How do we increase access to LA formulations: a community perspective
Speaker: Imelda Mahaka, Pangaea Zimbabwe AIDS Trust
The benefits of LA formulations are appealing to communities.
- Designed to address the challenges of taking daily pills: fatigue, stigma, disclosure, hard to reach populations.
- Introduce choice, convenience, privacy and support long term adherence.
Considerations to increase access to LA formulations from a community perspective.
- Community priorities surrounding quality care.
- Responsive to health needs, delivered in an acceptable manner, and results in better health outcomes.
- Safety and ease of access (convenient, timely); affordability (access without financial burden); availability; and continuity of care are important dimensions.
- Leverage broad community engagement in the design, development and roll out of LA formulations and build mechanisms for ongoing participation to assess, adapt, and refine programs.
- Fosters mutual respect, partnership, and accountability.
- Advocates and civil society have actively driven the access agenda for CAB-LA (e.g., AVAC, AFROCAB, African Women Prevention Accountability Community Board, Sisterlove, GBGMC)
- Bring communities and various stakeholders into the discussion early in development (e.g., BIOPIV, Coalition for LA-PrEP, WHO Think Tank, etc.).
- Choice matters – develop LA product options to meet the diverse needs and preferences of PLWH.
- Learn from contraception – increased choice was associated with increased persistence with chosen method; better health outcomes; and increased prevalence of contraceptive use (+12% for each additional method offered).
Understanding community needs and preferences surrounding LA formulations and health care service delivery are key to increase access and uptake.
- Perspectives of PLWH – results from two meetings convened in Africa.
- HIV prevention and treatment advocates in Kampala (CHAI and UNITAID)
- Strong preference for injectables due to privacy and reduced stigma.
- Questions arose about novel technologies, highlighting the need to invest in advocacy and literacy to fill knowledge gaps.
- There were groups that also preferred other methods.
- Peer-led meeting in Rwanda.
- Interested in options that require fewer clinic visits.
- Preferred self-injections and self-administered options to avoid clinic visits.
- LA products viewed as a way to reduce stigma through a more discreet product form.
- HIV prevention and treatment advocates in Kampala (CHAI and UNITAID)
- Differentiated service delivery models (DSD) – lessons from oral PrEP.
- Need for differentiated, simplified, integrated, and de-medicalized service delivery.
- Scale-up DSD models, replicate successful approaches, and prioritize those that help users access and stay on treatment.
- Build on models that have expanded due to COVID-19 (mHealth, multi-month dispensing, HIV self-testing), integrate PrEP and treatment with other services, and include peer/partner support interventions that are community led, accessible and non-discriminatory.
Cost of LA formulations and HIV testing protocols can be a barrier to access, especially in LMICs.
- Policymakers and funders generally make decisions based on cost-effectiveness – the value of choice and reaching new users may be discounted when considering novel formulations.
- Work with organizations to negotiate licensing, patent pooling, and other IP agreements for better pricing – generic manufacturing can reduce price and increase availability of products.
- Guidance on HIV testing protocols should balance safety and feasibility (e.g., impact on cost and feasibility of CAB).
Communities see the value in implementation research.
- Help with real-world programming and can guide funders, policy makers and other key decision makers.
- Communities are eager for earlier inclusion of pregnant and lactating women and adolescents in clinical trials – need a clear path of how to accomplish this.
Conclusions.
- Fill product introduction gaps –
- Communities need accelerated time from approval to introduction to impact.
- Implementation studies to show how to deliver in real life.
- Demand creation and program platforms.
- Differentiated and integrated service delivery for treatment and prevention.
- Fill LA product development gaps.
- Longer acting and event driven.
- User-friendly and developed with users.
- Dual-purpose/multi-purpose methods.
“For choice to become a reality it requires policymakers, researchers, developers, donors – all the stakeholders – to make the mix available, accessible and affordable.”
“We cannot afford siloed conversations if we want to increase access to LA.”