Breaking New Ground: Expanding Access to Lenacapavir—Lessons from Dolutegravir and the Future of HIV Prevention
This UAN Call, titled Breaking New Ground: Expanding Access to Lenacapavir—Lessons from Dolutegravir and the Future of HIV Prevention, brought together global health experts, community advocates, and civil society organizations to discuss the challenges and opportunities in ensuring equitable access to Lenacapavir.
This webinar was hosted by Unitaid.
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Restrategizing Civil Society Engagement for Pandemic and Global Governance
As we are building back from the aftermath of the COVID-19 pandemic, current and future generations face multiple grand-scale challenges, including the climate crisis, related disasters, pollution, and biodiversity loss. These challenges also heighten the threat of future pandemics from emerging or re-emerging diseases. On the 14th of August 2024, the WHO has declared the Mpox outbreak as a public health emergency of international concern (PHEIC) under the International Health Regulations (2005) (IHR), which highlighted the growing concerns.
The recent amendments to the IHR (2005), agreed upon during the 77th World Health Assembly, are pivotal in enhancing global health regulations. These amendments aim to address the shortcomings revealed by the COVID-19 pandemic. Fundamental changes include a broadened definition of pandemic emergencies, principles of solidarity and equality, and reinforced WHO authority.
We aim to draw lessons from the successful experiences of diverse CSOs in enhancing inclusivity in multilateral discussions and implementation of agreements/treaties on topics such as one health, other health issues, climate, human rights, and more. For example, the processes leading to the Paris Agreement have set important precedents for integrating diverse voices and ensuring meaningful participation in global decision-making. Indigenous groups have also been involved in the inception to implementation processes of the Convention on Biological Diversity (CBD).
This side event aims to serve as a consolidation platform for civil society to share and find strategies that redefine civil society roles in global decision-making processes that address health threats such as future pandemics, climate crises, and others.
Objectives
The side event will reassess the strategies utilized to expand the role and involvement of civil society in global governance for health, climate, and other development sectors. The event’s objectives are further detailed in the following:
To explore and develop concrete strategies that enhance participatory, inclusive global governance for health, climate, human rights and other global challenges, starting from the Pandemic Agreement through meaningful civil society engagement, particularly in the face of shrinking civic spaces.
To foster collaborations among CSOs from multiple sectors to advance health and health-related development agendas.
Moderator:
Samantha Rick, Multilateral Engagement and Pandemic Preparedness Advocacy Specialist, AVAC
Speakers:
Eloise Todd, Co-Founder and Executive Director of Pandemic Action Network
Lawrence O. Gostin, Faculty Director O’Neill Institute for National and Global Health Law
Neil Vora, Executive Director of Preventing Pandemics at the Source
Olivia Herlinda, Chief Research and Policy at CISDI
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Sustainability of the HIV/AIDS Response – Getting to 2030 & Beyond
The state of the HIV/AIDs endemic is reaching a critical point requiring evaluation of the current state of the global response, progress made thus far, and planning for post-2030 goals. The National Academy of Medicine is hosting a timely international meeting to facilitate discussion on these issues.
This one-day workshop is being held on September 18, 2024, from 9:00 AM – 5:00 PM US Eastern. Ambassador John N. Nkengasong, the Senior Bureau Official for Global Health Security and Diplomacy at the US State Department, will deliver the opening remarks. His address will set the stage for discussions across three subsequent panels.
Broadly, the goals of this workshop are to:
Explore how we can re-energize the global HIV response to reach the 2030 goals but also to look beyond.
Craft strategies to increase and sustain political commitment.
Highlight global accountability and domestic-donor financing.
AGENDA HIGHLIGHTS:
Introduction and Welcome
Victor Dzau,National Academy of Medicine
Carlos del Rio,Emory University and National Academy of Medicine
A summary of response since the setting of the 2030 agenda – successes, shortfalls, areas to evolve – and discussion of how to build upon momentum to design impactful, sustained response post-2030.
Sustaining Political Commitment to Ending HIV as a Public Health Threat
Discussion of how to sustain and increase global political support for prioritizing the HIV response to end the epidemic and sustain support post 2030.
Global Accountability: Domestic and Donor Support
A conversation on strategies to garner joint accountability as well as domestic and donor support for current and future financing of the HIV response.
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Do Vaginas Demand Perfection? Implications for Event-Driven PrEP
Dr. Jenell Stewart (University of Minnesota, Hennepin Healthcare) joined The Choice Agenda to discuss and analyze recent research on HIV PrEP and implications for event driven PrEP across sex and gender.
Major advances in long-acting HIV treatment and prevention, including the latest PURPOSE 1 results of lenacapavir for PrEP, hold great promise for achieving global targets. However, planning to coordinate among stakeholders, including pharmaceutical companies, governments, and multilateral organizations to deploy and ensure equitable access to these products, particularly in low- and middle-income countries, requires immediate action.
“Civil society organisations and HIV activists have been instrumental in holding pharmaceutical companies, financial donors, governments, and international organisations accountable for commitments to the international HIV treatment response for decades,” the authors write. “These organisations and activists are needed to promote transparency in pricing, challenge restrictive patent practices, advocate for affordable and widespread availability of drug innovations, prevent companies from restricting broad access to medications, and require funding to allow this work to be done independently.”
Key Messages
Long-acting antiretrovirals are perhaps the greatest advance in HIV care in over a decade and provide great promise towards achieving global HIV prevention and control programme targets.
Current long-acting agents are firmly under the control of originator pharmaceutical companies and remain unavailable or cost-prohibitive across much of the globe.
If action from the broader HIV community is stagnant, the populations who are most in need of these long-acting agents are unlikely to receive any benefit until well into the 2030s, resulting in a large number of preventable HIV infections.
Coordination by international agencies, with assistance from relevant financial donors and stakeholders, will be needed in the complex research and access programmes required to provide widescale use of these indispensable products to people living with HIV or affected by HIV.
Resources on Long-Acting HIV Prevention
The Lens on LEN: this primer for advocates shares the basics on injectable lenacapavir as PrEP.
Long-Acting PrEP Status Update: this webpage shares graphics and information synthesizing the current status of long-acting PrEP products. It’s updated quarterly.
PrEP Products Overview: this page on PrEPWatch shares the status of PrEP products in development and approved. Injectable Cabotegravir Evidence Gap Tracker: this webpage summarizes the latest insights from the Biomedical Prevention Implementation Collaborative (BioPIC) on injectable CAB for PrEP, links to learn more, and information on where evidence is still needed, mapped against priority evidence gaps.
The Long Wait for Long-Acting HIV Prevention and Treatment Formulations
This commentary in The Lancet HIV calls on WHO, financial donors, manufacturers, and governments to take coordinated action to make long-acting HIV prevention and treatment available at scale in lower- and middle-income countries.
Harnessing Private Sector Strategies for Family Planning to deliver the Dual Prevention Pill
The latest edition of the Journal of the International AIDS Societyfeatures newly published research by AVAC and partners on the benefits of delivering family planning and PrEP using pharmacies, e-pharmacies and telemedicine, in addition to private sector clinics. The research demonstrates why these delivery methods should be prioritized for rolling out the Dual Prevention Pill (DPP), a daily pill that combines oral PrEP with an oral contraceptive to prevent both unintended pregnancy and HIV.
Meta-analysis of Pregnancy Events in Biomedical HIV Prevention Trials in Sub-Saharan Africa: Implications for Gender Transformative Trials
CASPR partners authored new research published in AIDS and Behaviorhighlighting the need for clinical trial teams to balance the goals of generating scientific evidence with participants’ fertility choices. The authors argue that to better support participants, trials should adopt strategies that accommodate changing fertility preferences, plan for pregnancies, and consider the ethical implications of allowing pregnant participants to continue in studies. This approach would contribute to a more gender-transformative approach to pregnancy in HIV prevention trials.
Mark Your Calendars: Upcoming Webinar
TOMORROW, August 27: Opportunities to Expand Equitable Access to HIV Prevention Services through Community Pharmacies Join The Choice Agenda and RxEACH, a national coalition effort working to expand and sustain access to HIV prevention and linkage to care services in community pharmacies for a webinar discussing the opportunity to expand equitable access to HIV prevention services, including PrEP, and what is needed to grow and sustain community-based HIV prevention service programs in pharmacies.
August 29: PrEP Your Booty Join The Choice Agenda and HPTN 106 (REV UP), an innovative clinical trial from the HIV Prevention Trials Network that will investigate the safety and acceptability of a tenofovir-based rectal douche for HIV prevention, for a discussion with researchers leading the study.
September 11: Innovations in GPP Join AVAC and champions of Good Participatory Practices (GPP) as they illustrate the evolution of GPPS from CABs and town hall meetings to more innovative and partnership-based approaches.
Pandemic Accord Priority for 2025
As members of the Coalition of Advocates for Global Health and Pandemic Preparedness, a group of organizations advocating for an integrated and holistic approach to preparedness that emphasizes equity, inclusion, and synergies of multiple global health programs in advancing preparedness, we share the following asks with regard to the ongoing Pandemic Accord negotiations after their extension past May 2024.
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Vaccinology of HSV
Akiko Iwasaki, PhD, a professor of immunobiology at Yale School of Medicine and an investigator of the Howard Hughes Medical Institute, turned her focus to SARS-CoV-2 soon after reading the first reports coming out of China, before COVID-19 surfaced in the United States. Though she has long been recognized for her work within the scientific community, her work around COVID-19 has raised her media profile considerably. She is frequently quoted by newspapers and reporters, and has amassed a huge Twitter following of people seeking out her research updates. (Iwasaki believes that public education is a key ingredient for slowing the spread of the virus.)
This webinar featured speakers from around the world with experience implementing GPP at research sites, within networks, and at the sponsorship level.
They illustrated how GPP can expand beyond the more familiar (but always reliable) CABs and town hall meetings to newer ideas like partnership-based approaches, the creation of a community scorecard, and more.
Moderator and Presenter:
Ntando Yola, Desmond Tutu Health Foundation
Presenters:
Sarah Read, National Institute of Allergy and Infectious Diseases
What Happens to PrEP Initiations in Countries with Anti-Discrimination Policies?
Among 134 countries reviewed, 42 have comprehensive anti-discrimination policies covering a broad range of populations, while 24 lack any such policies. The remaining countries have adopted partial measures. Nations with comprehensive anti-discrimination policies, document significantly higher rates of PrEP initiation compared to those without such protections. Key studies show a strong link between supportive policies (which can enable PrEP eligibility, HIV self-testing, and lower age of consent for treatment, for example) and higher PrEP initiations.