March 10, 2026
By Cindra Feuer
This year’s CROI felt a whole lot leaner since my last attendance in 2017. It also felt a bit meaner, but in a good way. The field, down for the count in 2025, displayed a resilience in Denver that rose to the occasion of cuts to research, massive lay-offs, disdain for the scientific method and a general assault on the value of humanity. This time, conference participants not only reckoned with the losses but there was a spirit of organized push back; a renewed momentum rooted in the research and will.
A clear triumph was displayed by the bouquet of emerging long-acting (LA) ARV therapeutics, offering alternatives for people who struggle with optimal adherence to daily oral treatment. Ongoing research is expanding eligibility for salvage therapy to both the treatment naïve and those with non-suppressed virus. For example, a meta-analysis of cabotegravir-rilpivirine trials (FLAIR, LATTE-2, SOLAR, ATLAS, CARES, and LATITUDE) confirms the 8-week regimen can maintain viral suppression among diverse populations and settings and with varying treatment profiles. Of course, these new therapies come with their own challenges, including cost, access and injection site reactions, but new oral, long-acting options are also in development to clear these hurdles. A phase 2 study of islatravir and lenacapavir, an oral weekly combination regimen, showed no virologic failure, paving the way for the ongoing Phase 3 studies ISLEND 1 and 2. AVAC will provide a fleshed-out picture of the rapidly expanding, next-generation LA ARV treatment pipeline ahead of the 2026 IAS conference, to complement our ongoing long-acting ARV prevention pipeline tracking.
The SEARCH Community Precision Health Intervention, a cluster-randomized trial delivering HIV testing, PrEP, PEP and treatment referrals through community health workers in rural Kenya and Uganda, reported a striking 70 percent decline in HIV incidence in intervention communities. Reported PrEP coverage rose by just over one percentage point, so it will be important to review more data from SEARCH to understand what factors might contribute to such a steep decline in incidence. Most modeling studies and some empirical data suggest that substantially higher PrEP coverage is required to achieve even 50 percent reductions in new infections. This raises the possibility that factors beyond PrEP uptake contributed to the result, including behavioral change, treatment effects, baseline imbalances or instability given the small number of infections—22 in the control and 7 in the intervention. If relatively small increases in PrEP coverage can, indeed, generate population-level effects of this scale, the implications would be transformative. Clarifying the mechanisms behind these findings is essential to ensure that HIV prevention strategies are grounded in a clear understanding of what drives impact.
Implementation science (like the SEARCH study) was front and center at CROI, showing many ways to reframe delivery to reach priority populations and, thereby, increase equity and access. Renee Heffron from the University of Alabama grounded the CROI audience on the difference between “implementation science” and “implementation”. The former “is meant to accelerate the research to practice timeline—it takes an average of 17 years for a novel treatment to reach practice, so there’s lots to do.” She offered up a model of implementation-effectiveness hybrid strategy whereas clinical and implementation outcomes are dual goals. For example, a hybrid study would ask “If we implement 6-monthly LEN injections in health facilities, will this be feasible and will providers counsel about PrEP options with high fidelity to the counselling guidelines and what is PrEP uptake at facility level?” A clinical outcome would only track HIV incidence at the facility and an implementation outcome would only measure fidelity to guidelines.
Heffron asks, “Is implementation science a fleeting obsession or here to stay?” This is seemingly a loaded question, given Jay Bhattacharya, US NIH Director has gone all out with his support for implementation science, wanting to significantly increase the proportion of implementation science of the overall NIH budget from its current 7%, according to Geri Donenberg, Director of the NIH Office of AIDS Research. Others are suspicious, worrying that this support is in line with the current US administration’s efforts away from basic and clinical research.
Among the wrinkles at this year’s CROI was the decision to forego press conferences (both live and virtual) for the global media who have faithfully covered the meeting’s key scientific breakthroughs over the years. This was a missed opportunity against the backdrop of continued, deafening attacks on science, from vaccine research and rollout, attacks on communities across the board, funding shortages, withdrawal of membership in key normative bodies and many other transgressions of laws and moral principles. CROI needs to amplify the harmonious, as well as dissident, voices of researchers and community that the conference uniquely puts forth.
And, on an up note, I want to close with a preview report back from the AVAC-organized PEP Think Tank on the heels of CROI. Catalyzed by data that the experimental MK-8527 monthly PrEP pill might reach protective drug levels within one hour, a cross-section of talent gathered to brainstorm next-generation PEP options. Heady questions like, Is an RCT necessary? Is an RCT even possible with new PEP formulation? What evidence would be needed to qualify for a label extension? What evidence would be needed for normative guidance and national implementation guidelines? What do communities want? How to improve upon PEP programs of today while preparing for additional options of tomorrow? And how to simplify and de-silo ARVs for treatment, PrEP and PEP with the next-generation drugs? Perhaps we’ll have some answers next year at CROI 2027, in San Diego. And they will be broadcasted widely.