November 11, 2026
Idah Mulala, CTDA Member and Ascend Futures Foundation Programmes Manager, Zambia
When I joined AVAC’s Clinical Trial Design Academy (CTDA) in 2024, I thought it would be like joining any other group where we meet, discuss, learn and move on. I did not fully appreciate how much the experience would transform my understanding of clinical trials, nor how I saw my role as an HIV prevention research advocate.
Since joining the CTDA, my knowledge and capacity have grown tremendously. From exploring evolving clinical trial design concepts such as counterfactuals, double dummy trials and open- label studies, to understanding the basics of immune cells, broadly neutralizing antibodies (bNAbs) and correlates of protection, the journey has challenged me to think differently about clinical research and the role communities must play in it. It has also challenged me to reflect on what research advocacy looks like in the context of upstream research, particularly when some products are still in the very early stages of development.
The biggest shift for me has been moving from implementation and access advocacy to research advocacy, where the intervention or product is not yet available. It has meant finding my voice in research conversations, which require a different set of knowledge, skills and capacity. Sometimes these conversations are harder because you are engaging with scientists, product developers and funders who speak a different language and approach issues from a different perspective. But through the CTDA engagement, I have learnt just how critical this type of advocacy is. I now have a stronger understanding of clinical trial protocols, Good Clinical Practice (GCP) and Good Participatory Practice (GPP). More importantly, I have become more confident in engaging with researchers and product developers, asking informed questions and connecting scientific discussions to the realities, priorities and concerns of the communities I represent. Through this, I have come to appreciate how important it is for communities to have a voice early in the research process, when there is still an opportunity to influence what products get developed and how they are developed, so that they respond to community needs and ultimately make a meaningful impact.
For me, CTDA has been much more than a learning opportunity. It has changed how I approach my advocacy work. I no longer see community engagement as simply sharing information or ensuring that communities are consulted. I increasingly see it as ensuring that communities have the knowledge, confidence and opportunity to influence the questions researchers ask, how trials are designed and implemented, and how decisions about new health technologies are made.
“For me, CTDA has been much more than a learning opportunity. It has changed how I approach my advocacy work. I no longer see community engagement as simply sharing information or ensuring that communities are consulted. I increasingly see it as ensuring that communities have the knowledge, confidence and opportunity to influence the questions researchers ask, how trials are designed and implemented, and how decisions about new health technologies are made.”
From Learning to Influence: Opportunities That Have Changed My Advocacy
One of the clearest examples of how the CTDA has shaped my work was the opportunity to attend the Collaboration for AIDS Vaccine Discovery (CAVD) meeting, supported by the Gates Foundation in 2025. It was one of the most scientifically complex meetings I had attended to date. Yet, my foundation of research literacy from the CTDA enabled me to engage in the discussions with scientists. Having a front-row seat to these presentations helped me think through how I could help my communities back in Zambia be excited and informed about the promise of an HIV vaccine, but also to help manage expectations around the very real, difficult scientific discoveries yet to be made. Again, I was also reminded that it’s not just the late-stage, large-scale research that we need to engage with; we also need to sit with the tough, technical upstream science, and maybe most importantly, remind researchers of how it should be situated within the rest of the HIV response.
The CTDA has taught me the importance of engagement across the entire R&D pipeline, from early clinical trials through to efficacy studies, while also thinking ahead about how to translate clinical trial results into regulatory discussions and eventual product introduction. In 2024, I had the opportunity of attending a closed partners’ meeting on the side of the HIV Research for Prevention (R4P) Conference in Peru with Gilead Sciences, the developers of lenacapavir (LEN). After tracking the progress of the PURPOSE trials through the CTDA, being in a room with the developers of a product that could transform HIV prevention was a defining moment for me. It was an opportunity to move beyond following trial updates and apply the skills I had developed, engaging directly with the people at the centre of the science. What stood out for me was that the conversations in the room were not just about the science or trial results, but also about what would happen next and what this would mean for communities. We raised questions about when there would be clarity on the price of LEN, what access would look like for communities, what would happen to trial participants after the release of trial results and how regulatory approvals could be expedited to help countries prepare for introduction and scale-up. These have become some of the most important advocacy issues around LEN in countries we come from and at the global level.
That experience reinforced something important for me: community advocates must be equipped to do more than celebrate scientific progress. We must be able to ask – and push decision-makers to answer – difficult questions about who will benefit, under what conditions and when.
The shift in my approach to advocacy matters in Zambia, my home country. Here, we’re in the midst of the promise of new HIV prevention options, but are still actively, continuously pushing on access and equity issues. The engagement my colleagues at Ascend Futures Foundation and I had in the PURPOSE research program gave us the solid ground to push for LEN access. Understanding and engaging with the trial process, outcomes, regulatory processes and community perceptions strengthened our positions and our power to work with Gilead and national stakeholders to translate research into reality. As a result, it’s happening faster than ever.
What I Am Carrying Forward: Keeping Community Priorities at the Centre of Innovation
This year’s CTDA meeting was an incredible learning opportunity and a reminder of how exciting the HIV research pipeline has become across prevention, treatment and cure research. From monthly oral alimatravir (AMI) and the three-monthly vaginal ring to four-monthly injectable cabotegravir (CAB) and annual injectable LEN to investigational vaccines and bNAbs for prevention; weekly oral islatravir (ISL)/LEN combinations and long-acting CAB/rilpivirine (RPV) for treatment; and HIV cure research exploring a range of approaches to eliminate HIV from the body or achieve sustained control off therapy, the possibilities continue to expand.
As I reflect on these developments, my biggest takeaways from the Academy go beyond the science to the communities that will drive it and shape the future of prevention, and there is still so much work ahead:
- In the coming months and years, advocates will need to continue playing a strong accountability role in HIV R&D. This means tracking key developments in the field, translating scientific information for communities and preparing them for what is coming, including potential new products such as AMI for prevention and ISL/LEN for treatment. At the same time, we must continue advocating for equitable access to products that have already been proven effective.
- Advocates also need to remain engaged in upstream HIV research, including HIV vaccines, bNAbs and multipurpose prevention technologies (MPTs). These are areas where community voices and advocacy remain critical, even when products are still in the early stages of development. Now more than ever, the field needs stronger advocacy and more voices to protect the science, influence research priorities and ensure that the needs of communities remain at the centre of HIV R&D.
- The People’s Research Agenda (PRA) – a community-driven agenda for HIV research – must remain a living body of evidence that continually informs HIV research, innovation and the road that will lead to access to new HIV products. We must continue asking whether research is responding to the priorities of the people it is intended to serve. Are communities helping shape research questions? Are their preferences and lived experiences informing trial design? Are the concerns of young people, women and other communities disproportionately affected by HIV being heard? And are we thinking about access early enough, rather than waiting until a product is ready for introduction?
I am carrying these takeaways with me into my work in Zambia. I want to continue strengthening community understanding of clinical research, supporting meaningful participation and ensuring that community priorities inform discussions with researchers, policymakers and product developers. I also want to keep connecting emerging scientific evidence to the practical issues that matter to communities, including access, affordability, informed choice and accountability.
I want to see a future where community advocates from Zambia and across Africa are not merely invited into clinical research spaces to represent communities, but instead are equipped like I have been through the CTDA to understand the science, challenge decisions and influence how research translates into accessible prevention and treatment options.
“I want to see a future where community advocates from Zambia and across Africa are not merely invited into clinical research spaces to represent communities, but instead are equipped like I have been through the CTDA to understand the science, challenge decisions and influence how research translates into accessible prevention and treatment options.”