KUALA LUMPUR, August 23 — Malaysia will likely gain access to long-acting cabotegravir (CAB-LA) in the first quarter of 2025, offering people at risk of HIV infection a more reliable prevention option than daily oral PrEP.
Kuala Lumpur Hospital (HKL) infectious disease physician Dr Khairil Erwan Khalid believes that the injectable version of PrEP will benefit individuals who struggle with adherence to daily medication, as it requires only one injection every two months.
“The FDA (US Food and Drug Administration) approved it back in 2021, but at the moment, it is still not available in Malaysia. They are still in the process of trying to get it in, probably by the first quarter of next year.
“But we do know that there is a lot of data and evidence showing this long-acting injectable PrEP is superior to the daily oral PrEP we have currently, and it also helps with adherence because you just need to get injected once every two months.
“So for individuals who have problems with adhering to daily medication, this would be an advantage,” Dr Khairil told reporters during the launch of the Positive Living Initiative by the Malaysian AIDS Foundation (MAF) and Durex on August 6.
CAB-LA is a long-acting injectable form of PrEP, initially administered with two injections four weeks apart, followed by an injection every eight weeks thereafter.
Studies show that CAB-LA is highly effective at reducing the risk of HIV infection through sex, making it a more reliable option than daily PrEP pills, which are currently available for free in Malaysia’s public clinics and for a fee in private clinics.
However, CAB-LA is expected to be costly, with initial availability in Malaysia likely coming with a fee, and more affordable generic versions anticipated by 2027.
“When it arrives, it will likely be available for a fee. We will have to wait and see until it’s officially launched in our country,” Dr Khairil said.
According to The Guardian, the branded version of CAB-LA sells for about US$3,500 (RM15,537) for one injection in the United States, a price that makes it inaccessible for many lower- and middle-income countries.
Infectious disease expert and former International AIDS Society (IAS) president Prof Dr Adeeba Kamarulzaman has previously indicated that Malaysia will likely have access to generic versions of CAB-LA in 2027, along with other second-tier countries.
Making PrEP Available In Community Pharmacies
Under the Poisons Act 1952, the authority to prescribe medications, including PrEP, is limited to licensed medical practitioners, dentists, and veterinarians.
While pharmacists can dispense prescription medications, they can only do so with a valid prescription from a medical doctor. Currently, oral PrEP is primarily available through clinics, particularly government health clinics (Klinik Kesihatan).
Dr Khairil said there are ongoing projects exploring the potential for rolling out PrEP in community and retail pharmacies.
“I think when you talk about PrEP, prevention in the community, it has to be on a community base. So either retail or community pharmacies, community-based organisations, klinik kesihatan would be the best avenues for PrEP, not in a tertiary hospital setting,” Dr Khairil said.
In many countries, including Malaysia, pharmacists can only dispense PrEP after a patient receives a prescription from a health care pprovider. However, some states in the United States allow pharmacists to prescribe and dispense PrEP directly, following specific training or protocols.
There is also an effort to integrate HIV self-test kits with PrEP, ensuring that individuals can test themselves before starting the medication and then be linked to a general practitioner for the necessary prescription.
“So when somebody comes in to get PrEP, they will incorporate the HIV self-test kit, because they need to do an HIV test before you start on PrEP,” Dr Khairil said.
“And then, I think they’ll probably link you to the nearest GP, because for prescribing, you still need a doctor. You can’t get the pharmacist to prescribe. So it’s still sort of a process in the project, so we’ll see how it goes.”
