South Africa has started rolling out the twice-yearly HIV prevention injection lenacapavir, though success depends on managing interactions with common tuberculosis medicines.
The country recorded about 140,000 new HIV infections in 2025. Modelling indicates lenacapavir could reduce this figure to 65,000 annually by 2043 if one to two million people receive at least one dose by then.
Some tuberculosis drugs, including rifampicin, lower lenacapavir levels in the blood by 85 percent. National guidelines therefore recommend extra doses of lenacapavir for patients who start rifampicin treatment.
Researchers will soon begin the Oracle study in Durban to test these dosing adjustments. The trial will also examine whether lenacapavir can be used safely with rifapentine.
Anushka Naidoo, who leads the study at the Centre for the AIDS Programme of Research in South Africa, noted that 50 to 60 percent of people newly diagnosed with tuberculosis in parts of KwaZulu-Natal are also HIV positive. Norbert Ndjeka of the Department of Health said tuberculosis treatment must begin immediately, with HIV prevention maintained alongside it.
