Botswana is preparing to introduce lenacapavir, a long-acting HIV prevention drug, into its national HIV prevention programme, with the ministry of health targeting a pilot rollout in selected districts and health facilities during the first half of 2027.
The ministry says preparations are already underway following the registration of lenacapavir by the Botswana Medicines Regulatory Authority (BoMRA), with authorities working on clinical guidance, an implementation plan and resource mobilisation to secure the drug.
According to the ministry of health’s Public Relations Officer Dr Christopher Nyanga, preparations also include getting health facilities, healthcare workers and communities ready for the introduction of the new prevention option.
The planned pilot will allow the ministry to assess how lenacapavir is implemented, identify operational gaps and make adjustments before the programme is progressively expanded to other parts of the country. Lenacapavir is expected to complement existing HIV prevention methods, providing people with another option for protecting themselves against HIV.
The ministry has also confirmed that Botswana is engaging development partners, including the Global Fund and the US government, over access to lenacapavir. The discussions are aimed at securing supplies, mobilising resources and ensuring the country is prepared for the phased introduction and eventual scale-up of the drug.
The engagements come as Gilead Sciences, the developer of lenacapavir, has expanded its no-profit supply programme with PEPFAR and the Global Fund to potentially reach up to three million people across sub-Saharan Africa by 2028.
The ministry said discussions with its development partners are ongoing and that Botswana intends to work closely with them to facilitate timely and equitable access to lenacapavir for eligible populations. Ahead of the pilot, the ministry says it is developing clinical guidance and implementation tools while preparing healthcare workers to safely administer and manage the new prevention service.
Other preparations include strengthening supply and logistics systems, establishing monitoring and reporting mechanisms, and supporting health facilities to integrate lenacapavir into existing HIV prevention services. Preparations are intended to ensure the drug can be introduced safely, efficiently and in a coordinated manner once supplies become available.
With supplies expected to be limited during the initial phase, the Ministry says access will be guided by evidence and Botswana’s national HIV priorities. The Botswana National Strategic Framework for HIV and AIDS, population data from the Botswana AIDS Impact Survey V (BAIS V) and the Integrated Biological and Behavioural Surveillance Survey (IBBSS), together with HIV incidence data, will be used to identify populations and geographical areas with the greatest need.
The Ministry says lenacapavir will therefore initially be prioritised in areas where the risk of new HIV infections is highest, while seeking to ensure the process remains fair, transparent and aligned with national policy. The planned introduction comes amid growing evidence around lenacapavir as a long-acting HIV prevention option.
In information released ahead of the 2026 International AIDS Conference, Gilead reported new long-term follow-up data from the PURPOSE 1 and PURPOSE 2 trials evaluating twice-yearly lenacapavir for HIV pre-exposure prophylaxis (PrEP).
According to the company, more than 95 percent of eligible participants across the two trials opted to continue receiving lenacapavir or switch to it from daily oral PrEP during the open-label extension phases.
The company reported more than 7,178 person-years of follow-up in PURPOSE 1 and 5,295 person-years in PURPOSE 2. In PURPOSE 1, no new HIV infections were observed during the open-label extension, while PURPOSE 2 recorded one HIV infection among participants continuing on lenacapavir.
Adherence to the twice-yearly injections also remained high, with Gilead reporting that 96 percent of participants in PURPOSE 1 and 92 percent in PURPOSE 2 continued receiving lenacapavir through 52 weeks.
The company said the safety profile remained consistent with earlier findings, with no new safety signals identified. Gilead says its no-profit supply programme with PEPFAR and the Global Fund has been expanded from a planned reach of two million people to up to three million people through 2028.
Lenacapavir is already available in 10 priority countries across sub-Saharan Africa, while licensed manufacturers, governments and implementation partners are preparing for future generic availability. For Botswana, however, the immediate focus is on preparing the health system for the planned 2027 pilot.
