Anna Miti is a journalist, media trainer and advocate. She is the current chairperson of the Health Communicators Forum of Zimbabwe. She works with the Humanitarian Information Facilitation Centre to convene media science cafes in Zimbabwe.

In July 2021, The Health Times of Zimbabwe reported that the Medicines Control Authority of Zimbabwe approved the monthly Dapivirine Vaginal Ring for use as an HIV prevention tool, making Zimbabwe the first country to do so. This news is a milestone in a longer process of approvals and recommendations that was triggered when the ring received a positive scientific opinion from the European Medicines Agency in July 2020 for its use among women ages 18 and older in non-EU countries with a high disease burden. Next came WHO prequalification in November of 2020. Then, in January of 2021, WHO issued a recommendation for the ring as an additional prevention choice for women at substantial risk of HIV infection. Following these actions from the WHO, news of the approval of the ring in Zimbabwe generated a lot of excitement, locally and elsewhere, as this tool is one of the few HIV prevention methods that are solely within the control of women. The ring can be used covertly or overtly to reduce their chances of getting HIV.

I am excited too, but I’m not sitting down to rest with congratulations on my lips.

There is a popular song in Zimbabwe called Kure whose lyrics go “kwatinobva kure, kwatinoenda kure”—loosely translated to mean, “We have come a long way, but we still have a long way to go”. I’m singing that song as I consider the news of the approval of the Dapivirine Vaginal Ring in Zimbabwe. This journey has been really long. People have been struggling to push forward an option women control and can use discreetly for decades.

Over the years, some microbicide and PrEP studies showed promise, others ended with disappointing results (see box). But advocates, researchers, champions of women’s health, of women’s rights, of HIV prevention, we all pushed on. Researchers were exploring drugs such as tenofovir, using different delivery methods such as gels and films. It was not until 2016, when the results of two large-scale studies of the Dapivirine Vaginal Ring, ASPIRE and RING, that a woman-controlled option showed significant efficacy in HIV prevention. Five years later, the world has its first approval. Now, in the days, weeks and months to come, so much needs to be done. Women who need the ring must be able to find it when and where they look for HIV prevention, and they need to know about it, with every question answered, to feel empowered to choose it.

New research from AVAC and partners shows promising approaches to reach adolescent girls and young women (AGYW) with comprehensive and integrated services for HIV prevention and sexual and reproductive health (SRH), including expanding access to existing and future PrEP products. Assessments in Kenya, Malawi and Zimbabwe reveal lessons that can be applied across countries and identify areas for further investment to spur integration. Integration of HIV and Sexual and Reproductive Health in the Era of ARV-Based Prevention: Findings from assessments in Kenya, Malawi and Zimbabwe is now available on Gates Open Research.

Join us and representatives from the Ministries of Health in Kenya, Malawi and Zimbabwe, Pangaea Zimbabwe AIDS Trust (PZAT) and Georgetown University’s Center for Innovation in Global Health for a webinar on October 14, 8-9am ET / 2-3pm CAT / 3-4pm EAT to discuss these findings, progress to date and context-specific realities. Register here for the webinar.

Background

Though substantial progress has been made to curb the HIV epidemic over the past decade, high rates of new HIV infections persist among AGYW in sub-Saharan Africa, reflecting critical gaps in reaching them with integrated HIV prevention and SRH services. With the scale-up of oral PrEP, and introduction of novel HIV prevention products on the horizon, countries have a unique opportunity to expand innovative approaches to deliver HIV/SRH services and improve health for millions of people.

Advocacy Resources

There is still much to be done to fully realize the integration of HIV prevention with SRH. SRHintegration.org and www.avac.org/advance-hiv-srh-integration offer resources to inform advocacy for policies and programs to make these changes a reality.

AVAC applauds the Biden-Harris Administration on the nomination of John Nkengasong, a bold and inspiring choice, as the next US Global AIDS Coordinator to head the President’s Emergency Plan for AIDS Relief (PEPFAR), one of the most dynamic and effective foreign assistance programs ever developed.

Through four presidential administrations, PEPFAR has provided lifesaving HIV treatment to more than 18 million people in 50 countries and ensured access to prevention for tens of millions more. John Nkengasong is the right person at the right time to lead a program that has demonstrated its unique and unmatched value in the global AIDS response, but which also faces significant challenges in the future.

“John is exceptionally well qualified to confront those challenges, including increasing PEPFAR’s impact in the face of COVID-19 and building a foundation for pandemic preparedness and global health equity,” said AVAC Executive Director Mitchell Warren. “He is a highly accomplished scientist and administrator, known and respected in both the global North and South, with a strong commitment to global health equity. His work in establishing the African Society for Laboratory Medicine provided a critical foundation for PEPFAR effectiveness, and the rapid response to COVID under his leadership of the Africa CDC has been a shining light in the global pandemic response.”

“PEPFAR has been conceived as a partnership with other governments and communities, and Dr. Nkengasong has shown in his leadership at the Africa CDC that this is core to his approach. And hopefully his connections, relationships and track-record will help PEPFAR move even further and faster to ensure mutual accountability, co-financing with local governments and sustainability in building health infrastructure for HIV and pandemic response and prevention generally,” said Warren.

As the first person of African origin nominated for this position, John’s appointment also represents a major step toward the goal of ensuring that programs such as PEPFAR continue to incorporate and benefit from the perspectives and leadership of people from the regions in which these programs work.

“John has the passion, vision and experience to build on the noteworthy accomplishments of his predecessors and the unyielding commitment to following the data and engaging communities of current Acting US Global AIDS Coordinator Angeli Achrekar,” said Warren. “AVAC welcomes John’s appointment to this critical post and looks forward to working with him toward our shared goals of ending the AIDS pandemic and ensuring global health equity.”

For more than a decade AVAC Fellows have been building a movement for choices, access and equity in HIV prevention, from research to rollout. 77 Fellows and 67 partner organizations from 14 countries have put HIV prevention on the map since 2009. AVAC is currently accepting applications until October 12th for the 2022 class of Fellows. Bring HIV prevention home, apply here.

Today, world leaders attending the 76th United Nations General Assembly (#UNGA76) will join a US-convened Global COVID-19 Summit. While this meeting will tackle key decisions about how the world will respond to COVID-19, including targets for vaccination, oxygen, diagnostics, personal protective equipment (PPE) and financing, this meeting must also set an action plan for global pandemic preparedness for years, and even decades, to come.

Commitments and targets this week must translate into actions and accountability mechanisms that lay the groundwork for integrated, equitable and coordinated responses for COVID-19 today and future pandemics of tomorrow.

Below you will find resources on the issues that AVAC and partners have been advancing in the hope for equitable and resilient global health in the months and years ahead. Join us as we advocate for action now!

Framework for a Global Action Plan for COVID-19 Response

The global COVID-19 crisis demands leadership and a global plan of attack. A coordinated, global response must be grounded in equity at all levels – global, regional, national, subnational and community. A robust and effective response to the current crisis is also the best foundation for strengthening health systems and for future pandemic preparedness. At today’s “Global COVID-19 Summit: Ending the Pandemic and Building Back Better,” leaders must commit to the actions detailed in the Framework For a Global Action Plan for COVID-19 Response developed by the Pandemic Action Network and strongly supported by AVAC and partners. Read the full Framework here.

Ensuring #VaccinEquity

Breaking the Bottlenecks to COVID19 Vaccine Access identifies the critical steps to ensure global vaccine equity. Multiple factors are contributing to bottlenecks in the global supply of COVID-19 vaccines, and ensuring equitable global access will require multiple, simultaneous policy approaches: vaccine donations PLUS suspending patents PLUS technology transfer PLUS building manufacturing capacity PLUS ensuring easy access to raw materials.

Scaling Up Capacity

Calling on the Biden Administration to Scale Up mRNA Vaccine Manufacturing Capacity — This joint letter with more than 100 cosigners calls on the US administration to rapidly scale up mRNA vaccine manufacturing capacity to reach approximately 4 billion people by the end of 2021.

Funding for Resilient Health Systems

The Global Fund: A foundation for health equity — AVAC and partners have called on the US administration to lead a movement to reimagine the Global Fund and its potential in serving as the global funding mechanism for transforming health systems around the world to meet the challenge of COVID-19 and future pandemics.

Whether the next global pandemic lies years in the future or just months down the road, the time is now. We call on world leaders this week to translate commitments and targets into action plans.

The latest entry in the Protecting Global Gains series, In Thailand, Telehealth Moves PrEP Out of the HIV Clinic, profiles how Thailand trained lay providers—health workers without formal medical certifications—adapted to offer PrEP at community clinics nationwide during the pandemic.

The lockdowns and social distance protocols triggered by COVID-19 have led to devastating disruptions to health services in Thailand and around the world. Many countries report as many as 75 percent of their HIV services, including PrEP, have been impaired. Yet, flexibility and adaptability have paid dividends for connecting people to HIV prevention services. This update from Thailand explores a model of PrEP delivery in which lay providers relied on virtual consultations with medical staff to connect clients to a one-month supply of PrEP, and how this model proved instrumental to sustaining access to PrEP during COVID-19.

This model from Thailand, pioneered by the Bangkok-based Institute for HIV Research and Innovation (IHRI), demonstrates one more case of innovation. Other case studies, highlighted on the PGG website, show how health services that are community-centered and client-focused are especially resilient, able to quickly solve problems, sustain effective care, and minimize disruptions from the impact of COVID-19 and protecting lives.

Follow the Protecting Global Gains series on social media at @hivpxresearch, @theglobalfight, @Amref_Worldwide and #ProtectingGlobalGains, and consider amplifying these stories on your own social media. Advocates can call for national and international action to support the Global Fund’s COVID-19 response and for continued investment to end the TB epidemic. Visit www.protectingglobalgains.org to learn more about how to take action.