The Benefits To Americans Of US-Supported International HIV Research
US-funded HIV research conducted in Africa and other high-burden settings isn’t just a foreign aid story — it’s a direct driver of American public health gains. What gets discovered there impacts how healthcare is delivered here. It shapes the drugs Americans take, the guidelines their doctors follow, and the public health initiatives that serve the hardest-hit communities.
A new Health Affairs piece by Judith Auerbach, Jirair Ratevosian, and AVAC’s Mitchell Warren makes the case that cuts to US-supported global HIV research don’t just hurt partner countries. They undermine the scientific pipeline that delivers those advances to Americans most in need. As the Trump administration scales back global health investments, the US risks squandering decades of research returns just as they’re beginning to pay off.
Global Health Watch: France Cuts Global Fund, US Bilateral Health Platform, PEPFAR Timeline Uncertainty, New Lancet Africa Journal
Issue 59
This week, France sharply cut its contribution to the Global Fund, adding to the replenishment shortfall and broader strain on multilateral global health financing. Meanwhile, the US launched a new global health funding platform tied to bilateral agreements, even as delays in MoUs and shifting timelines continue uncertainty about service delivery under PEPFAR and what its future and the future of multilateralism looks like. Amid these shifts in global health architecture, The Lancet launched the inaugural issue of The Lancet Regional Health – Africa to elevate African leadership in health research and policy.
France Cuts Contribution to Global Fund
France, traditionally the second-largest contributor to the Global Fund to Fight AIDS, Tuberculosis and Malaria, has reportedly sharply reduced its pledge for the latest replenishment cycle. After increasing its support by 20% in each of the previous two cycles, France cut its contribution by 58%. This, combined with delays in a pledge from the European Commission and reductions in contributions from other major donors, brings the Fund well under its $18 billion target. As reported previously, the Global Fund Board approved $10.78 billion in country allocations for the 2027–2029 cycle and set aside $260 million in catalytic funding to accelerate access to innovations, including scale-up of lenacapavir for long-acting PrEP, new molecular tuberculosis diagnostics and improved malaria vector-control tools.
IMPLICATIONS: France’s cut reflects a broader reduction in support for multilateral global health institutions at a time when the global health architecture is being reconstructed. As Health Policy Watch notes, “when it comes to healthcare, multilateralism has yielded many tangible benefits that are helping keep people alive. In a world where every country stands alone, these benefits will simply fall away.” Moving forward, the question is not only which multilateral organizations will be appropriately funded, but whether future global health partnerships can preserve the collective action needed to address HIV, tuberculosis, malaria and emerging health threats, and what forms those partnerships will take.
US Launches New Global Health Funding Platform as Bilateral MoUs and PEPFAR Timelines Pass
The US State Department launched the “Advancing Global Health” Annual Program Statement (APS), a new global health funding mechanism that could provide up to $4.5 billion into projects tied to the administration’s emerging bilateral health Memoranda of Understanding (MoU) agreements with partner countries. The platform is designed as a standing funding mechanism where international organizations, NGOs, universities and others can respond to targeted calls for grants and compete for funding awards between $500,000 to $250 million.
The US State Department also released the full text of MoUs with Ethiopia, Kenya, Mozambique, Nigeria and Uganda. The documents do not include data and specimen-sharing provisions, and only five of the 24 signed agreements have been published, despite the deadline to finalize MoUs by December 31, 2025. This delay led to PEPFAR-supported countries, which have not yet signed agreements or secured funding under the MoUs, being granted a three-month extension to continue to receive funding at current levels. PEPFAR programs had previously been expected to stop operating after March 31, 2026, but the last-minute authorization allows funding to continue as MoUs are negotiated and implementation plans are completed in countries with signed MoUs. In addition, appropriated third quarter funds have not been transferred to global HIV programs administered by CDC, with buffer funds being used to cover costs, threatening services disruptions, and further destabilizing health systems.
IMPLICATIONS: These developments continue the shift toward bilateral global health funding tied to broad government-to-government agreements negotiated in conjunction with mineral rights, data access and other provisions under the “America First” framework. While the new APS could mobilize significant resources, limited transparency across the APS and MoUs, delays in finalizing agreements and transferring appropriated funds, lack of civil society engagement and unequitable terms, raise concerns about how smoothly the transition will unfold and to what degree politics and power dynamics are driving the model. The need for a last-minute three-month extension for PEPFAR programs further highlights the operational risks of this shift and raises serious concerns about further disruptions to HIV services.
The Lancet Launches New Journal to Elevate African Leadership in Global Health
The Lancet launched its inaugural issue of The Lancet Regional Health – Africa, a new publication to elevate African leadership in health research, policy and clinical practice. The journal aims to address longstanding imbalances by amplifying African voices and prioritizing research grounded in the lived experiences of communities, health systems and policymakers across the continent. A comment by Africa CDC colleagues reimagines a future global health architecture.
IMPLICATIONS: Framed as part of a broader effort to decolonize, localize and re-center health and medical research, the journal will publish evidence and analysis on the issues most critical to African populations while challenging Western-centric paradigms that have historically dominated global health discussion and debate.
The US National Institutes of Health (NIH) is seeking feedback to inform its next five-year Agency-Wide Strategic Plan. Two webinars will be held to gather input on the framework guiding the plan’s development.
The last few weeks have been action-packed for HIV prevention (and for AVAC and partners), with unpacking data and discussions from CROI; injectable lenacapavir for PrEP (LEN) rolling out in a number of Eastern and Southern Africa countries; signings (and not) of “America First” Bilateral Health Agreements; and our latest quarterly STI and HIV updates. AVAC is tracking it all; see below for the key updates.
And just last week, we announced the launch of our Access Bridge partnership — a new Kenyan-based organization to work with AVAC and the field to accelerate product introduction and access.
The annual Conference on Retroviruses and Opportunistic Infections (CROI) once again delivered a powerful mix of scientific progress and urgent warnings about the systems needed to turn real innovation into impact. From advances in HIV prevention, cure and treatment, new data on STI treatment and service delivery, the science pointed to expanding choice, but the discussion and debate underscored that scientific progress alone is not enough; sustainable funding, strong health systems and community leadership are essential to translate discovery into equitable access.
Read new blogs from AVACers who were on the ground at CROI: check out Cindra Feuer’s Hot Takes & Grace Kumwenda’s My CROI Notebook.
Momentum continues to build around the rollout of LEN — the latest scientific breakthrough for HIV prevention. LEN delivery is ongoing in Eswatini and Zambia, it’s been launched in Kenya and Zimbabwe, and initial supply has entered Lesotho, Mozambique, Nigeria and Uganda. AVAC, Access Bridge, and the Coalition to Accelerate Access to Long-Acting PrEP continue to track the progress. Here are the latest graphics.
Tracking the “America First” Bilateral Health Agreements
AVAC Board member Stephanie Psaki examines the emerging America First bilateral health Memoranda of Understanding (MoUs) and the questions they raise around financing, transparency and the future of global health engagement in this Think Global Healthpiece. AVAC and partners are tracking closely developments and their implications.
AVAC’s quarterly resources bring you the latest in biomedical HIV prevention research and STIs. The latest issue of PxWire showcases the status of access to oral PrEP with the best data available since the US foreign aid freeze disrupted PEPFAR operations beginning in January 2025.
The March issue of STI Watch focuses on a growing tension in the global STI response: real scientific and programmatic progress alongside persistent underinvestment, fragile systems and geopolitics.
My CROI 2026 Notebook: Science, Surprises, and the Big Question of Choice
Every year, the Conference on Retroviruses and Opportunistic Infections (CROI) feels like stepping into the future of HIV science for a few intense days. The coffee is strong, the slides are packed with data, and the hallway conversations are often as important as the plenaries. This year, I left with one big question echoing in my head: How much choice is enough in HIV prevention and treatment? That question showed up everywhere — from clinical trial design discussions to the rapidly expanding pipeline of long-acting products for both prevention and treatment. Here are a few highlights from my CROI notebook.
The Era of Choice Is Here… But Are Systems Ready?
Choice continued to be a recurring theme at this year’s conference. The field and science continue to build a menu of HIV prevention options: oral pills, vaginal ring and long-acting injectables administered at varying intervals, daily, 2-monthly, 6 monthly with the potential for even longer dosing intervals in the future. But choice also raises difficult questions. At the Long-Acting/Extended Release (LA/ER) Antiretroviral Research Resource Program (LEAP) Investigator Meeting held on the sidelines of CROI 2026, Carl Dieffenbach posed a provocative one: “There will be additional prevention choices developed, but the question remains: how many choices are necessary?”
Throughout the conference, we were reminded that health systems are not always designed to handle choice or complexity. Every new product brings new requirements — supply chains, provider training, redesigned delivery models, and, importantly, funding commitments, which are increasingly limited. Still, as AVAC has highlighted in the People’s Research Agenda, the message from communities is clear: people want prevention options that fit their lives and this conversation remains relevant.
Prevention is moving toward “Ultra-Long Acting”
If you follow HIV prevention science, you’ve probably heard the term “long-acting” more times than you can count. But at CROI this year, long-acting started to feel… almost short. Researchers are now exploring so-called “ultra-long-acting” prevention. A study on cabotegravir (CAB-ULA Extended 4M) explored whether injections could move from every two months to every four months. Researchers tested a range of doses and used pharmacokinetic modelling to predict how long drug levels would remain protective. The takeaway was that a 1600 mg injection every four months could potentially maintain protective drug levels, although an initial loading dose may be needed. It remains to be seen how different injectable options with varying dosing schedules will fit into the broader prevention landscape — and whether four-months of protection is actually “ultra-long-acting” in context.
If four-months sounded impressive, another study raised the stakes. Researchers are now exploring once yearly lenacapavir for PrEP. Using data from four Phase 1 trials and thousands of drug concentration measurements, researchers modelled a regimen that could maintain protective levels of lenacapavir for 52 weeks. The proposed approach would require two oral loading doses at the start (as with the current six-monthly LEN), followed by a 3000 mg injection once per year. The upcoming PURPOSE 365 trial will test whether this annual regimen really works in people. If successful, it could reshape HIV prevention. Imagine getting your HIV prevention once a year!
Additional follow-up data from the PURPOSE 1 study on the six-monthly injectable was also shared. During extended follow-up, two infections were reported: one participant who received injections on schedule, and another who missed a dose and discontinued lenacapavir, with HIV diagnosed 16 months after the last injection. This translates to a very low HIV incidence of 0.11 per 100 person-years, reinforcing the strong protective signal seen in earlier analyses. This update also underscores an important fact: there is no perfect product.
Expanding oral PrEP options?
We heard dosing data for MK-8527, an investigational oral drug being developed by Merck as a once-monthly PrEP pill. This data wasn’t totally new as it was also presented at CROI 2025 as a poster. Researchers presented further dose-selection data supporting the EXPrESSIVE Phase 3 trials, identifying 11 mg once per month as the dose predicted to maintain protective drug levels for a full month. Phase 2 studies, combined with pharmacokinetic modelling, showed that no dose adjustments are expected for pregnant participants or adolescents weighing more than 35 kg. If Phase 3 confirms safety and effectiveness, this monthly pill could offer a compelling middle ground between daily oral PrEP and long-acting injectables, adding another important option to the growing prevention toolbox. AVAC is supporting community engagement and Good Participatory Practice implementation throughout the trials and, in partnership with local organizations and communities, created demand generation materials for the trials.
A Two-in-One Implant: Preventing HIV and Pregnancy
Another fascinating early study looked at something many advocates have long called for: multipurpose prevention technologies. Scientists are developing a long-acting implant that could deliver dolutegravir for HIV prevention and levonorgestrel for contraception. Early animal studies suggest the implant could release drugs for up to a year. It’s still early days, but the idea is powerful: one product that helps address two major health needs at once. For many women, especially in high HIV burden settings, that could be transformative.
Innovation Isn’t Just About Products — It’s About Delivery
At CROI 2026 we saw examples of innovative service delivery models that bring prevention closer to people. A randomized study among postpartum women in South Africa showed that offering dynamic choice in how PrEP is delivered improved overall PrEP use, reinforcing a simple lesson: when people can choose how to access prevention, uptake improves. In another cluster randomized trial in Kenya, researchers compared pharmacy-based PrEP delivery models with traditional clinic-based services and found that pharmacy delivery particularly when PrEP was free and supported by HIV testing services (HTS) counsellors could successfully support both initiation and continuation of PrEP. These findings echo other promising models highlighted at the conference, including pharmacy-based PrEP study in Zimbabwe, the Person-Centred Care model in Zambia, and exploration of “post-exposure prophylaxis in your pocket.” Together, they signal a growing shift in HIV prevention, moving beyond clinic walls so people can access prevention through pharmacies, communities, and other everyday points of care. How this science translate into programs will be interesting to watch.
Rethinking Clinical Trials: What If People Choose?
One of my favourite sessions explored preference in pragmatic trial designs, a fascinating approach to clinical research. Instead of forcing participants into randomization, these trials ask: What if people could choose the intervention they prefer? Pragmatic trials can measure the preference effect, do people do better when they receive what they want? It’s a simple idea with profound implications. Many questions remain, including how to address potential bias, but this is one conversation I’m eager to continue following.
A Reality Check: The Funding Cloud
Amid the scientific excitement at CROI 2026, discussions repeatedly returned to the growing uncertainty in global HIV financing. In South Africa, more than 40% of clinics reported impacts, even among those not directly funded by PEPFAR, showing how deeply interconnected HIV systems are. Speakers also warned about silent disruptions such as reduced quality of care, weakened data systems, and strained services that may not immediately show up in the numbers. As Francois Venter of Ezintsha in South Africa noted, “the science may be racing ahead, but implementation and financing must keep pace if these breakthroughs are to reach people.”
My Biggest Takeaway
CROI 2026 made one thing clear, the future of HIV prevention and treatment is expanding rapidly. We are moving toward long-acting options that will include potentially once yearly prevention, but innovation alone is not enough. The real challenge now is ensuring that these tools reach the people who need them most and that communities have the information and agency to choose what works for them. Because in the end, the future of HIV prevention will not be defined by a single breakthrough; it will be defined by choices — across many facets and by many stakeholders.
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.
Global Health Watch: US Appropriated Science Funds Remain Frozen, Lenacapavir Rollout Advances + South Africa Pursues Local Production
Issue 58
This week four Latin American countries have signed bilateral health Memoranda of Understanding (MOUs) with the US under its America First Global Health Strategy. This new Think Global Health analysis examines gaps between country needs and new co-financing commitments with the US.
In this issue, we also look at delays in the release of US science funding, despite congressional approval, and new developments from South Africa and AVAC shaping the global rollout of HIV prevention options.
US Appropriated Science Funds Remain Frozen Despite Feb. 3 Law
One month after the US Congress passed a $50 billion foreign affairs spending bill, which the President signed into law, funding has still not begun flowing to several agencies that support scientific research. According to Nature, the Office of Management and Budget (OMB) has not yet authorized the release of all appropriated funds, leaving agencies unable to issue new grants. As a result, the National Institutes of Health (NIH) has not yet received approval to spend the research funding allocated by Congress, prolonging uncertainty for scientists and institutions awaiting support for ongoing and new research projects.
IMPLICATIONS: While Congress ultimately rejected the deep budget cuts proposed by the President, the delays underscore the broad expansion of the power of the Executive Branch and the fragility of the current political environment in the US. As we wrote in our February 6 issue, “uncertainty of whether global health and humanitarian programs will receive the funding Congress appropriated leave many reluctant to celebrate. Coordinated advocacy and sustained Congressional oversight will be needed to ensure all appropriated funds are obligated and spent.”
Lenacapavir Rollout Advances as South Africa Pursues Local Production
Momentum continues to build around the rollout of injectable lenacapavir for PrEP (LEN) across multiple countries. Four countries in East and Southern Africa have now launched LEN, with national launch events last week in Kenya and Zimbabwe. Eswatini and Zambia have already begun delivering LEN, and among the nine Global Fund to Fight AIDS, Tuberculosis and Malaria–supported early adopter countries, Lesotho, Mozambique and Uganda have also received initial supply. Nigeria is expected to receive shipments beginning next week. AVAC and the Coalition to Accelerate Access to Long-Acting PrEP continue to track the progress; see updated maps of regulatory approvals, initial programmatic access and implementation science.
In addition, this week, South Africa announced a new effort to enable local production of LEN, signaling growing interest in regional manufacturing. In October 2024, Gilead Sciences granted six voluntary licenses to generic manufacturers in Egypt (1), India (4) and Pakistan (1) to produce and supply generic LEN to 120 low- and middle-income countries. South Africa’s would mark a seventh voluntary license. As the majority of generic LEN is likely to come from Indian generic manufacturers (as four of six with licenses are from India), South Africa is looking to set up independent capacity and capability to be self-sufficient in the future.
IMPLICATIONS: The next phase of LEN rollout will depend on how quickly early launches translate into scalable, sustained access. A seventh license for a South Africa–based manufacturer could help accelerate the pathway from licensing to large-scale supply for regions most affected by HIV. Yet, it is not clear how long it might take the South African manufacturing to reach the market and at what price. In addition, the long-term sustainability of access remains uncertain amid broader disruptions to global health funding.
AVAC Announces New Partner in Product Introduction
Beginning a decade ago, AVAC expanded its advocacy work to include a focus on accelerating product introduction and access. This week, AVAC announced the establishment of Access Bridge, an independent Kenya-based organization advancing timely, sustainable and equitable access to HIV prevention, sexual and reproductive health and related health products.
Introducing Access Bridge, Our Partner in Product Introduction
As lenacapavir rolls out, Access Bridge is poised to meet the moment
Last week, Kenya became the fourth country in Africa to start administering lenacapavir (LEN) for PrEP — the injection that offers near perfect protection against HIV. Widely considered a breakthrough HIV prevention option, injectable LEN is scaling up at record speed, in no small part thanks to the coordinated efforts of advocates and civil society groups to push for accelerated processes.
LEN was launched in Eswatini and Zambia in December 2025 — just five months after the drug received US FDA approval — and in Kenya and Zimbabwe in February 2026. As implementation continues and more countries receive supplies, countries and communities need ongoing support to ensure LEN is delivered with speed, scale and equity, alongside other available PrEP options, to those who need it most.
It’s against this backdrop that AVAC is excited to introduce Access Bridge. Incubated over the past decade at AVAC as part of our Product Introduction and Access team, Access Bridge is an independent, Kenya-based nonprofit organization advancing timely, sustainable and equitable introduction of and access to HIV prevention, sexual reproductive health and related health products.
Led by Executive Director Wawira Nyagah, who led AVAC’s work in this area for the past five years, and a team of product introduction experts, Access Bridge brings a track record of proven success in moving HIV prevention options from evidence to real-world impact.
Building upon lessons learned from oral PrEP and injectable cabotegravir, the Access Bridge team has played a pivotal role in preparing the market for new products and in the initial rollout of LEN. Through high-level think tanks co-convened with WHO and the Coalition to Accelerate Access to Long-Acting PrEP, the Access Bridge team has aligned donors, Ministries of Health, civil society, researchers, and manufacturers around shared strategies and practical solutions. The Coalition’s leadership has helped shape the global LEN agenda, unlock regulatory and licensing pathways, increase pricing and supply transparency, and drive major procurement commitments and regulatory approvals across Africa.
The team worked closely with country stakeholders to establish a Ministry of Health Community of Practice fostering cross-country learning and supported civil society in LEN priority countries including across East and Southern Africa, to ensure community leadership, accountability and transparency throughout the introduction process. Through these initiatives and collaboration with AVAC on its trusted platforms such as PrEPWatch and the Global PrEP Tracker, Access Bridge acts as a trusted convener, translator and technical partner to countries as they prepare for LEN rollout in an expanding PrEP landscape.
As the Secretariat and lead of the Dual Prevention Pill (DPP) Consortium (combining oral PrEP with oral contraception), the Access Bridge team has driven the global effort to prepare for and introduce the DPP, enabling major progress across regulatory guidance, country planning, stakeholder engagement, and delivery systems, including private sector delivery, to position the DPP for introduction. Through this coordination, the consortium defined a regulatory pathway for multipurpose prevention technologies, advanced HIV/SRHR integration at country level, built broad stakeholder buy-in, and generated growing interest in integrated prevention solutions, moving the field closer to offering women a new dual-protection option. The team has also led efforts to harness private sector strategies for family planning to deliver the DPP. The team engages directly with commercial distributors, manufacturers, and social marketing organizations to strengthen distribution pathways, expand market reach, and identify opportunities to grow the commercial sector.
Access Bridge was purpose-built to meet this moment — an era marked by scientific breakthroughs and growing demand for integrated, people-centered care. AVAC looks forward to our continued and expanded work to accelerate R&D and product introduction of new options, and will partner closely with Access Bridge into the future.
Access Bridge was there as community health advocate, Samson Mutua, became the first Kenyan to receive lenacapavir at an event as Kenyan Health Cabinet Secretary Aden Duale looks on.
Global Health Watch: Zimbabwe steps away from US health MoU, new domestic funding in SA, LEN launched in Kenya + Zim, investment case for Global Fund
Issue 57
This week’s issue covers Zimbabwe’s decision to halt negotiations on its Memorandum of Understanding with the US for global health funding; new domestic funding in South Africa; a new investment case for US funding for the Global Fund; the launch of injectable lenacapavir for PrEP (LEN) in Kenya and Zimbabwe; and key takeaways from CROI 2026 on the links between science, funding, and delivery.
Zimbabwe Declines US Health MoU, Zambia May Follow
This week, the government of Zimbabwe formally terminated negotiations on the proposed Memorandum of Understanding (MoU) with the United States under the America First Global Health Strategy. In a public clarification, Zimbabwe’s Secretary for Information, Publicity and Broadcasting Services, Nick Mangwana, said the government’s decision followed an inter-ministerial review and reflected concerns that the draft agreement did not reflect an equitable partnership. While acknowledging the historic role of US health assistance, including PEPFAR, the government cited risks to data sovereignty and misalignment with Zimbabwe’s commitment to ongoing negotiations on the WHO Pathogen Access and Benefits Sharing (PABS) mechanism under Pandemic Agreement adopted last year. “Zimbabwe was being asked to share its biological resources and data over an extended period, with no corresponding guarantee of access to any medical innovations—such as vaccines, diagnostics, or treatments—that might result from that shared data,” Mangwana wrote. “In essence, our nation would provide the raw materials for scientific discovery without any assurance that the end products would be accessible to our people should a future health crisis emerge. The United States, meanwhile, was not offering reciprocal sharing of its own epidemiological data with our health authorities.”
Other countries are also taking critical reviews of their MoUs: Kenya’s MoU is suspended pending a court challenge. Zambia is reported to have rejected its agreement as well. A leaked draft has drawn criticism for containing weaker protections and more onerous terms than other agreements.
IMPLICATIONS: These developments, along with the abrupt withdrawal of other forms of US humanitarian assistance from seven African countries, raise serious questions about the power dynamics embedded in the new bilateral approach. For many governments, the choice may not be between partnership models, but between accepting unequal terms or losing support altogether, which puts health systems, sovereignty, and long-term equity at risk.
Following the termination of USAID grants in South Africa, the country’s Finance Minister announced new domestic funding (R26 billion) to provinces for HIV programs, with an additional R410 million to be reprioritized from the national Department of Health over the medium term to offset research grant funding withdrawn by the US. The new allocation is intended to support core interventions, including prevention of mother-to-child transmission and continued access to treatment.
IMPLICATIONS: South Africa’s response underscores both resilience and vulnerability in the current global health landscape. While the government’s decision to mobilize domestic resources reflects strong political commitment and a recognition that HIV programs are essential services, it also highlights the scale of the gap left by abrupt external funding withdrawals.
Following the conclusion of the Global Fund’s 8th Replenishment Conference last year, Friends of the Global Fight released a new FY2027 US Investment Case urging US Congress to appropriate funding in the fiscal year (FY) 2027 budget to protect hard-won gains against HIV, tuberculosis (TB), and malaria and to prevent further disruption to services already under strain. Advocates are calling on Congress to appropriate $1.533 billion for the Global Fund in FY27, or one third of the $4.6 billion US pledge for the 8th Replenishment. The investment case underscores the Global Fund’s role as a core pillar of global health security, highlighting its impact on saving lives, strengthening health systems, and advancing country-led responses.
IMPLICATIONS: This new call for continued US government investment comes just after the Global Fund fell short of meeting its $18 billion target and as the Board endorsed a shift toward a rolling, longer-term replenishment model, as well as greater emphasis on country transitions. Without predictable, robust donor commitments from public and private sectors, ambitions for achieving sustainability, methodical transition, and ending these three diseases will remain fragile.
Lenacapavir for PrEP launches in Kenya and Zimbabwe Amid Uncertain Future for Access
This week marked a major milestone for the rollout of lenacapavir for HIV PrEP (LEN). Both Kenya and Zimbabwe held national launch events to mark the rollout of LEN in their countries. Kenya received its first 21,000 doses last Friday and announced at the launch that the Global Fund committed an additional Sh256 million (approximately $2 million) to support rollout activities, including service delivery support, training, community engagement and systems to ensure consistent access. Zimbabwe’s initial phase of the rollout, supported by PEPFAR and the Global Fund, is expected to reach approximately 46,000 people across 24 sites.
IMPLICATIONS: These rollouts mark major milestones, but the future sustainability of access remains unclear. Scaling LEN beyond this initial phase will depend on reliable financing, supply chains, health workforce capacity and long-term political commitment, all of which are under strain amid broader disruptions to global health funding. Zimbabwe’s decision to decline the MoU with the US underscores this fragility: with the transition to conditional, transactional bilateral health arrangements, access to public health tools (like LEN) risks becoming vulnerable to shifting geopolitical priorities, rather than being guided by data and public health need.
CROI 2026: Progress in HIV Science, Pressure on the Systems That Deliver It
The Conference on Retroviruses and Opportunistic Infections (CROI) 2026 convened this week in Denver with a clear and urgent message: scientific progress in HIV treatment, prevention, and cure cannot be separated from the global infrastructure, sustained funding, public trust, resilience, and activism needed to sustain it. Across three and half days, researchers, policymakers, regulators and advocates heard advances—from durable PrEP options like lenacapavir and MK-8527 to advances in treatment, cure and vaccine research. And critical questions on whether the world is willing and able to currently and eventually deliver these tools equitably and at scale. Speakers warned that funding cuts, dismantled programs, and political interference threaten infrastructures that took decades to build, stressing that the interruption of HIV research and delivery “is not a policy choice.”
IMPLICATIONS: As the science accelerates, CROI made clear that access, delivery, and trust are the main challenges. Data presented on service disruptions after the foreign assistance freeze, alongside warnings about threats to PEPFAR and global HIV infrastructure (read this new Lancet comment), underscored that breakthrough science and innovation mean little if systems fail to deliver them equitably and at scale. Community advocates emphasized that “country ownership” must be matched by activism, real-time data, and accountability that runs in both directions.
AVAC’s continued coverage of CROI summarizes key themes from the final two days of the conference, including the vital importance of choice and steps needed to make choice a reality. See AVAC’s summary of the first two days of CROI here.
Day 3: From Innovation to Impact
Day 3 kicked off with a Community Breakfast Club focused on prevention science: From Innovation to Impact. Moderated by Adaobi Olisa of Root to Rise and AVAC’s Clinical Trial Design Academy, the conversation previewed data on PrEP, and panelists Renee Heffron from University of Alabama, Brian Minalga from the Office of HIV/AIDS Network Coordination (HANC), and Linda-Gail Bekker of the Desmond Tutu HIV Centre and AVAC Board member emphasized that scientific breakthroughs only matter if they reach communities and are implemented equitably, inclusively and at scale.
Progress and Challenges in STI Prevention and Treatment In a plenary session, IDSA CEO and AVAC Board member, Jeanne Marrazzo, highlighted advances and challenges in STI treatment and prevention. While DoxyPEP reduces syphilis among gay, bisexual, and other men who have sex with men and transgender women, the effect is not seen across all U.S. populations, and incidence of congenital syphilis continues to rise. Resistant gonorrhea remains a pressing challenge, but two newly approved antibiotics offer new treatment options. Marrazzo called for increased efforts to address structural barriers putting cisgender women at higher risk for STIs and for innovation in diagnostics, antimicrobials, and vaccine development. Read coverage of her plenary in AJMC.
Expanding Access, Improving Inclusivity Echoing Marrazzo’s plenary, various sessions underscored the need to address structural and scientific barriers to expand choice and deliver person-centered solutions to meet the needs of people and communities.
Gabriel Chamie presented data from the SEARCH study, a community health intervention pairing digital tools with tailored in-home HIV services provided by trained community health workers that reduced HIV incidence by 70%. The findings underscore the power of bridging communities and health systems through technology and locally driven care.
In a Malawi study presented by Deborah Hoege, people initiating long-acting injectable cabotegravir had higher continuation rates than those on oral PrEP (61% vs. 21% at month 1; 41% vs. 7% at month 5).
Rena Janamnuaysook shared how community-generated data from the Tangerine Clinic was used to advocate for gender affirming services in Thailand’s national health insurance program, reinforcing the power of community leadership, data, and policy advocacy to increase access to services for trans and gender diverse individuals.
Gabby Chromhout presented Azaphile pediatric ATI trial findings that about one-third of children treated as young as age 3 achieved remission. The data point to the critical importance of early ART initiation, potential sex differences in control, and the remarkable capacity of pediatric immune systems.
Gilead presented trial design and dose modeling for a new study testing once-yearly lenacapavir for PrEP. PURPOSE 365 is a single-arm, open-label study that will enroll 300 people who would benefit from PrEP. Based on population pharmacokinetic (PK) modeling, a dose of 3000 mg delivered intramuscularly was chosen, including 600 mg of oral loading doses on Days 1 and 2.
Andrew Hill highlighted the stark gap between PrEP need and access and suggested that more than 40 people must be reached with PrEP to prevent a single HIV acquisition – but that only 122 countries reached this 40:1 target. Only 2.3 million people are currently on oral PrEP, far below UNAIDS targets, and injectable cabotegravir and lenacapavir represent just 2.9% and 0.9% of use, respectively.
Edith Namulema presented findings from a study that trained taxi drivers to offer self-testing kits to friends, family, passengers, and other contacts. Over 12 months, they distributed 2,474 kits, of which 97% were successfully used. This helped identify new cases and connect people to care, reinforcing that community networks can expand HIV prevention.
Advances in Cure Research
Jeff Murray presented a promising new IL-15 molecule designed to target CD4 cells. In animal models, pairing this agent with bNAbs delayed viral rebound longer than comparators, but clade diversity questions mean cautious optimism as this advances toward human trials.
Katie Fisher highlighted the power and limits of autologous antibodies. In participants who achieved control in a bNAb study, strong autologous neutralizing antibodies and CD8 responses initially suppressed rebound virus. However, viral escape emerged after ~2 years, reinforcing that durable remission will likely require layered, combination immune strategies.
Brad Jones presented research showing how properly guided T-cell responses could gradually reduce viral reservoirs, offering a promising path toward HIV control and potential cure.
Focus on Long-Acting Treatment The final CROI Community Breakfast Club highlighted advances in long-acting HIV treatment. As moderator Sean Hosein of EATG noted, “while long-acting therapy may not be for everyone, it gives choice to many people.” Panelists highlighted sessions, demonstrating that science is moving fast. Community activist Shari Margolese noted that access is not keeping pace: “as a community we need to get much angrier about the fact that we can’t get access to the drugs.” Francois Venter of Ezintsha in South Africa warned that the field risks celebrating breakthroughs that never reach communities. He noted that without action, “we might be sitting here again in 10 years’ time” with innovation benefiting only a tiny fraction of people.
Subsequent CROI presentations included a range of long-acting treatment options in early development including a new injectable HIV-1 capsid Inhibitor, VH-499, which was found to be safe and generally well tolerated in its first human trial, suggesting that it could be dosed as infrequently as twice a year; GS-3242 data demonstrating a favorable safety profile, antiviral activity, and PK data supporting possible dosing interval of 3 months; and tolerability and PK data on VH-184 supporting long-acting dosing.
Progress in HIV Vaccine Design Kevin Saunders of the Duke Human Vaccine Institute delivered a plenary on the HIV vaccine research landscape. He outlined the germline targeting and discovery clinical trials that dominate the field, reminding the audience that developing broadly neutralizing antibodies (bNAbs) is a formidable scientific challenge. But progress is happening, and clinical and animal data shows it is possible to initiate and hone specific protective bNAb responses. He shared progress in developing CD8 T-cell inducing vaccines – there is consensus that a successful vaccine will ultimately need to induce both bNAbs and T-cells. He capped off his talk by describing how AI and machine learning are being used to identify mutations and sequences necessary for the germline targeting approach.
Looking Forward: Heading in the Right Direction As John Frater noted at the start of CROI 2026, this year’s conference is about the incremental steps that push boundaries and are “building out that evidence that gives confidence and strength to say we are moving in the right direction.” From innovative delivery models to advances in vaccine design, the science presented this week delivered exactly that.
Seeking more CROI coverage? Be sure to check out our friends at Aidsmap.
CROI 2026: Science, Solidarity and High Stakes for the HIV Response
CROI 2026 opened with a sobering message and defiant acknowledgment: progress in HIV treatment, prevention, and cure depends not only on scientific discovery, but also on global infrastructure, sustained funding, public trust, resilience, and activism that make science possible. Against a backdrop of funding cuts, dismantled programs, and growing political interference, speakers on the first two days of CROI warned that interrupting support for HIV research “is not a policy choice; it threatens infrastructures that took decades to build.”
Day 1: Opening Session
The call to collective responsibility followed presentation of CROI’s inaugural Lifetime Achievement Award to former Director of the National Institute of Allergy and Infectious Diseases (NIAID) Carl Dieffenbach, whose leadership at NIAID was consistently rooted in partnership—championing community engagement, global collaboration, and the principle that science only succeeds when it serves and engages the people most affected.
Sharon Lewin, Director of the Peter Doherty Institute in Melbourne, Australia, delivered the opening Bernard Fields Lecture with an expansive look at Thirty Years of Persistence, Progress, and Partnerships in HIV Cure Science, tracing how decades of basic research have shaped the many cure strategies now being explored. She highlighted the central challenge of the HIV reservoir—why infected cells remain hidden despite effective treatment—and how newer approaches are working to reveal, reduce, or control them. Lewin described innovative work using mRNA to deliver Tat, a viral protein that “wakes up” latent virus so it becomes visible to the immune system, as well as advances in CRISPR-based activation and immune-mediated control. Across these approaches, her message was clear: progress toward a cure is real, but it depends on sustained collaboration and investment across disciplines and communities.
The Martin Delaney Lecture was then presented by longtime activist Peter Staley, cofounder of Treatment Action Group and PrEP4All, who urged the field to prepare for what comes next. Tracing the shared evolution of activism and science forged during the early HIV epidemic, Staley described how advocates and researchers learned from one another, reshaping clinical trials, access programs, and ultimately the field itself. He was clear that today’s moment presents an equally grave challenge. Drawing stark parallels between past and present, Staley warned that renewed attacks on science, public health, and HIV programs—including threats to PEPFAR—are part of a broader authoritarian playbook in which dissenters and institutions are deliberately targeted. His message was unmistakable: the same collective power that transformed the HIV response in the earliest days must once again be mobilized to defend science, health, and human rights.
“Believe that the pendulum that has been swinging against us this past year will, if we fight for it, eventually swing back. You are a community that gives us miracles, with empathy as your driving force, you save lives, history will pull that pendulum back,” Staley said.
The Opening Session closed with Linda-Gail Bekker, Director of the Desmond Tutu HIV Centre and AVAC Board member, reframing HIV prevention through The ART of Prevention: People, Science, Progress. She offered a new “ABCs” for the current moment with a framework requiring scientific advances, political will, urgency and community-led action to end the epidemic: A calls on the field to Advocate, Agitate, Act, and Accelerate; B urges Bold scale-up of proven and emerging tools; and C emphasizes Creating demand, providing choice, and working with communities most affected.
Day 2: Spotlight on Cure and Prevention Science
AVAC’s Jessica Salzwedel opened Monday by leading the first of three Community Breakfast Club sessions, this one focused on HIV cure. In an excellent session, Salzwedel and leading cure researchers John Frater, Katherine Bar and Allison Agwu helped participants break down the complex landscape of cure approaches highlighted at the conference. Salzwedel summarized cure strategies as working in two complementary ways: strengthening the body’s immune system, and directly targeting the virus by waking it up, keeping it dormant, or cutting it out. “Most often, these work together in combination,” she noted, reflecting a recurring theme across CROI sessions.
That emphasis on combination and durability carried into new prevention research presented at the conference. New PrEP research underscored the durability of new PrEP options and the importance of strong delivery systems to support their impact.
In the first plenary of the day, Ilesh Jani of the Instituto Nacional de Saúde in Maputo, Mozambique, reviewed progress in HIV over the past 30 years, described the challenges the past year has brought, and highlighted “4 I’s” in the way forward: Integration, Inclusion, Innovation and Impact.
In the second plenary session of the day, Wes Sundquist of the University of Utah described the HIV capsid and its importance in the development of LEN. His research collaborations, which began in the early 1990’s, led to understanding the structure, functions, and inhibition of the HIV capsid. As he shared with AVAC on a June webinar, “LEN didn’t emerge overnight. It’s the result of patient, persistent basic science—of believing we could understand a virus deeply enough to target it effectively.” He closed by reflecting on the “bench to bedside to community” journey that made LEN possible, crediting clinicians, regulators, and community activists, and warned that while the field now has “a really powerful new tool in the arsenal,” forces are blocking its use. “It will be a human tragedy,” he said, “if we don’t overcome those.”
Data on dose selection for the investigational monthly oral PrEP candidate MK-8527 showed that a once-monthly 11 mg dose could maintain protective drug levels in at least 95% of participants, including pregnant people and adolescents, while allowing an additional week of coverage for late doses. The cumulative data from Phase I and II studies informed the dose selection in the newly launched Phase III EXPrESSIVE efficacy studies.
Long-term follow-up of the ANRS PREVENIR study, presented by the study’s Principal Investigator, Jean Michel Molina, assessed 3,209 PrEP users in France across more than 13,000 person-years. Results showed HIV incidence of 0.11 per 100 person-years, with no significant differences between daily, on-demand, or switching regimens, reinforcing PrEP’s real-world effectiveness.
Resistance data from the PURPOSE 1 and PURPOSE 2 lenacapavir for PrEP (LEN) trials were presented by Stephanie Cox of Gilead, which showed that across both studies, resistance was rare and occurred in the context of waning drug levels of monotherapy. Of two HIV acquisitions occurring among participants taking LEN in PURPOSE 1, one was diagnosed at Study Day 365 with the capsid resistance–associated substitution N74D, while the other acquired HIV at Study Day 670, more than a year after their final LEN dose and with no resistance observed. In PURPOSE 2, two previously reported participants developed the N74D capsid substitution, while one newly identified case developed Q67H+K70R. The five total infections across the two trials highlight that while not perfect protection, LEN is clearly a remarkably safe and effective prevention option.
What’s at Stake: Funding, Evidence and the Human Cost
The first two days of CROI made clear that the systems needed to deliver scientific advances to the real world are at extraordinary risk. Jen Kates of KFF opened the session Sleepless in Denver: Impact of Funding Changes on HIV Care by describing a “fundamental rupture” in global HIV service delivery following the US Administration’s funding and policy changes. PEPFAR, one of the most consequential global health achievements, has saved more than 25 million lives since 2003. In a post-foreign-assistance freeze world marked by a dissolved USAID and disrupted services, Kates emphasized that concern about human impact is widespread and so should be concern for real-time data.
New research presented during the session began to do just that. Aaron Richterman shared results from a rapid survey of AIDS Drug Assistance Programs across three US states showing that 47% of clinics reported HIV service disruptions, including medication shortages, while Lindsay Vlatru reported that 40% of clinics in KwaZulu-Natal experienced disruptions affecting an estimated 830,000 people with HIV. Speakers warned that these disruptions threaten the resilience of HIV prevention and care systems and risk long-term population health consequences. Moving ahead means closing evidence gaps and finding ways to gather real-time data on how these funding changes are affecting people’s lives.
Speaking on behalf of communities and partners across Africa in the symposium session, Strategic and Resilient Responses to the Funding Crisis Across Africa, Solange Baptiste, Executive Director of ITPC and AVAC Board member, shared the effects of the foreign assistance freeze. “When finances pause abruptly, it’s not just a marginal adjustment, it’s really a systemic shock… where the speed and the severity of those cuts really matter.”
She showed how confusion, service interruptions, and loss of trust followed. Referring to Geoff Garnett’s presentation on the impacts of funding shifts, Baptiste noted that what is really missing from national data and mathematical models “is the community intelligence” to see the full picture. Meeting this moment, she said, requires a response that is “country owned, but community driven,” and that vision must be backed by action. “Community power has to be funded, not just praised,” engagement must be “baked into the design” of programs rather than added on later, and accountability must be “bi-directional,” with communities recognized as “co-pilots and co-architects,” not just watchdogs.
Looking Ahead
Across the first two days of CROI, it’s clear that the science is advancing, the tools are within reach, and that “we share a responsibility to defend and sustain funding for international HIV programs and research,” as Nicolas Chomont, CROI Conference Chair from Université de Montréal in Canada, said in the Opening Session. As the conference continues, the challenge is not only to push the science forward, but to ensure that science can be delivered, equitably and at scale, to everyone who needs it.
Community Breakfast Club
Join CROI, AVAC, EATG, Fiocruz, TAG, and other partners tomorrow at 7:00am MT for the last virtual Community Breakfast Club webinar on Advances in Long-Acting HIV Treatment: Science, delivery and equity. Register here.
And be sure to follow our partner, Aidsmap, as they report during the conference and afterward.
