero.

Last year, the drug’s producer ViiV Healthcare faced increased criticism surrounding the low accessibility of the medication, with many celebrities and leading figures in healthcare calling for the price to be lowered. At the end of March this year, the company finally announced that three licences would be granted to produce a generic, non-branded version of the treatment, which is less expensive. 

The licences were sold to Aurobindo, Viatris and Cipla, three different Indian pharmaceutical companies, the last of which has confirmed plans to manufacture the generic drug either in Benoni or Durban, both of which are cities in South Africa.

With ViiV’s branded product selling at about $3,500 (€3,243) for one injection in the US and subsequently being out of reach for poorer countries, ViiV giving up its monopoly on producing CAB-LA gives hope for more affordable treatment. 

The Food and Drug Administration, the medicine regulator in the US, estimates that the price of a drug is cut by 39% even if only one generic manufacturer enters the market compared to the price when there is only one branded option available.

But the licence to produce generic medicines is only the first step in making the treatment truly accessible.

The reality is that, especially on the African continent, less than 40% of the needed medicines can be produced locally, with only 38 countries being estimated to have any drug manufacturers at all. 

Adding to that, “CAB-LA is a sterile, injectable product with a very complex manufacturing process,” ViiV Healthcare’s Head of Research and Development Kimberly Smith told Bhekisisa, a health journalism centre, last year. 

This mostly means that anyone wanting to produce a generic version of the medication has to learn the manufacturing process before being able to do so, which can take a significant amount of time. Therefore, it may be a while before Cipla will be able to actually bring the generic version of CAB-LA to the South African market. According to Bhekisisa, it could take three to five years until the generics will be ready to be sold. 

However, Esteban Burrone, the Medicines Patent Pool’s Head of Policy, assured that when selling licences, they “zoomed in on the three manufacturers who are most ready” to address demand rapidly.