Precision medicine to maximise the benefits of long-acting injectable antiretrovirals in Africa (PRECISION)

Long-acting antiretroviral therapy (ART) is the most significant treatment paradigm shift of the last decade for the 34 million people living with HIV. To maximise the benefits of this innovation in sub-Saharan Africa, key questions need answering to reduce the risk of treatment failure due to underlying risk factors, late injections and drug interactions with tuberculosis prevention or treatment. I will build upon an ongoing clinical trial to bring precision medicine to the field. I will measure long-acting cabotegravir and rilpivirine drug levels in 270 trial participants from East/Southern Africa and develop a population pharmacokinetic model, filling the African data gap. I will use the model to simulate the impact of late injections. I will also use modelling to identify predictors of treatment/virological failure (including personal characteristics, viral factors, pharmacokinetic parameters) and I will co-create a clinically-useful risk predictor tool, supporting precision medicine at scale. Lastly, I will conduct a phase II pharmacokinetic study examining the safety of a novel clinical strategy to enable the co-administration of long-acting ART and rifamycins. .. The one-size-fits-all approach to HIV care has failed the most vulnerable. This research personalises long-acting ART to reduce the risk of virological failure, supporting safe implementation in sub-Saharan Africa.