Adaobi Olisa, FHI 360

I attended the 31^st Conference on Retroviruses and Opportunistic Infections (CROI 2024) in Denver, Colorado, earlier this month after being awarded a community educator scholarship by the conference. What an amazing experience! I am still digesting all the science and innovation that was presented, but four themes stood out to me. In this post, I share my key takeaways from CROI 2024 through the lens of a community educator and member of the MOSAIC NextGen Squad.

Choice for HIV prevention options leads to a reduction in the number of new HIV acquisitions.

I was elated by findings from a randomized trial, the SEARCH Dynamic Choice for HIV Prevention including Injectable Cabotegravir (CAB PrEP) study, which showed that offering choice for HIV prevention increased use of prevention products and reduced the number of new HIV acquisitions. The study included person-centered, structured choice among oral pre-exposure prophylaxis (PrEP), post-exposure prophylaxis (PEP), or CAB PrEP and the ability to switch between or stop products over time based on client product preference and need. Results showed zero new HIV acquisitions in the study arm and seven participants who acquired HIV and one perinatal transmission in the standard of care arm (incidence rate: 1.8%).

My dear community advocates, we have been calling for choice for HIV prevention, and now we have evidence that expanding HIV prevention options can reduce new HIV acquisitions. However, we still need to find a sustainable way to provide HIV prevention choice, especially as new PrEP products enter the market. I’m hopeful that the CATALYST study, which is being implemented in 28 public health facilities across five African countries, will contribute evidence of the most realistic and sustainable way to deliver PrEP choice at scale. Also, a community poster walk session with Grace Kumwenda (Regional Program Manager for Research Engagement, AVAC-Malawi) and Susan P. Buchbinder (Clinical Professor of Medicine and Epidemiology, University of California, San Francisco) helped me and my fellow community scholars appreciate numerous posters that highlighted the increased uptake of services through community service delivery models.

Precision prevention: honing on technological advancements could improve HIV prevention.

I was also intrigued by a topic that may be the future of HIV prevention services: precision prevention. During his presentation at the Scott M. Hammer Workshop for New Investigators and Trainees, LaRon E. Nelson of Yale University defined precision prevention as the use of geographic information systems (GIS), epidemiologic data, machine learning, and artificial intelligence (AI) to predict prevention needs and preferences and to provide targeted, individualized services. He explained that precision prevention can be implemented at various levels, including using GIS and epidemiologic data to geo-target, monitor, and adjust prevention interventions; machine learning to predict prevention needs and preferences; and AI to provide counseling and adherence support, among others.

I believe utilizing data analytics for targeted interventions and honing these technological advancements to improve precision in planning, resource allocation, and delivery of prevention services is a great idea. For example, the use of GIS and epidemiologic data to monitor trends in new HIV acquisitions and target resources accordingly will help inform resource allocation at global but most importantly national and subnational levels, ensuring optimum use of the limited resources available. However, when I raised the question of how this work on precision prevention is being informed by emerging evidence from implementation science, the consensus was that more work needs to be done.

As we strive to find a cure for HIV, we need to break silos and elevate all aspects of research.

This year, CROI was heavy on HIV cure, with lots of presentations about emerging evidence from cure research. I also met the amazing Adam Castillejo. (Known as the “London patient,” he is the second person in the world to have been cured of HIV). Adam inspired hope during his presentation and highlighted the need for more efforts and funding toward developing a sustainable cure.

I was intrigued by discussions during the Community HIV Cure Research workshop that highlighted the key role of social and behavioral sciences in the development of high-impact interventions. In the words of Advocate/CROI community liaison Jim Pickett, “all the science and research will mean nothing if we develop a cure that remains on the shelf and out of reach because we did not account for the preferences and lived experiences of the end users.” We need to ensure that the clinical research is informed by social and behavioral sciences, and we need to generate more evidence that elevates the lived realities and preferences of the communities we serve. This year CROI encouraged more high-quality abstract submissions related to social and behavioral sciences; however, more work is needed to break the silos and elevate all aspects of research as we strive toward a sustainable cure.

We must build the next generation of leaders who will sustain gains in reaching HIV epidemic control

CROI was intentional about encouraging the next generation to sustain the gains. This message came out strongly during the Scott M. Hammer workshop. The new investigators and young scholars were encouraged to speak up, carry on the work, and ensure that all the progress is accelerated and sustained. CROI also provided us with unique networking opportunities with the highest levels of leadership in HIV prevention. I met with Rebecca Bunnel (Deputy Coordinator for PEPFAR), Benny Kottiri (Research Director, USAID’s Office of HIV, or OHA), Mary Latka (USAID/OHA Microbicide Branch Chief), the leadership of the MATRIX project, Vilma Vega (US Director of Patient Affairs, ViiV Healthcare), and Toyin Falusi Nwafor (Senior Medical Director of HIV Prevention, ViiV Healthcare). It’s so empowering to see that the big shots at PEPFAR/USAID are sincerely interested in elevating young people. These opportunities are crucial because they prepare and inspire the next generation of leaders. I am eager to see more young people receiving and optimizing opportunities like this.

I’m super grateful for this mind-blowing opportunity to participate in CROI. A shout out to the really passionate cohort of community scholars, mentors, and the wonderful CROI Community Liaison Subcommittee!