Seven months after Rwanda introduced injectable PrEP, a preventive drug for people without HIV, health officials report that the programme is moving forward though access is still limited to just two health centres in Kigali.

Currently, the oral PrEP is the primary HIV prevention method in Rwanda and it is offered for free at all public health facilities, along with counselling to support consistent use.

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The pre-exposure prophylaxis (PrEP) injectable, called cabotegravir, which is administered once every two months, was launched in January this year, as part of efforts to prevent HIV infection among people at substantial risk. Currently, it is only available at Busanza and Gikondo health centres in Kicukiro District.

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"Enrollment has been slow because services are restricted to just two facilities, and we are still assessing the programme before we expand," said Dr Zephanie Nzeyimana, the HIV Key Population Strategic Officer at Rwanda Biomedical Centre (RBC).

"The pilot is expected to run for a full year. During this period, health workers are monitoring uptake, adherence, and any side effects to determine whether the injectable should be scaled up nationally or remain a complementary option to oral PrEP."

Dr Nzeyimana said that 90 people have received the injection and feedback has been positive, as most of them said taking the drug every two months is more manageable than taking a pill every day.

The programme focuses on groups considered to be at higher risk, such as men who have sex with men, female sex workers, adolescent girls and young women, and HIV-negative partners of people living with HIV.

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The official noted that 15,525 people were using PrEP nationally as of June 30. Despite the availability of oral PrEP, uptake is inconsistent.

"Limited awareness, stigma, and inconsistent engagement with healthcare, often linked to substance use or unstable living conditions, have hindered PrEP uptake," he said. "The injectable was introduced to address these barriers by offering a discreet, easier-to-manage alternative to daily pills.”

Although the injectable is available to anyone in the country, distance makes access difficult for many. It’s not practical to expect someone from a rural area to travel all the way to Kigali just for an injection. If the service is offered closer to where people live, more will use it, he explained.

How manageable are side effects?

While global studies have reported side effects like fever, headache, and diarrhea, in Rwanda, clients have only experienced pain at the injection site, Dr. Nzeyimana said.

He added that the most commonly reported side effect is pain at the injection site, usually lasting up to three days after the injection.

He advised users to manage the pain with painkillers such as paracetamol or ibuprofen, noting that those who didn’t take the recommended medication might have worse discomfort.

"Only one person has stopped using injectable PrEP because of pain, and a few others have decided to go back to oral PrEP," Dr Nzeyimana said. "While some participants have missed follow-up appointments, most are coming back for their scheduled injections.”

The Ministry of Health plans to expand the programme to additional facilities within the next one to three months. They are taking a measured approach to assess its effectiveness before moving to a nationwide rollout.

Young people face specific challenges in accessing injectable PrEP. Even when the service is available, stigma and misinformation can discourage them from using it. Dr Nzeyimana noted that negative experiences shared among peers, such as pain after the injection, may deter others from trying this prevention method.

A 2019 survey by RBC, called the Rwanda Population-based HIV Impact Assessment (RPHIA), found that approximately 5,400 new cases of HIV are reported annually among adults in the country. The prevalence of HIV among adults in Rwanda was 3 per cent.

According to the Ministry of Health, Rwanda has recorded a 76 per cent reduction in HIV incidence over the past 15 years. The country has also successfully met the UNAIDS 95-95-95 targets, which aim to ensure that 95 per cent of people living with HIV know their status, 95 per cent of those diagnosed receive antiretroviral therapy (ART), and 95 per cent of those on treatment achieve viral suppression by 2030.