A global clinical trial found that HIV-positive teenagers who switched from daily pills to an injection given once every eight weeks were six times less likely to experience viral rebound, a result researchers say could reshape how adolescents with HIV are treated across Africa, where the vast majority of the world’s HIV-positive teens live.
What the Trial Found
The LATA trial, published Sept. 18 in The Lancet, enrolled 476 adolescents ages 12 to 19 with already-suppressed HIV at five clinics in Kenya, South Africa, Uganda and Zimbabwe, following them for 96 weeks. Participants were randomly assigned to continue daily oral antiretroviral pills or switch to an injectable combination of cabotegravir and rilpivirine, sold in the United States as Cabenuva, given every eight weeks.
Viral rebound occurred in just 1% of participants on the injectable, compared with 6% of those who stayed on daily pills, according to University College London, which sponsored the trial. Among those on the injectable, 94% said the eight-weekly schedule was easier to manage than taking a pill every day.
“Long-acting injectables taken every two months can help young people to lead a more normal life,” said Professor Sarah Pett of UCL’s Innovative Clinical Trials Unit, the trial’s chief investigator. Dr. Deborah Ford, the study’s corresponding author at UCL, said, “The lack of availability of injectable treatments in Africa risks increasing inequalities in HIV care.”
The Arithmetic Behind a Sixfold Difference
A drop from 6% viral rebound to 1% represents a sixfold reduction in risk, or an 83% relative decrease, for teenagers who switched to the injectable. That gap matters specifically because adolescence is widely recognized as one of the hardest periods for consistent daily medication adherence, given stigma, forgetting doses and fear of a pill bottle being discovered by family or peers. An eight-week injection schedule removes the daily decision entirely, replacing it with roughly six clinic visits a year, a structural change that appears to have driven the difference in outcomes more than any difference in the drug’s underlying effectiveness once taken.
An Access Gap That Predates the Study
Injectable cabotegravir and rilpivirine has already been available in the United States for several years. The trial’s core finding, that the treatment works better for teenagers than daily pills, is not new in terms of the drug’s basic mechanism; what is new is the evidence specifically in African adolescents, the population that makes up roughly 90% of teenagers living with HIV worldwide, according to trial researchers.
That population has had far less access to injectable treatment than teenagers in wealthier countries, even though the disease burden falls overwhelmingly on Africa, a gap Ford’s statement pointed to directly rather than treating the trial’s result as a purely clinical finding.
Who Funded and Ran the Trial
The LATA trial was sponsored by University College London and funded jointly by the European Union’s EDCTP2 program, Johnson & Johnson Innovative Medicines and ViiV Healthcare, the pharmaceutical company that markets the injectable combination commercially. Dr. Mutsa Bwakura-Dangarembizi served as the trial’s principal investigator at the Harare, Zimbabwe site, one of five clinics across the four participating countries.
Running the trial across four separate African health systems, rather than a single country, was itself part of what makes its findings broadly applicable: the consistent results across Kenya, South Africa, Uganda and Zimbabwe suggest the injectable’s advantage over daily pills held regardless of differences in each country’s health infrastructure, rather than reflecting conditions specific to just one clinic or one national system.
What Happens Next
Researchers are calling for expanded access to injectable HIV treatment within African health systems, where oral therapy remains far more available than the injectable option this trial tested. Any expansion would likely require both regulatory approval processes specific to each country and substantial new investment in cold-chain storage and clinic infrastructure needed to administer injectable medication at the scale oral pills currently reach.
Whether donor governments and global health organizations respond to the trial’s findings with expanded funding for injectable rollout in the four trial countries, and beyond them, is the clearest next step the research points toward.
The trial’s 96-week follow-up period also gives researchers a longer view of durability than many treatment-switch studies typically capture, since a shorter study might have shown an early adherence benefit that faded as the novelty of switching to a new treatment format wore off. That the injectable group’s advantage held up nearly two years into the study suggests the improvement reflects a lasting change in how manageable teenagers found their treatment, rather than a short-term boost tied to just having switched to something new.
The trial adds to a broader body of research on long-acting injectable HIV medications, which have gained ground globally in recent years as an alternative to daily oral regimens for both treatment and prevention. Most of that prior research, however, was conducted primarily in adult populations in wealthier countries, leaving a gap in adolescent-specific, African-based evidence that the LATA trial was specifically designed to fill.
That gap is part of why researchers framed the results as an equity argument as much as a clinical one: without data like this, health systems and donors have less basis to prioritize injectable access for exactly the population, African teenagers, that carries the largest share of the global adolescent HIV burden.
