Uganda's new injectable HIV prevention drug shows promise but rollout stalls amid cost and supply woes

Lenacapavir, a long-acting injectable marketed for HIV pre-exposure prophylaxis, delivered unprecedented protection in the PURPOSE 1 trial involving nearly 4,200 Ugandan women, with zero infections after participants switched from placebo. Administered twice a year, the drug seeks to solve daily-pill adherence problems. Uganda's Ministry of Health obtained its first shipment of almost 20,000 doses in February and started distribution in April, but the initial rollout excluded high-risk districts such as Kalangala and supplied only 60 courses to a clinic in Kasensero.

Supply uncertainty, a $28,000 list price for two injections, and Gilead's centralized procurement have drawn criticism, while a generic version priced at $40 per patient is expected in 2027. Reduced U.S. aid has also thinned the HIV workforce, complicating outreach and monitoring. Despite challenges, about 980 Ugandans have begun the regimen, and the U.S. State Department pledges millions of doses worldwide, though demand far outstrips current availability.