Lloyd Mulenga, M.B.Ch.B., Ph.D., on rationing lenacapavir for PrEP | IAS 2026

Zambia has received only about 13,000 of the tens of thousands of doses of lenacapavir it is expecting for HIV prevention, forcing the country to ration the long-acting injectable drug for pre-exposure prophylaxis (PrEP), according to Lloyd Mulenga, M.B.Ch.B., Ph.D., director of infectious diseases at the Zambia Ministry of Health. Mulenga is listed as a featured speaker at AIDS 2026, the 26th International AIDS Conference. Preconference sessions were held today, but the conference officially begins tomorrow.

Zambia is expecting 60,000 to 80,000 doses of lenacapavir for PrEP through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), another 22,000 from the Global Fund to Fight AIDS, Tuberculosis and Malaria, and 5,000 more from Unitaid, Mulenga said in an interview with Managed Healthcare Executive before the meeting. So far, only part of the Global Fund shipment has arrived. Mulenga said the shortage is limited to prevention. Zambia has adequate commodities for HIV treatment and is not rationing treatment, he emphasized.

The gap has led to a limitation in the number of sites offering lenacapavir and to prioritizing reinjections for people already on the drug over initiations, Mulenga said.

Lenacapavir has stirred up new hope for preventing HIV transmission because it only requires an injection only twice a year. Positive results for the PrEP injectable were presented two years ago at the IAS meeting in Munich. Positive results for open-label extensions are scheduled to be presented at this meeting, and the results have already been shared in a pre-meeting news conference.

In this interview with Managed Healthcare Executive, Mulenga discusses how Zambia is trying to close the gap between the volume of lenacapavir it has committed to distributing and the commodities and delivery systems currently available to get the drug to patients.

Asked whether the country's delivery infrastructure will be ready before shipments arrive, Mulenga said the ministry is looking beyond the standalone clinics it has relied on. “We’re trying to be innovative in the delivery mechanisms, moving away from these expensive standalone delivery structures that government cannot maintain," he said. Options under discussion include distributing lenacapavir through private pharmacies and using community-based volunteers, he said.

But delivery capacity is not the immediate constraint, Mulenga said. "The problem we have is the commodities, because we have only received commodities from the Global Fund. So right now, we are rationing. We have not received the huge commodities we're supposed to receive from PEPFAR from the U.S. government. So that is the immediate worry right now — can we get more commodities as we even try to use these other delivery models?" he said.