Potential impact and cost-effectiveness of long-acting injectable lenacapavir plus cabotegravir as HIV treatment in Africa

Andrew Phillips (), Jennifer Smith, Loveleen Bansi-Matharu, Kenly Sikwese, Cissy Kityo, Charles Flexner, Marco Vitoria, Nathan Ford, Meg Doherty, Zack Panos, David Ripin, Matthew Hickey, Diane Havlir, Monica Gandhi, Michael Reid and Paul Revill
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Andrew Phillips: University College London
Jennifer Smith: University College London
Loveleen Bansi-Matharu: University College London
Kenly Sikwese: AfroCAB
Cissy Kityo: Joint Clinical Research Centre
Charles Flexner: Johns Hopkins University School of Medicine
Marco Vitoria: WHO
Nathan Ford: WHO
Meg Doherty: WHO
Zack Panos: Children’s Investment Fund Foundation
David Ripin: Clinton Health Access Initiative
Matthew Hickey: University of California San Francisco
Diane Havlir: University of California San Francisco
Monica Gandhi: University of California San Francisco
Michael Reid: University of California San Francisco
Paul Revill: University of York

Nature Communications, 2025, vol. 16, issue 1, 1-13

Abstract: Abstract Although viral suppression is attained for most adults living with diagnosed HIV in East, Central, Southern and West Africa (ECSWA), challenges remain with sustained adherence to daily oral pill taking for some in the population. Here, we evaluate the potential effectiveness and cost-effectiveness of introduction of a new combination of long-acting injectable drugs of lenacapavir + cabotegravir to increase levels of sustained viral suppression. We find there is potential for a significant impact on HIV deaths and disability adjusted life years, including due to a decrease in mother to child transmission. If lenacapavir + cabotegravir can be sourced at a cost of around $ 80 per year or less, our analysis suggests there is potential for a policy to introduce it to be cost-effective in settings in ECSWA. Recognising the limitations of a modelling study, we suggest that implementation studies be conducted to confirm the viability of these approaches.

Date: 2025
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DOI: 10.1038/s41467-025-60752-y

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