Lenacapavir: The case for investing in delivering HIV prevention

The promise of long-acting PrEP has been super-charged this year by studies showing the powerful efficacy of an antiretroviral known as lenacapavir (LEN).

This episode of PxPulse goes deep on LEN for PrEP. Recorded just days before Gilead’s announcement that PURPOSE 2 also found very high efficacy, Dr. Flavia Kiweewa, a principal investigator of PURPOSE 1, the first trial to announce efficacy, lays out the research findings and what they mean. And Chilufya Kasanda Hampongo of Zambia’s Treatment Advocacy and Literacy Campaign and Mitchell Warren of AVAC talk about how to change a long history of squandered opportunities to get rollout right.

The PURPOSE1 trials announced findings in June that a twice-yearly injection of LEN was 100% effective among cisgender women, with zero new cases of HIV. And the PURPOSE 2 trial among cisgender men, and trans and non-binary people, was shown to reduce the risk of HIV by 96%.

LEN now enters a select category, one of five ARV-based options for PrEP that all protect against HIV if you take them. But many of the people applauding the results from PURPOSE 1 and 2 will tell you that breakthrough science like this is, as hard as it is, is still the easy part. To break the back of the HIV epidemic demands overcoming an altogether different challenge—coordinating and accelerating every step in rolling out new products so that everyone who needs HIV prevention can get it.

Listen to this podcast to learn what must be done to finally deliver on the promise of highly effective HIV prevention, from pills to rings to injectable PrEP and beyond.

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PxPulse: An Advocacy Chronicle on U=U in South Africa with Mandisa Dukashe

On this episode of PxPulse: The Advocacy Chronicles, Mandisa Tyadi Dukashe, Treatment Technical Lead at the South African National AIDS Council (SANAC) describes her work in helping to inspire and launch a National U=U Campaign in South Africa in 2024.

What is U=U? Undetectable equals Untransmittable refers to a major breakthrough in the science and understanding of HIV treatment. From data published in 2019, researchers confirmed that people living with HIV who have an undetectable viral load and take medication as prescribed have zero risk of transmitting HIV to their sexual partners.

This evidence galvanized a worldwide campaign, with the hope that spreading the word, Undetectable equals Untransmittable, would reduce stigma around HIV and inspire people to maintain their treatment. 

The WHO released guidance in 2023 on how to monitor viral load, which provided supportive global policy for ministries of health. But WHO action is not enough to set public health policy or fulfill the promise of U=U.

Mandisa has long list of credentials behind her: She’s the co-founder of the U=U Africa Forum, part of the U=U Global Community Advisory Board, an alumnus of the AVAC Cure Research program and the AVAC Advocacy Fellows Program. Among many accolades, she has also been recognized as a 2021 Amazing People Living with HIV by HIV Plus Magazine.

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PxPulse: The Advocacy Chronicles with Ruth Akulu

On this episode of the Advocacy Chronicles: a look at advocacy in Uganda for the Dual Prevention Pill (DPP), a new product combining oral PrEP and oral contraception.

Ruth Akulu is a Youth Representative of the Uganda Country Coordinating Mechanism Board for Global Fund, member of the DPP Civil Society Advisory Group, and a 2022 AVAC Advocacy Fellow. Akulu talks about her work to mobilize regulatory authorities to prepare for the DPP. And while she was at it, the establishment of a groundbreaking new initiative, the Product Regulator’s Engagement Committee, which is supporting ongoing engagement between government regulators and young women representing their communities.  

Listen to learn why the DPP is a priority for young women and HIV prevention, the challenges Ruth confronted and tactics that supported the success of this advocacy.

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PxPulse: The Advocacy Chronicles with SMUG’s Allan Mwasa

On this episode of The Advocacy Chronicles, we’re speaking with Nsubuga Allan Mwasa, a Ugandan activist, clinical psychologist and an advocate for mental health and LGBTQ+ rights. Allan serves as Strategic Initiatives Manager at Sexual Minorities Uganda, or SMUG, which has been at the forefront of the fight for LGBTQ rights, often facing severe challenges including legal battles and violent opposition.

Despite these challenges, SMUG continues to advocate for the fundamental human rights of the LGBTQ community. It does this through legal action, public awareness campaigns, and international advocacy. SMUG is also part of Convening For Equality Uganda, or CFE, a coalition of civil society groups dedicated to challenging Uganda’s Anti-Homosexuality Act. The Anti-Homosexuality Act (AHA), signed into law in May 2023, significantly increased discrimination and violence against the LGBTQ+ community. Despite widespread international condemnation and ongoing legal challenges, the law was upheld by the Constitutional Court in April 2024. Petitioners have since filed an appeal to the Supreme Court seeking to overturn the law, which remains one of the strictest in the world, including life imprisonment and death penalty for certain offenses.  

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Follow the Conversation at Convening For Equality Uganda’s Social Media Accounts

An HIV Vaccine: Looking into the Future with Nina Russell 

On HIV Vaccine Awareness Day in 2024, the field is confronting extraordinary breakthroughs and extraordinary challenges.  

It’s considered one of the most important and most difficult scientific enterprises in the history of modern medicine—the hunt for an HIV vaccine. It has led to vast knowledge of HIV and the immune system, and to breakthrough technology (think COVID vaccines and mRNA platforms). But developing an effective HIV vaccine is still out of reach. Meanwhile, HIV incidence remains intractably high in hard-hit regions around the world, even as the field is hoping to speed up access to longer-acting PrEP. It’s a complex landscape, alongside incredibly complex science in HIV vaccine R&D.

In this episode of PxPulse, Dr. Nina Russell, Director of TB & HIV Research and Development for the Bill and Melinda Gates foundation, talks about where she sees promise in the science, the goals for an HIV vaccine, and why it has an essential role to play, alongside the scale up of PrEP.

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PxPulse: The Advocacy Chronicles with APHA’s Yvette Raphael 

Our debut episode of the Advocacy Chronicles features Yvette Raphael, the Executive Director of Advocacy for Prevention of HIV and AIDS (APHA) in South Africa, and a leader in the development of The Choice Manifesto, supported from start to finish by CASPR.

As co-chair of the African Women Prevention Community Accountability Board (AWPCAB), Yvette and other board members launched the manifesto in Kampala, in September 2023, calling for choice in HIV prevention options for women — such as oral and injectable cabotegravir for PrEP, the dapivirine vaginal ring and the Dual Prevention Pill — and a commitment to expanding access to them. A call heard by UNAIDS Executive Director Winnie Byanyima, who was on hand at the launch to endorse the manifesto.  

Yvette, who is also a 2014 AVAC Advocacy Fellow and celebrated as one of South Africa’s leading human rights activists, lays out why The Choice Manifesto matters and how advocates are leveraging it. 

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Decolonizing Global Health: Dr. Madhukar Pai and COMPASS Africa Tell Us Why and How

Produced and hosted by Jeanne Baron.

Investing in the long-term success of African leadership is essential to breaking cycles that perpetuate inequity and that stall progress in the HIV response. In January, The Coalition to build Momentum, Power, Activism, Strategy and Solidarity (COMPASS Africa) announced a major transition, with Pangaea Zimbabwe assuming the role of secretariat and the launch of a decentralized approach to governance across the coalition. These changes come as other efforts, such as negotiations on the Pandemic Accord, are struggling to advance, uphold or safeguard equity.

In this episode of PxPulse, we talk about why and how the decisions that shape global health must be made by those facing the greatest risks. As the world evaluates the pandemic response and debates on decolonizing global health gain momentum, equity in global health has never been more urgent. 

This conversation features global health leader and critic, Dr. Madhukar Pai. And two members of the transnational coalition COMPASS Africa, Francis Luwole and Barbra Ncube, offer an up-close look at the coalition’s pioneering new model for power-sharing.

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Inclusion of Pregnant and Lactating People in HIV Research

What you need to know 

Produced and hosted by Jeanne Baron

People who are pregnant or lactating (PLP) have historically been excluded from research because of concerns for the developing fetus. But this has led to a dearth of data on new interventions against health threats for this population. In the case of HIV, pregnancy raises the risk of acquiring HIV by up to three times, but providers often do not have the data to know whether a new intervention is safe or how it will work for pregnant patients. As a result, PLP and their physicians are left to make difficult decisions around the use of proven HIV prevention products as they await more data specific to pregnancy and lactation. 

But change is in the air. Champions for the inclusion of PLP in research are paving the way for a paradigm shift—one that will redefine this population from needing protection from research to being better protected through research. In this episode of Px Pulse, AVAC’s Manju Chatani-Gada takes us through conversations with a trial participant who became pregnant, researchers, policymakers and donors to understand why this population gets excluded, the impact it has and what to do about it.   

Tune it to hear:

  • Dr. Anne Drapkin Lyerly, Principal Investigator of the PHASES Project to advance equitable inclusion of pregnant women in HIV research and its follow-on project, PREPARE, focused on ethical HIV research in adolescents who are pregnant. 
  • Elisia Madende, trial participant in the HPTN 084 trial in Zimbabwe 
  • Dr. Ashley Lima, Health Science Specialist and Lead Technical Advisor for Socio-behavioral Research — USAID Office of HIV/AIDS Research Division 
  • Dr. Takunda Sola, HIV Prevention and Key Populations Medical Officer — Zimbabwe MoH AIDS/TB Unit 

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PEPFAR at 20: Keeping the promise

2023 is a big year for PEPFAR. Considered one of the greatest US foreign policy and global development achievements of the century, the program has saved upwards of 25 million lives since it launched in 2003. But PEPFAR is marking its 20th anniversary while fighting for its future.  

Its authorization expires September 30. Until a couple of months ago, most expected smooth sailing in the US Congress for a five-year reauthorization of the program. PEPFAR has enjoyed deep and broad bipartisan support since its founding. Evangelical Christians, staunch conservatives, DC Democrats, progressive HIV activists, and public health leaders have championed PEPFAR, year in and year out. But a handful of Republicans, including past PEPFAR allies, are pulling reauthorization into high-stakes partisan politics. 

In this episode, Px Pulse talks to some of the people who put PEPFAR dollars into action and to global health leaders who explain why PEPFAR’s approach has been so effective, and what’s at stake in this debate. 

Tune in to hear:

  • Ilda Kuleba from Mothers 2 Mothers talks about the impact of their work across 10 countries, training and employing HIV positive mothers as peer healthcare workers.
  • Dr. James Mukabi of World Vision’s Kenya program talks about how this Christian relief organization has changed the lives of thousands of orphans and other populations who are vulnerable to HIV. 
  • Tom Hart, President of the One Campaign, which was founded by the rock star Bono, to be an early champion of PEPFAR and other poverty fighting efforts talks about PEPFAR’s accomplishments at the global level and what’s next as congress debates reauthorizing the program.

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Evolving Strategies for an HIV Vaccine: One researcher explains where the field is going and why?

Produced and hosted by Jeanne Baron

With several large HIV vaccine trials in the last few years finding no efficacy, the field is in transition. There are diverse ideas in vaccine research, but there’s no clear concept that’s ready to test in a late-phase trial or move towards product development currently. Researchers are back to testing new ideas in early phase research.

In this episode of our Px Pulse podcast, Evolving Strategies for an HIV Vaccine: One researcher explains where the field is going and why?, Dr. Katy Stephenson explores the implications of recent trial results, the big questions driving next generation vaccine development, and new strategies underway in early phase research. Katy is a doctor, a researcher, a professor of medicine at Harvard Medical School, affiliated with Beth Israel Deaconess Medical Center, and part of the Center for Virology and Vaccine Research.

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