A novel injectable pre-exposure prophylaxis, cabotegravir, has greater efficacy and acceptability than oral TDF/FTC for prevention of HIV infection. Cabotegravir is currently priced at $22,200 per year, over 185-times higher than the $60-$119 estimated cost-effectiveness threshold for MICs. Following civil society pressure, ViiV agreed access to generic versions in 90 countries with the Medicines Patent Pool (MPP), including all African nations. However, several MICs outside Africa have rapidly growing HIV epidemics. We analysed the ViiV-MPP deal to assess population covered and Gross Domestic Product (GDP) per capita. There were 38 countries excluded from the ViiV-MPP deal despite having a GDP per Capita lower than the highest earning African country. These countries include 2.4 billion people (30% global population), with an incidence of 122 thousand (8%). For cabotegravir to have a significant impact on HIV infections, millions will need to be treated at affordable prices in a wide range of countries.

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