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Reimagining HIV Prevention Trials in the Era of 95-95-95

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Globally, the HIV response has seen significant progress. In Botswana, for instance, over 95 per cent of people living with HIV (PLHIV) are aware of their status, receive treatment, and achieve viral suppression. These results reflect sustained investment in public health and strong community engagement. As a result, the country has seen a notable decline in HIV incidence. While this is an encouraging development, it introduces new complexity for HIV prevention researchers. With fewer new infections, widespread access to antiretroviral therapy (ART), and the availability of proven prevention tools like pre-exposure prophylaxis (PrEP), we are faced with a pressing question: How do we design HIV prevention trials in settings where the number of new infections is becoming increasingly low? The Paradox of Success Traditionally, HIV prevention trials have measured the rate of new HIV infections between those who receive an intervention and those who do not. In high-coverage setting...
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Aging with HIV in Botswana: Time to Update Our Treatment Guidelines

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A New Face of Botswana’s HIV Epidemic As an HIV activist, I have witnessed a profound shift in our epidemic’s demographics. Two decades ago, the focus was on keeping people alive. Today, thanks to widespread antiretroviral therapy (ART), many of those same people are alive into their 50s, 60s, and beyond. In fact, Botswana’s HIV population is graying rapidly. By some estimates, over 50% of people living with HIV in Botswana are now over 40 years old, making older adults the new face of our country’s HIV community. This is a testament to our success in expanding treatment, but it also presents urgent new challenges. While ART has extended life expectancy, additional years of life are not necessarily spent in good health. Many older PLHIV are surviving, but not thriving. They struggle with chronic pain, fatigue, heart disease, or depression. Such stories underscore a hard truth: we have won on longevity, but we are lagging on quality of life. Medical complications, multimorbidities, ...
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HIV Prevention Research in a Time of Scarcity: Why Health Economics Must Lead the Way

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What is Health Economics? Health economics is a field of study that examines how health resources are allocated, used, and financed. It helps decision-makers understand the trade-offs involved in investing in different health interventions by analysing their costs, benefits, and overall impact on population health. Through tools such as cost-effectiveness analysis and budget impact modelling, health economics supports evidence-based decisions that aim to maximise health outcomes with limited resources. In HIV prevention, this means ensuring that every intervention, from new biomedical tools to health service delivery, delivers real value for money and is accessible to the people who need it most. Why Health Economics Literacy Matters for HIV Advocates As an AVAC Clinical Trials Design Academy member and advocate for HIV prevention, developing health economics literacy is vital. It empowers advocates to engage meaningfully in decision-making spaces, to interrogate the value and feasi...
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Calling for Urgent Adoption of Lenacapavir in PrEP Guidelines: A Step Forward in HIV Prevention

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Lenacapavir represents a major advance in HIV prevention. As a capsid inhibitor, it interrupts multiple stages of the HIV lifecycle, making it distinct from other treatments. This long-acting injectable has shown remarkable efficacy in blocking HIV replication, making it a promising option for both prevention and treatment, particularly in heavily treatment-experienced adults with multi-drug-resistant HIV. The introduction of Lenacapavir is a game-changer, offering new hope to millions affected by HIV, especially in high-incidence, resource-limited countries. With Gilead’s recent voluntary licensing agreements, six generic manufacturers have been empowered to produce and supply Lenacapavir at low cost. This decision to roll out Lenacapavir through partnerships in 120 countries, including Botswana, South Africa, and Kenya, underscores Gilead’s commitment to global health equity. By offering the drug at no profit until generic manufacturers can meet demand, Gilead has set a new benchma...
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Botswana HIV Cure Research Academy Launch: A New Era of Community Engagement in HIV Cure Research

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On 30 August 2024 , the Botswana Community HIV Cure Research Academy was officially launched at the CEYOHO Centre in Tlokweng, marking a significant milestone in the fight against HIV. The launch of the Academy symbolises a new era where community-driven insights are integrated with scientific research to accelerate the global pursuit of an HIV cure. The event brought together a diverse group of stakeholders, including People Living with HIV (PLHIV), researchers, civil society organisations (CSOs), and other community representatives. Vision of the Academy The Academy’s vision is to become a pivotal platform that harmonises community-driven perspectives with scientific research, to accelerate progress towards finding a cure for HIV. It is designed to bridge the gap between PLHIV and researchers, ensuring that community members actively shape research efforts, study designs, and policy advocacy. The Academy aims to provide education and awareness on HIV cure science, advocate for ...
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Prioritizing Privacy and Support: Shifting the Focus of HIV Programs in Botswana

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Good afternoon, Champions. I have noticed an increasing trend among development partners funding HIV programs to require that patient reach forms include not only ID numbers and age but also, in some cases, signatures. While I understand the need for accurate data collection, this approach raises concerns about client privacy. Collecting such sensitive information crosses a line, as it could compromise data safety and confidentiality, making clients more vulnerable to potential breaches or misuse of their personal information. Additionally, there is an ongoing push to identify more undiagnosed positives in the community, even though Botswana has already surpassed the 95% target of people living with HIV (PLHIV) being diagnosed. This focus seems increasingly misaligned with our current context, where a shift in priorities would be more effective. It is time to engage our funders in meaningful conversations about these shifting needs. We should now prioritize investments in programs desi...
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Highlights from the HIV Cure Pre-Conference at AIDS 2024

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The 2024 HIV Cure Pre-Conference at AIDS 2024, held today, 21 July 2024, in Munich, was a pivotal event that brought together leading experts and researchers from around the globe to discuss the latest advancements, ongoing challenges, and the future direction of HIV cure research. This pre-conference served as a critical platform for sharing insights into the scientific, structural, and global coordination efforts needed to push forward the ambitious goal of achieving a functional or complete cure for HIV. Keynote Presentation by Deborah Persaud The event began with a powerful keynote address by Dr. Deborah Persaud, who is recognized for her groundbreaking work in pediatric HIV cure research. Dr Persaud provided a comprehensive overview of the current landscape of HIV cure research, particularly focusing on Latency-Reversing Agents (LRAs) in clinical trials. She presented a detailed systematic review that highlighted the need for meticulously designed studies to determine the precise ...
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