Long-acting technologies for infectious diseases in LMICs

• Published in: The Lancet (British edition) 2018-11, Vol.392 (10158), p.1610-1611
• Main Authors: Marmora, Lelio, Casas, Carmen Pérez, Grubb, Ian, McClure, Craig
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; AIDS; Antiretroviral agents; Antiretroviral drugs; Birth control; Developmental stages; Disease prevention; Drugs; Hepatitis; HIV; Human immunodeficiency virus; Infectious diseases; Malaria; Mental disorders; Nanotechnology; Prevention; Transplants & implants; Tuberculosis; Vector-borne diseases
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(18)32544-3

In high-income countries, the shift from daily oral medication to weekly, monthly, and less frequent LA formulations has been reported to have better adherence and health outcomes across many areas such as antipsychotic treatment for schizophrenia,1 the management of severe, chronic asthma,2 and opioid substitution therapy.3 In sub-Saharan Africa, LA hormonal contraception, as an injection or implant, has become the method of choice for most women of reproductive age.4 LA formulations are not approved for prevention or treatment of HIV, tuberculosis, malaria, or hepatitis C, but active research is being undertaken in these areas, some with non-traditional delivery methods. [...]the broadly neutralising antibody VRC01, delivered every 8 weeks by intravenous infusion, is being studied in a phase 3 trial for HIV prevention, and other broadly neutralising antibodies are at earlier stages of development.6 In malaria, LA formulations are being explored for chemoprophylaxis and vector control.7,8 Nanotechnology might even have the potential for development of a one-shot cure for hepatitis C virus or a one-shot treatment for latent tuberculosis infection.9 George Osodi Injectables are just part of this emerging landscape. Currently, more than 90% of the antiretroviral drugs supplied by major funders such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and the US President's Emergency Plan for AIDS Relief (PEPFAR) are sourced from generic suppliers.10 If a similar approach is to be applied to LA products, complex intellectual property and generic manufacturing issues—for the drugs themselves, the processes used for LA formulation, and the delivery devices—will have to be addressed before the completion of clinical trials, and those trials will need to include all potential beneficiary populations in LMICs.