Christian Gaebler

After yesterday’s groundbreaking results on long-acting preexposure prophylaxis (PrEP) using Lenacapavir, today's session on HIV prevention strategies provided important context through three outstanding talks. These talks highlighted recent developments in HIV vaccine research and addressed the challenges and critical needs for improving HIV prevention through enhanced PrEP implementation.

Devin Sok provided a fantastic update on HIV vaccines, emphasizing the exciting progress in HIV vaccine research. He pointed to the AMP trial’s results as “a signal to work towards.” Using an Olympic analogy, he explained germline-targeting and affinity maturation for broadly neutralizing antibodies, highlighting current immunogens as well as new platforms such as mRNA that improve immunogen design and antibody responses compared to protein-based immunogens. He noted a robust pipeline with promising immunogens and AI-guided innovations that could accelerate vaccine efforts. Sok concluded optimistically, stating, "We will have a vaccine," while stressing the importance of affordability and access. Elizabeth Irungu highlighted the disparities and delays in the rollout of ARV-based HIV prevention, stating that 6.7 million people on PrEP is abysmal and that "100 million people on PrEP" are needed. She reminded us that even in the US, women, Black and Hispanic populations are too often not reached. Irungu made a powerful statement that "we have enough studies and need to focus on implementation." In line with that, Dulce Ferraz highlight the importance of putting people first and in the center of PrEP research, with bottom-up implementation as well as the overall simplification and demedicalization of PrEP.

“We cannot treat ourselves out of this epidemic” was the key message of this session. Prevention tools are central to efforts to end the HIV epidemic and should be viewed as a relay race, with existing tools like daily oral PrEP working hand-in-hand with long-acting PrEP and a potential vaccine to ultimately end the epidemic. However, vaccines or PrEP alone cannot end epidemics; successful vaccinations and PrEP uptake can. Therefore, implementation of current PrEP strategies is at the heart of the discussion, as well as expedited regulatory submissions, quick guideline development, and immediate start of implementation plans for long-acting Lenacapavir.

Florian Voit

The plenary session "HIV Prevention Strategies" discussed advancements in HIV vaccine development, PrEP implementation in low- and middle-income countries, and community-based research for PrEP access among key populations. Key themes included the importance of PrEP choice, addressing inequities, leveraging community-led models, and the synergy of biomedical and non-biomedical interventions.

Devin Sok from IAVI provided an update on the current state and future prospects of HIV vaccines. Using an analogy with Olympic athletes, he discussed the germline-targeting approach to elicit bnAbs, comparing the process to training elite athletes like Simone Biles. Ongoing clinical trials aim to optimize this strategy and build a robust pipeline of vaccine candidates. Elizabeth Irungu from Jhpiego discussed the challenges and opportunities in PrEP implementation in low- and middle-income countries. She highlighted the slow progress, with only 6.7 million PrEP initiations over 12 years, and significant gaps in reaching key populations. Irungu stressed the need for PrEP choice, simplified delivery models, and increased investment from donors and governments. She also pointed out missed opportunities, such as PrEP for pregnant and breastfeeding individuals and better utilization of PEP. Dulce Ferraz from Fundação Oswaldo Cruz emphasized the role of community-based research in advancing PrEP access among key populations. She reported on an ongoing systematic review examining the effectiveness, implementation, and outcomes of community-based PrEP delivery models. Ferraz highlighted the effectiveness of community-led design, which showed better adherence and retention compared to clinical trials, and advocated for increased funding and support for community-based interventions.

The session highlighted the critical need for tailored HIV prevention strategies, particularly in low- and middle-income countries. Devin Sok showed promising advancements in HIV vaccine development. Elizabeth Irungu discussed the slow progress in PrEP implementation and the necessity of introducing PrEP choice and simplifying delivery models. Dulce Ferraz highlighted the effectiveness of community-based research and the importance of involving key populations in designing and delivering PrEP services. Robust funding and community engagement are crucial for success.