Implementation of long-acting injectable cabotegravir for PrEP in Brazil with Beatriz Grinsztejn

Regarding your study, the IMPREP CAP Brazil that focuses on implementation of HIV prevention or ALPREP, and maybe more importantly in this case, long-acting cabotegravir.

So to start, what is long-acting cabotegravir and where does it currently fit into Brazil's prevention programs, HIV prevention programs?

Yes, so long-acting cabotegravir or CABLA is an injectable antihetroviral drug used for HIV pre-exposure prophylaxis or PrEP.

It can also be used for treatment, of course.

Cabotegravir is an integrase transfer inhibitor or INSTI.

It works by blocking HIV integrase, an enzyme the virus needs to integrate its genetic material into human cells and establish the infection.

The long-acting formulation is given as a deep intramuscular injection.

After the initial dose, we give a second dose 30 days after, and then injections are administered every two months, providing sustained protection against HIV without the need to take a pill every day or on demand.

So compared with oral PrEP, Kebele offers a very different prevention strategy.

Instead of relying on pill-taking, protection can be maintained with just six injections per year.

And this is particularly relevant in Brazil.

Brazil has a long-standing public HIV prevention program.

and oral PrEP has been available free of charge through our unified health system since 2017.

Access to PrEP has expanded substantially in recent years, but HIV transmission remains an important public health challenge, and the epidemic is not evenly distributed across the population.

According to the latest Brazilian HIV and AIDS epidemiological bulletin, almost 60% of reported HIV cases in 2024 were among black and mixed race people.

And among young men diagnosed with HIV, gay and other MSM, accounted for more than half of cases, around 60% of those aged 13 to 19, and 56% among those aged 20 to 29.

So at the same time, access to PrEP remains quite unequal.

Young people, black Brazilians, transgender women, and other gender diverse persons are still not benefiting from PrEP to the same extent as other groups.

So we have an important prevention gap.

Some of the populations most affected by HIV are also those facing greater barriers to assessing and remaining engaged with existing prevention strategies.

And this is precisely where having additional PrEP options, including long-acting PrEP, could make a real difference.

So back to CAB-LA, it was approved by the Brazilian Regulatory Agency, Anvisa, in 2023, but it's not yet routinely available through our public health system.

More recently, there has been important progress.

In 2026, Conitec, The committee that evaluates new technologies for our public health system issued a preliminary favorable recommendation for its incorporation.

But still, no decision has been made.