SPOTLIGHT: Lenacapavir gains ground as Western Cape uptake passes 3,600

At a mobile clinic in Cape Town’s Philippi Village, 20-year-old Olwam Plaatjie has switched from a two-monthly HIV-prevention injection to lenacapavir, administered every six months. Small nodules formed at the two injection sites on her abdomen, but she says she is delighted with the new medicine.

Plaatjie, who lives in Crossroads, began using cabotegravir three years ago. She said her concerns grew after seeing many HIV-positive people, particularly girls, and because her boyfriend did not want to be tested. “So that’s why I started to have a fear. I was like, you know, maybe there is something he is hiding,” she said.

The Western Cape had recorded 3,641 lenacapavir initiations across 22 government clinics by 23 August, according to national Health Department spokesperson Foster Mohale. The national total stood at 47,934. Supply remains severely constrained, so the injection is being offered at 360 facilities in six provinces. Free State, Limpopo and Northern Cape are not included in the current rollout.

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I see many people who are HIV-positive. Many of them are girls. Guys often don’t even want to be tested; my boyfriend didn’t want to go for HIV tests. So that’s why I started to have a fear. I was like, you know, maybe there is something he is hiding.

Gauteng accounts for more than a third of the participating facilities and KwaZulu-Natal for about a quarter. The Western Cape’s 22 sites represent about 6% of the total. Clinic selection partly reflected performance in providing HIV-prevention pills, which are available at almost all public-sector health facilities.

The three Western Cape clinics with the highest administrations as of 26 August were Khayelitsha Community Health Centre, Michael Mapongwana Community Health Centre and Nolungile Community Health Centre, all in Khayelitsha. Hilary Goeiman of the provincial health department attributed the strong uptake partly to the area’s large population of adolescent girls and young women, who were a priority group in the rollout. She also credited Nolungile’s clinical leadership and integration of lenacapavir into routine prevention services.

Lenacapavir is delivered through two 1.5-millilitre injections in the buttocks, thigh, abdomen or upper arm. Most recipients are women, reflecting the initial focus on adolescent girls and young women, women of reproductive age, and pregnant and breastfeeding women considered at substantial risk.

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Nolungile Community Day Centre has demonstrated strong clinical leadership and effective implementation of the programme, successfully integrating lenacapavir into routine HIV prevention services.