HIV Prevention Forward: Choices for the Future

On January 27–28 and February 3–4, 2021, the National Institutes of Health (NIH) Office of AIDS Research (OAR) participated in the 4th HIV Research for Prevention Conference (HIVR4P), as both a funder and a member of the Programme Organizing Committee. HIVR4P brings together the world’s leading prevention researchers, funders, and policymakers to exchange information on the latest developments in biomedical, behavioral, and social science–based HIV prevention research and implementation and to discuss, debate, and set the direction for the field.

This year’s virtual conference featured a combination of live and recorded presentations that addressed current HIV and global health challenges. The speakers presented interdisciplinary perspectives to meet the following conference objectives:

• Present new scientific research findings and enhance global scientific collaborations and knowledge.
• Refine HIV prevention research agendas to reflect identified opportunities and knowledge gaps.
• Advance evidence-informed and human rights–based HIV prevention approaches designed to reduce health disparities and meet the needs of affected and vulnerable groups.

Undeniably, the Coronavirus Disease 2019 (COVID-19) pandemic has created a unique framework for these discussions, with many participants working from remote offices. Although the pandemic has presented challenges, the virtual platform offered ample opportunities to engage with colleagues, navigate quickly to topics of interest, and discuss the impact of COVID-19 on HIV prevention response and HIV prevention broadly. Notably, the virtual platform made the conference more accessible globally and drew 1,800 attendees from 85 countries. In comparison, the in-person HIVR4P 2018 conference drew more than 1,400 participants from 52 countries.

Although the COVID-19 pandemic has led to challenges with conventional access to HIV prevention services and HIV testing, some positive developments emerged, including evidence showing that longstanding efforts to increase access to HIV prevention tools have achieved important successes. For example, responses to disruptions in service delivery fostered an increased use of telehealth and HIV self-testing programs.

The lessons learned through the realities of HIV and COVID-19, as well as recently conducted research, have been mutually beneficial. HIV research and advocacy has informed breakthrough research for COVID-19 vaccines and treatments. The COVID-19 experience is providing HIV researchers with new insights, methods, and innovations to advance HIV prevention.

Across the 4-day event, NIH OAR Leadership and senior science advisors heard about the latest developments in HIV prevention. Throughout, discussions clearly focused on the need to expand the prevention toolkit for people at risk for HIV, to provide a wider range of options and choices to fit different needs and lifestyles.

Another significant conference theme centered on the barriers to accessing services and engaging communities. For example, stigma persists as a major barrier to both HIV prevention and treatment service delivery for men who have sex with men (MSM). The Many Men, Many Voices intervention that was tested originally in the United States was adapted and provided to MSM in Ghana to mitigate the negative effects of stigma on engagement in prevention and care.

A broad spectrum of findings and topics was presented and discussed, including these highlights:

• Findings from the Antibody-Mediated Prevention trials among more than 4,600 women in sub-Saharan Africa as well as men, and transgender persons, who have sex with men in the Americas and Europe support the concept that broadly neutralizing antibodies can be used to prevent HIV infection in populations that are at greatest risk for HIV. These studies demonstrated the utility of an assay used to measure antibody potency that can be used to calibrate future studies in both humans and animal models.
• As noted in my December Director’s Blog, the HIV Prevention Trial Network 084 (HPTN 084) showed the superiority of long-acting injectable cabotegravir (CAB) over daily oral medication among cisgender women, confirming CAB as the first safe and effective injectable pre-exposure prophylaxis (PrEP) agent for cisgender women. These incredible results mirror similar findings from the HPTN 083 trial among cisgender men and transgender women.
• The prevention needs of adolescent girls and young women (AGYW) in sub-Saharan Africa were discussed across several sessions, with special attention to the need for multipurpose options and choices for HIV prevention, sexually transmitted infection (STI) prevention, and contraception. Notably, gender-based and intimate partner violence that exacerbates HIV risk was addressed; we know that HIV interventions that do not address violence and related vulnerabilities among AGYW are insufficient. Special attention was given to the themes of PrEP during pregnancy, PrEP discontinuation, and the importance of PrEP support systems.
• The latest research results on multipurpose prevention technologies (MPTs)—which have the goal of preventing HIV, STIs, and unintended pregnancies while minimizing the burden of multiple separate interventions—were encouraging and emphasized the consistent thread throughout the conference of the need to increase effective and efficient prevention choices and options. A wide range of MPT research was presented, including the safety, pharmacokinetics, pharmacodynamics and acceptability of MPTs such as vaginal ring use containing tenofovir and levonorgestrel.
• The promising interim analysis from a phase 2a trial of once-monthly islatravir oral PrEP and an important World Health Organization recommendation on the dapivirine vaginal ring (DPV-VR) as an additional prevention choice for women at substantial risk of HIV infection, as part of combination prevention approaches, indicate that both treatment methods could add to the long-acting options for HIV prevention.
• Multiple HIV vaccine studies are underway, such as Mosaico and PrEPVacc; new vaccine approaches are in development; and coinciding with the HIVR4P, the news that a first-in-human clinical trial showed the feasibility of a promising novel HIV vaccine approach was announced.

As coordinator of the NIH HIV/AIDS research portfolio, NIH OAR remains committed to prioritizing research that advances HIV prevention. In keeping with this commitment, we continue to foster the development of early-stage investigators who are essential to strengthening the research pipeline. Thus, I was honored to serve as the 2021 host of the HIVR4P New Investigator Awards and to announce the six outstanding early investigators. Among the awards featured was the Mathieson Award to a New Investigator in HIV Research, which went to Dr. Nathifa Moyo of the University of Oxford in the United Kingdom. The award recognizes the late Dr. Bonnie Mathieson, a former OAR senior science advisor and lead of the NIH HIV vaccines portfolio who is remembered fondly for her unwavering dedication to the field of HIV research and to mentoring young investigators.

To learn more about the HIVR4P highlights, I encourage you to watch the first 2021 Live with Leadership conversation hosted by the U.S. Department of Health and Human Services Office of Infectious Disease and HIV/AIDS Policy (OIDP). Dr. Carl Dieffenbach, the director of the Division of AIDS, at the NIH National Institute of Allergy and Infectious Diseases, joined Mr. Harold Phillips, chief operating officer for Ending the HIV Epidemic: A Plan for America and senior HIV advisor of OIDP, to discuss conference highlights and ways that the latest research can help us to end HIV in the United States.

We look forward to the implementation and acceleration of critical HIV prevention modalities to reduce HIV acquisition and transmission significantly in 2021 and beyond.

Maureen M. Goodenow, Ph.D.
Associate Director for AIDS Research and
Director, Office of AIDS Research
National Institutes of Health