Experts warn access barriers could limit South Africa’s Lenacapavir rollout

South Africa’s national rollout of Lenacapavir the world’s first twice-yearly injectable for HIV prevention could fail to reach the people who need it most unless longstanding access barriers are addressed, public health experts said during a webinar hosted by the Rural Health Advocacy Project (RHAP).

Rollout details and priority groups

South Africa officially launched the Lenacapavir rollout on June 5. Implementation has begun at selected health facilities in the Western Cape, with the initial programme prioritising adolescent girls and young women, sex workers, men who have sex with men, and transgender people.

Experts call for community-based delivery

Jacqueline Pina, a psychologist and public health specialist supporting the National Department of Health’s rollout, said clinical trials show the medicine is effective but that the main challenge is ensuring equitable access.

“What we do know from clinical trials is Lenacapavir is incredibly effective,”

Pina warned that a clinic-based model risks excluding key populations who often avoid facilities because of stigma, discrimination and humiliation. She urged that Lenacapavir be made available through community organisations, mobile outreach teams, pharmacies, and youth-friendly services, arguing prevention should be taken to where people live, study and work.

“The question is not simply, can we stock Lenacapavir? A more important way of phrasing this is: can we reach people who need it? Are we reaching adolescent girls and young women, men who have sex with men, transgender people, and female sex workers who generally do not go to facilities because of stigma, discrimination, and humiliation?”

Pina also cautioned against repeating mistakes from the oral PrEP rollout, saying limited awareness campaigns and group-targeted messaging had fuelled stigma.

“If it’s inconvenient for them to get it, they’re not sick. They’re simply just not going to go.”

Measuring success beyond doses given

Dr Zoe Duby, a senior scientist at the South African Medical Research Council and honorary research associate at the University of Cape Town, said the programme’s success depends on whether services become more accessible and acceptable to high-risk groups.

“Our work with young women shows that the judgement they feel in clinics, gossip, rumours, fear about disclosure and service inconvenience will all affect whether a young woman can use HIV prevention consistently,”

Duby said success should be measured not only by injection numbers but by whether people return for their six-monthly doses and remain protected during their most vulnerable periods.

Rural realities and engaging men

University of the Western Cape Associate Professor Sakumzi Mkhize-Kaane said the rollout must account for rural realities, including transport challenges, cultural norms and limited healthcare access that affect how men engage with prevention services.

“We need to meet men where they are, not just men but communities broadly,”

Mkhize-Kaane argued that programmes designed without understanding local contexts are unlikely to reach their full impact.

Delivery model as the key innovation

Speakers at the RHAP webinar framed the major innovation not only as the injectable itself but how the health system chooses to deliver it. They warned the biggest risk would be successfully rolling out the medicine while failing to transform service delivery to make prevention accessible and acceptable to the populations most at risk.