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CORDIS

Pragmatic use of long-acting Oral Antiretrovirals in Africa

Project description

Measuring the impact of oral HIV therapy in sub-Saharan Africa

Nearly 40 million people worldwide live with HIV, yet viral suppression remains below the UNAIDS target of 95 %. Daily oral antiretroviral therapy can be difficult to maintain, often leading to treatment failure. A new weekly regimen combining lenacapavir and islatravir (LEN + ISL LA) offers promising results. The EU-funded POA project aims to roll out an open-label trial in Côte d’Ivoire, Kenya, Uganda, and Zimbabwe. Participants aged 18 and older will be randomly assigned to switch to the long-acting injectable LEN + ISL or continue standard care. The project will assess the rollout of oral long-acting ART, pharmacokinetics, adherence, and health economics to inform policy.

Objective

Despite tremendous/significant efforts to expand access to antiretroviral therapy (ART), in 2023 there were still 1.3 million new HIV infections worldwide and 630,00 HIV/AIDS-related deaths. There are 39.9 million people living with HIV worldwide (PLWH), and viral suppression rates for those on ART are below the UNAIDS target of 95%. Current ART guidelines recommend lifelong daily oral therapy which can be burdensome, and incomplete adherence risks treatment failure. Injectable long-acting (LA) ART formulations reduce the burden of taking tablets daily and could simplify adherence but are associated with implementation challenges in many settings. A novel regimen of weekly oral lenacapavir and Islatravir (LEN + ISL LA) has successfully completed phase II studies in the United States and could offer an LA treatment solution which is easier, both for individual patients and programmatic roll-out. However, no LEN + ISL LA trials have been conducted in sub-Saharan Africa, where 75% of PLWH live.

We will conduct a phase III parallel-group, open-label, multi-country, multi-centre multi-country randomised, controlled trial in Uganda, Kenya, Côte d'Ivoire, and Zimbabwe. PLWH who are aged ≥18 years and virologically suppressed on daily oral first line ART (tenofovir, lamivudine, and dolutegravir) will be randomised to switch to LEN + ISL LA or remain on standard of care treatment. The primary outcome will be comparison of ongoing viral suppression rates between study arms at 48 weeks. We we will also use mixed Implementation Science methods to explore strategies, barriers, and facilitators for broader roll-out of oral LA ART, describe the overall pharmacokinetic profile of our new drugs across our study countries including some subpopulations, validate a urine assay for monitoring adherence, and carry out health economics evaluations to inform health policies. The project will be implemented by co-leads on each work packages to allow for capacity development.

Fields of science (EuroSciVoc)

Keywords

Programme(s)

Topic(s)

Funding Scheme

HORIZON-JU-RIA - HORIZON JU Research and Innovation Actions

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Call for proposal

(opens in new window) HORIZON-JU-GH-EDCTP3-2024-01-two-stage

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Coordinator

THE UNIVERSITY COURT OF THE UNIVERSITY OF ST ANDREWS
Net EU contribution
€ 601 861,25
Address
NORTH STREET 66 COLLEGE GATE
KY16 9AJ ST ANDREWS
United Kingdom
Region
Scotland Eastern Scotland Clackmannanshire and Fife
Activity type
Higher or Secondary Education Establishments
Links
Total cost
€ 601 861,25

Participants (6)