Potential impact and cost-effectiveness of long-acting injectable lenacapavir plus cabotegravir as HIV treatment in Africa

Andrew Phillips; Jennifer Smith; Loveleen Bansi-Matharu; Kenly Sikwese; Cissy Kityo; Charles Flexner; Marco Vitoria; Nathan Ford; Meg Doherty; Zack Panos; David Ripin; Matthew Hickey; Diane Havlir; Monica Gandhi; Michael Reid; Paul Revill

doi:10.1038/s41467-025-60752-y

Potential impact and cost-effectiveness of long-acting injectable lenacapavir plus cabotegravir as HIV treatment in Africa

Andrew Phillips, Jennifer Smith, Loveleen Bansi-Matharu, Kenly Sikwese, Cissy Kityo, Charles Flexner, Marco Vitoria, Nathan Ford, Meg Doherty, Zack Panos, David Ripin, Matthew Hickey, Diane Havlir, Monica Gandhi, Michael Reid, Paul Revill

Centre for Health Economics

Research output: Contribution to journal › Article › peer-review

Abstract

Although viral suppression is attained for most adults living with diagnosed HIV in East, Central, Southern and West Africa (ECSWA), challenges remain with sustained adherence to daily oral pill taking for some in the population. Here, we evaluate the potential effectiveness and cost-effectiveness of introduction of a new combination of long-acting injectable drugs of lenacapavir + cabotegravir to increase levels of sustained viral suppression. We find there is potential for a significant impact on HIV deaths and disability adjusted life years, including due to a decrease in mother to child transmission. If lenacapavir + cabotegravir can be sourced at a cost of around $ 80 per year or less, our analysis suggests there is potential for a policy to introduce it to be cost-effective in settings in ECSWA. Recognising the limitations of a modelling study, we suggest that implementation studies be conducted to confirm the viability of these approaches.

Original language	English
Article number	5760
Number of pages	13
Journal	Nature Communications
Volume	16
Issue number	1
DOIs	https://doi.org/10.1038/s41467-025-60752-y
Publication status	Published - 1 Jul 2025

Bibliographical note

Keywords

Humans
Africa/epidemiology
Anti-HIV Agents/economics
Cost-Benefit Analysis
HIV Infections/drug therapy
HIV-1/drug effects
Infectious Disease Transmission, Vertical/prevention & control
Pyridones/economics
Acetamides
Indazoles
Diketopiperazines

Access to Document

10.1038/s41467-025-60752-yLicence: CC BY

Potential impact and cost-effectiveness of long-acting injectable lenacapavir plus cabotegravir as HIV treatment in Africa
© The Author(s) 2025
Final published version, 1.84 MBLicence: CC BY

Cite this

Phillips, A., Smith, J., Bansi-Matharu, L., Sikwese, K., Kityo, C., Flexner, C., Vitoria, M., Ford, N., Doherty, M., Panos, Z., Ripin, D., Hickey, M., Havlir, D., Gandhi, M., Reid, M., & Revill, P. (2025). Potential impact and cost-effectiveness of long-acting injectable lenacapavir plus cabotegravir as HIV treatment in Africa. Nature Communications, 16(1), Article 5760. https://doi.org/10.1038/s41467-025-60752-y

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abstract = "Although viral suppression is attained for most adults living with diagnosed HIV in East, Central, Southern and West Africa (ECSWA), challenges remain with sustained adherence to daily oral pill taking for some in the population. Here, we evaluate the potential effectiveness and cost-effectiveness of introduction of a new combination of long-acting injectable drugs of lenacapavir + cabotegravir to increase levels of sustained viral suppression. We find there is potential for a significant impact on HIV deaths and disability adjusted life years, including due to a decrease in mother to child transmission. If lenacapavir + cabotegravir can be sourced at a cost of around $ 80 per year or less, our analysis suggests there is potential for a policy to introduce it to be cost-effective in settings in ECSWA. Recognising the limitations of a modelling study, we suggest that implementation studies be conducted to confirm the viability of these approaches.",

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author = "Andrew Phillips and Jennifer Smith and Loveleen Bansi-Matharu and Kenly Sikwese and Cissy Kityo and Charles Flexner and Marco Vitoria and Nathan Ford and Meg Doherty and Zack Panos and David Ripin and Matthew Hickey and Diane Havlir and Monica Gandhi and Michael Reid and Paul Revill",

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Phillips, A, Smith, J, Bansi-Matharu, L, Sikwese, K, Kityo, C, Flexner, C, Vitoria, M, Ford, N, Doherty, M, Panos, Z, Ripin, D, Hickey, M, Havlir, D, Gandhi, M, Reid, M & Revill, P 2025, 'Potential impact and cost-effectiveness of long-acting injectable lenacapavir plus cabotegravir as HIV treatment in Africa', Nature Communications, vol. 16, no. 1, 5760. https://doi.org/10.1038/s41467-025-60752-y

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AU - Kityo, Cissy

AU - Flexner, Charles

AU - Vitoria, Marco

AU - Ford, Nathan

AU - Doherty, Meg

AU - Panos, Zack

AU - Ripin, David

AU - Hickey, Matthew

AU - Havlir, Diane

AU - Gandhi, Monica

AU - Reid, Michael

AU - Revill, Paul

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KW - Infectious Disease Transmission, Vertical/prevention & control

KW - Pyridones/economics

KW - Acetamides

KW - Indazoles

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