Lenacapavir Injections Roll Out in Zambia, Promise Hope Amid Funding Challenges

On a humid March morning, newly trained student recruiters streamed into the sprawling green campus of the University of Zambia, navigating a flurry of paperwork, laundry, and instant noodles to reach classmates ready for a quick health offer.

“Come with me right now for an injection that will protect you from HIV for six months. It takes two minutes and it’s free!” the recruits urged.

The initiative aimed to deploy lenacapavir, a cutting‑edge pre‑exposure prophylaxis (PrEP) that, according to clinical trials released in 2024, provides 100% protection for patients receiving biannual injections. The drug is now being introduced into sub‑Saharan Africa, with Zambia among the first recipients.

The rollout unfolded inside a cramped clinic room where students received two injections around the navel and a small course of tablets. The scene underscored a stark reality: Zambia’s HIV program, once supported by nearly $400 million annually through PEPFAR, has been severely hampered by cuts under the Trump administration. Although the Biden administration has reaffirmed and expanded its investment—adding enough funding to supply three million doses by 2028—local health infrastructure remains fragile.

“This is a chance to bend the epidemic curve,” said Jeremy Lewin, the State Department’s senior foreign aid official. “Lenacapavir could be pivotal in ending the epidemic.” Yet the country’s health system faces shortages in personnel, testing capacity, record‑keeping, and even clean water at key maternal health centers.

Gilead Sciences markets the drug at over $25,000 per patient per year in the U.S., but has licensed generics that will supply it in the U.S. and low‑income countries at about $40 per person per year by 2027. In the interim, Gilead sells lenacapavir at a no‑profit price of roughly $100 per patient per year.

In late 2023, Zambia began offering lenacapavir to women at the national teaching hospital’s maternal clinic in Lusaka. Nurses there explained the injection while paperwork for routine prenatal care progressed. Many women, including 19‑year‑old Mavis Mwanza—one of the early recipients—expressed enthusiasm, noting the convenience of a single injection that covers six months of protection.

Glenda Malyangu, nurse manager at the clinic, highlighted the advantage of lenacapavir’s discreetness. “It works for the women we serve because it requires no daily pill and no discussion with a partner,” she said. “They can think about HIV risk for half a year.” However, staff shortages—reduced by two‑thirds after U.S. funding cuts—complicate delivery, as does the lack of reliable water for patients to swallow accompanying tablets.

With over 1.4 million people living with HIV in Zambia, the introduction of a novel prophylaxis tool must be paired with robust testing, education, and follow‑up systems. “We need new partnerships, funding, and resources,” Dr. Lloyd Mulenga, head of the national HIV program, emphasized. “Lenacapavir must reach every corner of the country, including those who never visit a clinic.”

The university event itself faced logistical hurdles. A missing authorization document delayed staffing, resulting in students churned in and out of the injection room without formal records. No electronic system was in place, hampering future dose scheduling. Several participants, like 22‑year‑old Esther Banda, left without clear guidance on how to secure their six‑month follow‑up.

While lenacapavir offers a promising, free prophylactic option, its success in Zambia hinges on overcoming systemic challenges—financing, infrastructure, supply chain, and patient tracking—before it can fulfill its potential to curb new HIV infections across the nation.

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