By John Mutiso
A new study conducted across three African countries has found that an injectable HIV treatment—Cabotegravir/Rilpivirine (CAB LA + RPV LA), administered every two months—is safe, well tolerated, and preferred by most patients.
The Month-12 results, drawn from study sites in Kenya, Uganda, and South Africa, offer renewed hope for improved treatment adherence, fewer HIV-related deaths, and better overall quality of life for people living with HIV.
The IMPALA study, a 24-month randomized controlled trial, was carried out in partnership with the Medical Research Council and the Uganda Virus Research Institute, which served as the coordinating center.
It was sponsored by the London School of Hygiene & Tropical Medicine and funded by the Janssen Pharmaceutical Companies of Johnson & Johnson.
Dr. Loice Ombajo, an infectious disease specialist and co-director at the Center for Epidemiological Modelling and Analysis (CEMA) at the University of Nairobi, and the study’s principal investigator for Kenya, emphasized the significance of the findings.
“Many HIV patients in Africa struggle with taking multiple drugs, stigma, and side effects, which can make it difficult to stay on treatment and may eventually lead to resistance and treatment failure. Injectable therapy offers a promising solution—by reducing the burden of daily pills, adherence becomes easier, improving quality of life and helping prevent HIV-related deaths,” she said.
Despite significant advances in treatment, the global HIV response remains at a critical crossroads.
WHO estimates that in 2024, 40.8 million people were living with HIV, 1.3 million acquired the virus, and 630,000 died from HIV-related illnesses.
Currently, standard HIV treatment requires a daily pill combining three or four medicines that work together to suppress the virus.
This regimen includes Dolutegravir (DTG), recommended by WHO in 2016 for its fewer side effects, reduced drug interactions, and strong resistance barrier.
While the once-daily pill transformed HIV treatment and remains Kenya’s first-line regimen, daily adherence continues to be a major challenge—especially among adolescents, young adults, and marginalized groups.
These adherence barriers contribute to increased hospitalizations, higher healthcare costs, and played a role in the 680,000 HIV-related deaths recorded globally in 2022.
UNAIDS aims to achieve the 95-95-95 targets by 2030: 95 per cent of people living with HIV diagnosed, 95 per cent of those diagnosed on treatment, and 95 per cent of those on treatment virally suppressed.
However, by December 2021, only 71 per cent of people living with HIV globally were diagnosed, on treatment, and virally suppressed—falling far short of the target.
To close this gap, researchers have been exploring simpler, more flexible treatment options. Long-acting injectable HIV therapy has emerged as one of the most promising solutions.
The IMPALA study focused on adults whose viral load had remained unsuppressed for two years despite prior antiretroviral therapy (ART), indicating a history of adherence challenges. The goal was to determine whether CAB LA + RPV LA could work effectively for this group in sub-Saharan Africa.
Findings show that the injectable regimen was non-inferior to the standard oral dolutegravir-based therapy (TLD) among patients who had previously struggled with adherence.
In practical terms, the injectables worked at least as well as the daily pill—while significantly reducing the burden of daily medication.
“These results show that transformation is not only possible—it’s within reach. Long-acting injectables offer a real opportunity to accelerate progress toward the UNAIDS 95-95-95 targets and help people living with HIV lead longer, healthier lives,” Dr. Ombajo said.
“This year’s World AIDS Day theme—‘Overcoming Disruption, Transforming the AIDS Response’—calls on all of us to remain united and focused. Studies like IMPALA show how innovation can re-energize the HIV response and ensure that no one is left behind.”
