In Montreal the pressure was on.
AIDS 2022 showed the global response to HIV at a crossroads. The field has achieved groundbreaking advances in biomedical solutions. But intensifying disparities in HIV prevention and global health at large threaten to eclipse these achievements. Scrutiny of the inequities was center stage in Montreal. Advocates from the Global South hosted and co-hosted meetings with key decision-makers to make the urgent case for faster and more equitable access to new PrEP options—including meetings with Winnie Byanyima of UNAIDS, Amb. John Nkengasong of PEPFAR and Atul Gawande of USAID. Accountability, at every level, is essential—for HIV prevention, treatment, human rights, health systems and health equity.
Getting Rollout Right
Fulfilling the current promise of new HIV prevention options requires advancing a people-centered, integrated approach for introducing proven products. This priority was also center stage in Montreal. The Coalition to Accelerate Access to Long-Acting PrEP (with AVAC serving as the secretariat), The HIV Prevention Road Map announced by the Global HIV Prevention Coalition, and the just-launched WHO guidelines for injectable PrEP that simplify PrEP delivery, are helping to lay the groundwork. The agreement between the Medicines Patent Pool (MPP) and ViiV is also a welcome step toward a sustainable market of generic manufacturers for injectable CAB and future products.
But more must be done. Delivering the fruits of science must become as urgent as their development. Putting in place the right programs, policies and investment to deliver choices at scale and bend the curve of the epidemic utterly depends on a commitment to integrated, equitable, people-centered, and community-led approaches. Be sure to read AVAC’s Plan for Accelerating Access and Introduction of Injectable CAB for PrEP, (or a summary of it), which outlines why funding commitments, creating demand, WHO guidelines, implementation studies, technology transfer, generic manufacturing and more must be coordinated and expedited now.
Several sessions and events at AIDS 2022 took a deep dive into why and how this people-centered, integrated approach must frame product introduction. Here are quick highlights on key sessions:
- Accessing long-acting HIV prevention and treatment innovations: Landscape, service delivery, and pathways to affordability. This session included CAB drug-maker, ViiV, on the panel, and advocates disrupted the session turning up the fire on demands for a speedy rollout of affordable CAB for PrEP. Uganda’s Lillian Mworeko said, “we cannot talk about five years, we need to talk about now” and called for strong accountability.
- Equitable roll out of health products: What will it take? Panelists discussed the need for much greater integration between product development and getting those products to the people who need them. The most efficacious product will fail without investment in innovative, tailored programs. This session also discussed how advances in HIV self-testing and adaptable community-based access do support effective product delivery.
- PrEP-ing for 2030: Why optimization and scale-up of the PrEP service and product mix is critical to addressing unmet PrEP need and supporting effective use towards 2030 HIV prevention goals. 3 million people have started oral PrEP by June 2022; however, this represents a small fraction of the tens of millions who could benefit from it. This session provided a look at PrEP scale-up and examples of community-led delivery that propelled increases in the number of people starting PrEP. AVAC’s Jessica Rodrigues detailed the factors contributing to this unprecedented increase, most notably the role of PEPFAR funding in major gains in PrEP uptake.
- Our next shot: Effectively delivering injectable cabotegravir for PrEP. Imelda Mahaka of MOSAIC and Pangaea Zimbabwe AIDS Trust (PZAT) discussed barriers to rolling out CAB including cost, testing, service provider capacity, and access.
Populations and Products in Focus
The following sessions put an important spotlight on particular populations or products:
- A session on how prevention programs can prepare for multipurpose prevention technology (MPTs) such as the Dual Prevention Pill, which combines protection against pregnancy and HIV, offered marketing insights. Among the key takeaways: breaking down silos with the family planning community will be essentia. The session presented recommendations for provider counseling on a combined product. See the DPP Consortium’s e-poster.
- The CASPR and AVAC Research-to-Rollout Literacy and Networking Zone hosted several discussions on a more inclusive HIV research agenda. One discussion focused on growing consensus, and an action plan, for the inclusion of pregnant and lactating people in research (see AVAC’s guide to the Inclusion of Pregnant and Breastfeeding Populations in Research).
- Another Networking Zone discussion updated on the work prioritized in No Data, No more: Manifesto to Align HIV Prevention Research with Trans and Gender Diverse (TGD) Realities. Brian Minalga from HIV/AIDS Network Coordination at Fred Hutch shared new literature raising the profile of these priorities and discussed progress, in particular two trials underway centering TGD people. The Get It Right Study, looking at interactions between treatment and gender confirming therapy (GCT). And HPTN 091 looking at the co-location of HIV services and GCT.
AVAC at AIDS 2022
For a look at AVAC’s work at AIDS 2022 go to our dedicated page. And in case you missed it, the latest webinar from the The Choice Agenda provided a status update on the rollout of injectable PrEP, with presentations from providers, researchers, the WHO and others.
The picture of HIV prevention today is full of promise and peril. Navigating the challenges is both possible and imperative. Here’s how AVAC Executive Director Mitchell Warren put it at the launch of the new Global HIV Prevention Roadmap:
“In 41 years we’ve never had such opportunity in prevention. We have a package of proven methods for the first time, and global health leaders are offering renewed commitments to spearhead and sustain programs that are designed to reach those who need prevention most. These programs should be focused on integrating HIV services with sexual reproductive health and rights. But we won’t get this done without going beyond simple community engagement and the old siloed models of delivery. Now is the time to integrate, coordinate, and invest. Now is the time for a global response that is community led.”