Why in news?
On 19 February 2026 Zimbabwe became one of the first countries to begin administering the long‑acting HIV prevention drug lenacapavir. Health Minister Douglas Mombeshora launched the programme, funded by the U.S. and the Global Fund, targeting more than 46,000 high‑risk individuals at 24 sites across the country.
Background
Lenacapavir is a first‑in‑class HIV‑1 capsid inhibitor developed by Gilead Sciences. Unlike most antiretroviral drugs, which target enzymes such as reverse transcriptase or protease, lenacapavir binds to a pocket on the virus’s capsid (outer protein shell). This disrupts multiple stages of the HIV life cycle, including viral replication, assembly and nuclear import. Because of its unique mechanism, the drug can be administered as a subcutaneous injection only twice a year.
Key features and benefits
- Twice‑yearly dosing: Lenacapavir remains in the body at protective levels for at least six months after injection. This extended half‑life overcomes adherence challenges associated with daily oral pills.
- High efficacy: In phase III trials (PURPOSE 1 and PURPOSE 2), more than 99.9 % of participants receiving lenacapavir did not acquire HIV infection. It showed superiority over daily oral pre‑exposure prophylaxis (PrEP) with tenofovir/emtricitabine.
- Mechanism of action: By binding to the capsid protein, lenacapavir impairs capsid stability, nuclear import of viral DNA and assembly of new virions, resulting in malformed, non‑infectious virus particles.
- Potential to transform prevention: Long‑acting PrEP could increase uptake among populations who find it difficult to adhere to daily or two‑monthly regimens. It may also reduce stigma associated with daily pill taking.
- Zimbabwe’s rollout: The programme will be phased in and aims to help the country maintain its progress toward the UNAIDS 95‑95‑95 targets (95 % of people living with HIV know their status, 95 % of those diagnosed receive treatment, and 95 % of those on treatment achieve viral suppression).
Challenges and considerations
- Access and cost: Lenacapavir is currently approved for PrEP in the United States (under the brand name Yeztugo) and is undergoing regulatory review elsewhere. Ensuring affordable access in low‑ and middle‑income countries will require financing mechanisms and manufacturing partnerships.
- Clinical infrastructure: Delivering injections every six months demands reliable supply chains and trained healthcare workers. Systems must also monitor patients for rare side effects such as injection‑site reactions.
- Resistance: Although rare, resistance mutations may arise if injections are delayed or if individuals acquire HIV during the dosing interval. Ongoing surveillance and adherence to testing protocols before each injection are essential.
Conclusion
The rollout of lenacapavir in Zimbabwe marks a milestone in HIV prevention. By combining novel pharmacology with a public health commitment to reach high‑risk groups, this long‑acting injection offers hope for reducing new infections. Effective implementation and equitable access will determine whether it fulfils its promise.
Sources: DTE