DELAYED

 

Botswana is expected to launch a targeted pilot implementation of the groundbreaking HIV-prevention drug Lenacapavir in 2027, marking the earliest projected introduction of the long-acting injectables into public facilities.

Responding to a questionnaire, Ministry of Health Chief Public Relations Officer, Dr Christopher Nyanga, said Botswana has cleared the legal path following the Botswana Medicines Regulatory Authority's (BoMRA) landmark registration of the drug in March 2026. The Ministry confirms that local vetting is officially complete. Though a public rollout remains at least a year away, the move marks a massive structural shift in how Botswana manages HIV especially its prevention strategies.

Nyanga said the registration serves as the final regulatory hurdle, legally authorizing Lenacapavir for immediate importation, distribution, and use under the supervision of qualified healthcare professionals, locally. He said while private sector access hinges entirely on commercial availability, the strategy for public healthcare will take a more measured approach.

Rather than a blanket rollout, he said this initial phase will focus strictly on high-risk populations, specific geographic hotspots, and service delivery platforms where HIV acquisition is highest. He stated that this localised trial will allow health officials to evaluate user acceptability, operational demands, and overall feasibility while managing limited public resources.

“A nationwide rollout will not occur until the 2027 pilot phase concludes and the ministry intends to scale up the program progressively, using data from the pilot to guide expansion. Ultimate national availability will depend heavily on securing sustainable financing, ensuring commodity supply chains, and verifying that the broader health system is fully equipped to handle the demands of a nationwide distribution,” Nyanga shared.

Recognising that commodity security and cost are critical barriers to a full national rollout, Nyanga said Botswana is also looking beyond its borders for long-term supply solutions and that government has officially agreed to support and actively participate in the newly proposed Southern African Development Community (SADC) Secretariat Task Force.

According to Nyanga, this regional coalition is specifically designed to help South Africa secure a voluntary license to locally manufacture affordable, generic versions of Lenacapavir. By embedding itself in this initiative, Nyanga said, Botswana aims to foster regional self-reliance, improve affordability, strengthen supply security, and secure a steady pipeline of the drug to accelerate access across the entire SADC region.

“To overcome the high international market cost of the drug, the Ministry of Health has positioned itself by strategically pivoting its existing financial portfolios. Instead of waiting for new budget cycles, Botswana has successfully navigated an approved reprogramming process of its current $23.45 million Global Fund Grant, which runs through December 2027,” Nyanga explained.

He said by optimizing these existing resources, the government has earmarked specific funding to bankroll the initial procurement and the 2027 pilot phase, while these redirected funds will be strictly funneled into buying the innovative long-acting PrEP (LEN-PrEP) and deploying it directly to the priority populations. Responding to the question of prospects of probable partnerships in the region, Nyanga explained that while the immediate pilot is financially secured by the current grant, the Ministry of Health is already looking ahead to ensure long-term sustainability. He said relevant officials within the ministry are actively exploring additional funding opportunities under expanded international frameworks, including the US-Global Fund commitment to scale up long-acting PrEP.

“Engagements with the Global Fund and various development partners are currently ongoing to secure future funding and formal financing arrangements will be made public once these discussions conclude and resources are locked in. It should be noted that the total financial requirement for a broader, permanent national scale-up will be carefully assessed later, heavily relying on the data gathered during the implementation experience and future commodity pricing,” Nyanga said.

While civil society celebrated the BoMRA registration of Lenacapavir, the delayed public facility rollout has sparked debate. Prominent health rights organizations, such Botswana Network on Ethics, Law and HIV/AIDS (BONELA) and local activists are anxious for immediate roll out. While South Africa is moving ahead with an immediate, large-scale rollout across 300 clinic, Botswana is stalling. Activists argue that delaying Botswana’s public implementation until 2027 leaves local adolescent girls, young women, and key populations unnecessarily exposed to HIV acquisition for another two years.