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Long acting HIV PrEP Africa
Long-Acting HIV PrEP mu Sub-Saharan Africa: Njira za Kakhazikitsidwe Kopambana

Released: February 22, 2026

Flavia Matovu Kiweewa
Flavia Matovu Kiweewa, MBChB, MSc., PhD
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Key Takeaways
  • Kutsatira PrEP yapakamwa tsiku ndi tsiku kukupitirizabe kukhala kovuta mu Africa, makamaka pakati pa amayi achichepere.
  • Long-acting PrEP imapereka njira yatsopano yothanirana ndi zolepheretsa kutsata komanso kulimbikira.
  • Kukhazikitsa moyenera kwa long-acting PrEP kudzafuna akatswiri ndi mabungwe azachipatala kuti athetse mipata yayikulu pakusamalira.

Pre-exposure prophylaxis (PrEP) imagwira ntchito, koma pokhapokha ngati anthu angakwanitse kuitsatira. Ndikufuna kugawana nanu nkhani ya munthu wina, yomwe imasonyeza momwe ubale wa munthu ndi PrEP ungasinthire pakapita nthawi.

M’tauni yotakasuka ya Entebbe, kumene mphepo yochokera ku Nyanja ya Victoria imatulutsa fungo la mvula ndi nthaka mumakhala Peter (osati mayina enieni), mwamuna wazaka 36 amene amagonana ndi amuna anzake. Peter pano akugwira ntchito yophunzitsa anthu ngati iyeyo pa Most-At-Risk-Populations Clinic ku Mulago. Atapita ku wekishopu ya zaumoyo kumapeto kwa chaka cha 2017, mwadzidzidzi nkhawa inamugwira. Anazindikira kuti moyo wake ukufunika chitetezo ku HIV. Anayamba kumwa mapiritsi a tsiku ndi tsiku, koma sizinali chifukwa chopatsidwa mphamvu; zinali zochokera mu mantha aakulu..

Peter anagwira botolo laling'ono m'manja mwake, ndipo botolo lapulasitikilo limazizirira pachikhatho chake. Mkati mwake munali mapiritsi a buluu 30, lonjezo la mwezi ndi mwezi la chitetezo lotchedwa PrEP. Amadziwa kuti mwambo wa tsiku ndi tsiku uwu unali chisankho chanzeru pa thanzi lake, koma pamene ankayika botololo m'kabati yake yamankhwala, anachita mantha. Iye anada nkhawa kuti anzake angaganize chiyani akaliwona, kapena kuti anthu azimuti ndani. Kwa Peter, botolo linkamudetsa nkhawa kwambiri kuposa momwe limawonekera.

Kumwa piritsi tsiku lililonse kunayamba kukhala chipsinjo. M'mawa uliwonse, phokoso la botolo linkamveka ngati tcheni. Linali chikumbutso chosalekeza cha chiwopsezo ndi chipsinjo zimene zimamumvekera ngati wanyamula katundu wolemetsa. Peter anaona kuti watsekeredwa ndi ndondomekoyi, maganizo ake nthawi zonse ankangokhalira kukabati yosungiramo mankhwala.

Pamene masabata anasanduka miyezi, kulemera kwa ndondomekoyi kunayamba kupepuka, ndipo maganizo a Peter anayamba kukhala m’malo. Mausiku amene ankakhala kunja mochedwa kapena mathero a sabata amene amapumula, mapiritsiwo ankakhala m’kabati. "Sindikukumana ndi aliyense pakadali pano," amadziuza yekha, "moyoy wanga suli pachiwopsezo chilichose." Chizoloŵezi cha tsiku ndi tsiku chinayamba kutha pamene anadzitsimikizira kuti chitetezo chinali chofunikira pokhapo pamene akuona "kuti ali pachiopsezo," osati ngati chishango chokhazikika.

Kumasuka kumeneko nthawi zambiri kunkatha pambuyo pa usiku wina wosatsimikizika, wodzikayikira. Mwadzidzidzi, "chiwopsezo chochepa" chomwe ankachidalira chija chinakhala ngati galasi losalimba. Mantha analoŵa m’malo mwa kusalabadira kwake. Peter ankapita kwa dokotala wake kuti akamuthandize kupewa matenda pakulandira post-exposure prophylaxis (PEP). Pambuyo pake anayamba kuyika ma alarm atatu mosiyanasiyana pa foni yake, kuthamangira kunyumba ngati wayiwala mlingo wake wa PrEP. Kulimbana ndi kumwa mapiritsi tsiku ndi tsiku sikunalinso chifukwa chodzisamalira; anali kuchita izi chifukwa cha nkhawa yochuluka yoti akhoza kutenga kachilombo ka HIV yomwe inkamveka kumbuyo kwa malingaliro ake.

Atatopa ndi kuvutika m’maganizo, Peter anaganiza zopita kuchipatala. Anakumana ndi Dr Aris, dokotala wachifundo yemwe anamvetsera popanda kuweruza. "Piritsi la tsiku ndi tsiku ndi chida chachikulu, Peter," Dr Aris anatero modekha, "koma ngati likukuvutitsani kwambiri, tili ndi njira zina zokutetezerani. Zaumoyo ziyenera kugwirizana ndi moyo wanu, osati mwanjira ina."

Dr Aris anapereka lingaliro la "on-demand" PrEP, nthawi zambiri limatchedwa njira ya 2-1-1. Izi zikutanthauza kuti Peter amafunika kungomwa mapiritsi pa nthawi yokhayo imene akudziwa kuti afunika chitetezo; 2 zisanachitike, 1 zitachitika ndi 1 inanso tsiku lotsatira. Peter anasangalala ndi zoti sazifunikira  kukumbutsidwa tsiku lililonse kuti amwe mapiritsi. Kwa kanthawi ndithu, imeneyi inaoneka ngati njira yabwino kwambiri ndipo ankamva kuti ali ndi mphamvu yochita zinthu momasuka popanda kupanikizika ndi botolo lija.

Ngakhale njira ya on-demand imagwira ntchito kwa ena, Peter anapeza kuti nthawiyo ndi yovuta kuyikwanitsa ndipo sanakhulupirire kuti njira iyi inali yokwanira kumutetezera. Ankafuna njira ina yosavuta, yomwe siyinkafuna kuti azichita masamu kapena kusunga mapiritsi.

Madzulo a tsiku lina, paulendo wake wachizolowezi wodzatenganso mankhwala a PrEP, Dr Aris anauza Peter za njira yatsopano: jakisoni wa PrEP wotchedwa cabotegravir. "Ndi jakisoni m’modzi m’miyezi iwiri iliyonse," anatero modekha mtima. "Palibe mapiritsi a tsiku ndi tsiku, palibe kuwerengera maola. Kungokhala chitetezo chokhalitsa."

Peter anaganiza zosintha. Mchipinda choyezeramo mwakachetechete, Dr Aris anakonza jakisoni. Kunali kubaya kofulumira, kopweteka mu mnofu wake, mu masekondi pang'ono chabe. "Zatheka basi," Dr Aris anatero, akutaya singanoyo. "Mwatetezedwa kwa miyezi iwiri ikubwerayi." Peter anasangalala kwambiri. Kwa nthawi yoyamba m’chaka chimodzi, sanade nkhawa ndi botolo la mapiritsi kapena chowerengera nthawi.

M’maŵa mwake, Peter anamva kupweteka kwa mbola. Mnofu wake unali kumuwawa, zomwe zimamupangitsa kuti azitsinimphira pang'ono popita kukhitchini. Madzulo a tsiku limenelo, mutu unkamupweteka kuseri kwa maso ake. Anakhala pakama wake, akumva kukhumudwa pang'ono, ndikudabwa ngati njira yatsopanoyi ikukhala yovuta ngati yoyamba. "Kodi izi ndizabwino kuposa mapiritsi?" Analingalira, uku akudzithowa ndi nsalu yozizirira pamphumi pake. Anafikira kuchipatala, ndipo Dr Aris anamutsimikizira kuti zotsatirazi zinali zofala ndipo nthawi zambiri zimakhala zosakhalitsa.

Mogwirizana ndi mawu a dokotala, kusowetsa mtendere kuja kunazimiririka m’masiku oŵerengeka, ndipo kwa nthaŵi yoyamba m’zaka zambiri, chipsinjo cha kumwa mapiritsi chinatha, m’malo mwake anayamba kudzidalira ndipo zimenezi zinkaonekera mmene ankachitira zinthu zatsiku ndi tsiku pa moyo wake. Pofika nthawi yomwe Peter anakakumana naye kachiwiri patatha miyezi iwiri, malo obayidwa aja sanapweteke kwambiri ngati poyamba paja, ndipo mutu sunamupwetekeso. Peter anazindikira kuti sanaganizirepo za HIV kapena ndondomeko ya mapiritsi kwa milungu ingapo. Chizoloŵezi cha "kubaya" chinakhala chophweka, kamodzi pa miyezi iwiri, sichinakhale chovuta kuposa kumetetsa tsitsi kapena kupita kwa dokotala wa mano.

Tsopano, Peter akuyenda m'mphepete mwa Nyanja ya Victoria mopepukidwa momwe sanamveko chiyambire pomwe anagwira botolo lamapiritsi abuluu. Chitetezo chake ndi chosawoneka, chobisika m'thupi lake m'malo mokhala pashelefu. Anazindikira kuti kusamalira thanzi nthawi zonse sikophweka, koma pamafunika kulankhulapo maganizo ako ndikuwunika njira zoti usankhe, pamapeto pake anapeza njira yomwe inamuyendera bwino. Iye sankachitanso zinthu mopanikizika chifukwa cha piritsi; iye anali Peter basi, kukhala moyo wake mokwanira. Iye akuyembekezera mwachidwi njira yatsopano yobaya jakisoni yomwe imangofunika kuti upite ku chipatala kawiri m'malo mwa ka 6 pachaka. Uwu udzakhala ufulu womaliza, opanda mabotolo a tsiku ndi tsiku, opanda kuganiza kwambiri za njira ya 2-1-1 on-demand, komanso maulendo ochepa opita ku chipatala! Moyo wotetezedwa umene udzamulola kukonda, kukhala ndi moyo, ndi kupuma mpweya wa Entebbe ndi mtima wampumulo.

Ulendo wa Peter ukutsindika chowonadi chenicheni pa kapewedwe ka HIV: kuchita bwino pamapepala sikumatanthauza kuchita bwino m’kachitiro. Kumwa mapiritsi tsiku lililonse a PrEP kwathandiza kapewedwe ka HIV padziko lonse lapansi. Komabe, kupambana kwake kumadalira kutsatira dongosolo moyenerera ndi mosalekeza —vuto lomwe likupitirirabe m'madera ambiri a ku Africa, makamaka pakati pa amayi achichepere.

Anthu ambiri akhala akupanga malipoti kuti kumwa mapiritsi a tsiku ndi tsiku kumakhala kolemetsa komanso kochititsa manyazi, poganizira njira zomwe zimagwiritsidwa ntchito pochiza kachilombo ka HIV zimagwiritsidwanso ntchito popewa. “Kodi ndingamutsimikizire bwanji neba wanga, yemwe ali ndi kachilombo ka HIV, kuti ndilibe kachilombo pomwe tikumwa mankhwala ofanana, ndikukawatenga kuchipatala kofanana komweko?” anafunsa mayi wina wachichepere, amene anasiya kumwa PrEP yake ya tsiku ndi tsiku chifukwa chakusowa kwachinsinsi.

Mavuto ena aang'ono kuphatikizapo zinthu zina zokhudza moyo ngati kuyenda kwambiri zachititsa kuti anthu asiye kutsatira kumwa PrEP mwandondomeko. Zolepheretsa izi zimapangitsa kuti anthu azisiya kwambiri zomwe nthawi zambiri zimapangika chifukwa chakuona kuti chiwopsezo ndi chochepa, mavuto akapangidwe ka zinthu (mwachitsanzo, mtunda wautali kuti ukafike ku zipatala), ndi zifukwa zamaganizo, monga kuopa kuwululika kapena kutsutsidwa ndi mnzanu. Izi zitha kupangitsa kuti pakhale kutsika kwambiri kwa chiwerengero cha anthu otenga nawo mbali komanso kuwonongetsa ndalama zapulogalamu.

Mu Africa, kumwa komanso kupitirizabe ndi PrEP yamapiritsi tsiku ndi tsiku kwatsika kwambiri zedi. Malinga ndi kafukufuku wochokera ku Unduna wa Zaumoyo ku Uganda, mwa anthu 10 aliwonse amene amayamba kutenga PrEP ya HIV, awiri okha amapitirizabe kulandira chithandizo chaka chimodzi.

Lowani Long-Acting PrEP
Njira zina za long-acting HIV PrEP —jakisoni wa cabotegravir yemwe munthu amabayidwa pa miyezi iwiri iliyonse komanso jakisoni wa lenacapavir yemwe munthu amabayidwa pa miyezi 6 iliyonse—zimapereka chitetezo chodalilika. Izi sizimangokhala njira zothandizira thupi zogwira mtima, ndi zida zomwe zingathandize kutukula miyoyo. Njira zatsopanozi mu HIV PrEP, kuphatikiza zina zomwe zikubwera (mwachitsanzo, MK-8527, mapiritsi a pamwezi), zikuthana ndi vuto lalikulu lomwe limalepheretsa anthu kutsatira njira ya PrEP yomwa mapilitsi tsiku ndi tsiku. Zidzathandiza kuthetsa chipsinjo chomwa mapiritsi a tsiku ndi tsiku, kuchepetsa kufunika kwa kumwa mankhwala kunyumba moti ena angaone—ndipo, motero, manyazi okhudzana ndikumwa mankhwalawo—komanso kuthandiza anthu kuti apitirize kugwiritsa ntchito PrEP nthawi zonse.

Kwa akatswiri azaumoyo a healthcare professionals (HCPs), long-acting PrEP imabweretsa malingaliro atsopano azachipatala. Zikuyenereka kutsimikizika kuti mulibe kachilombo ka HIV musanabayidwe jakisoni aliyense kuti muchepetse kukana kwa mankhwala. Ogwira ntchito ayenera kuphunzitsidwa kabayidwe ka jakisoni, kusamalira bwino pamene pabayidwapo komanso kulondoloza nthawi imene anthu azibwera kuchipatala. Ngakhale zotsatira za malo omwe abayidwa jakisoni nthawi zambiri chiopsezo chake chimakhala chochepa, kupereka uphungu kwa odwala kumakhalabe kofunika. Kalongosoledwe ka mitengo ndi katundu, kuphatikiza zofunika temperature yozizira, zitha kubweretsa zovuta zazikulu pamajekeseni ena. Ndipo, potsiriza, kuwonetsetsa kuti odwala akudzisamalira bwino ndikofunikira chifukwa ayenera kubwerera miyezi iwiri kapena isanu ndi umodzi iliyonse kuti akalandire chithandizo cha cabotegravir kapena lenacapavir, pachokhapachokha.

Tsogolo la Long-Acting PrEP mu Africa
Ngakhale pali zopinga izi, kupindula komwe kungachitike ku Africa ndikwambiri. Pazaka zisanu zikubwerazi, long-acting PrEP ikhoza kusintha zinthu kwambiri kwa amayi achichepere ndi anthu ena omwe anakhudzidwa kwambiri ndi HIV. Kuwonjezera njira zimenezi m'zipatala kuthandiza kupititsa patsogolo njira zomwe zilipo kale ngati PrEP wamapiritsi womwa tsiku lililonse. Ndi njira zambiri zomwe zilipo, odwala tsopano ali pabwino poti akhoza kupeza njira yabwino yomwe iwo agwirizana nayo. Suggestion for clarity: Ngati mankhwalawa angamapezeke pamtengo wabwino komanso kupezeka mosavuta, chiwerengero cha anthu atsopano omwe angatenge HIV chikhoza kuchepa.

Komabe, kuti zinthu ziyende bwino zikudalira pa zimene anthu angachite pothana ndi zolepheretsa  kuti cholinga cha mapulogalamuwa chitheke. Kufufuza mitengo ndikofunikira kuti ikhale yoti anthu ambiri akhoza kukwanitsa. Kugwiritsa ntchito zotsatira za pa kafukufuku wa sayansi kungathandize pulogalamu ya PrEP izigwirizanadi ndi zimene odwala akufuna. Oona zaumoyo ayenera kuonetsetsa kuti aphunzitsa anthu awo bwino, mankhwala akuperekedwa komanso mapulogalamuwa akutsatiridwa mwandondomeko yake.  Pomaliza,  zotsatira za kafukufuku wa mmene mankhwala amagwirira ntchito ngati munthu wamwa kwa nthawi yaitali, yemwe anachitika kwa anthu a magulu osiyanasiyana, komanso zotsatira zoyeserera mankhwala, zonsezo ndi zofunika kwambiri.

Ma HCP amagwira ntchito yofunika kwambiri pothandizira kusankha zinthu mwanzeru. Kulola odwala kuti apange chosankha mothandizidwa ndi azachipatala, kuwaphunzitsa zinthu mogwirizana ndi chikhalidwe chawo komanso kudziwa bwino moyo wa aliyense payekha kungathandize odwalawo kuti azitha kusankha njira yomwe ikugwirizana ndi zosowa zawo komanso moyo wawo. Pothandiza anthu kuzindikira zikhulupiriro zabodza, ma HCP amathandizanso anthu kuona ubwino wa long-acting PrEP komanso kukwaniritsa cholinga chake.

Ngakhale kuti long-acting PrEP ikuthandiza kwambiri kupewa HIV, ikuperekanso chiyembekezo choti kutsogoloku, kupewa kachirombo ka HIV kudzakhala kosavuta, kotheka komanso kuzidzapereka mphamvu kwa anthu kulamulira thanzi lawo. Patakhala dongosolo labwino komanso kuonetsetsa kuti odwala akusamalidwa bwino, njira ya long-acting PrEP ikhoza kuthandiza kuti anthu azilandira mankhwala mokhazikika komanso ikhoza kuthetsa mwachangu mliri wa HIV ku Africa.

Maganizo Anu
Ngati wodwala wanu anasankha PrEP kodi mumawabaya maulendo angati pachaka? Mutha kutenga nawo gawo pazokambirana polemba ndemanga pansipa.

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