INTEREST 2022: new perspectives in HIV treatment,pathogenesis and prevention in Africa

The HIV epidemic continues to rage on four decades after the discovery of the first case. ¹ As of 2021, about 84 million people were estimated to have been infected by HIV, and 40 million people have died from HIV/AIDS-related illnesses since the start of the epidemic. ² Sub-Saharan Africa (SSA) bears the brunt of the HIV epidemic. SSA is home to two-thirds of the over 38 million people with HIV (PWH) worldwide. ² Although the incidence of HIV is declining in the region, ³ mortality is still unacceptably high due to meningitis, ⁴ malnutrition ⁵ and tuberculosis. ⁶ This is at the backdrop of limited access to health care services whereby more than 7 million PWH lack access to health care within 10-min travel time. ⁷ The COVID-19 pandemic added a tremendous burden on an already inadequate health care system in SSA and led to closure of antiretroviral therapy (ART) clinics, loss to follow-up of clients in care and repurposing of resources intended for HIV programme work. ⁸ This is likely to undo the progress made hitherto in the region. Innovative strategies are needed to address this disproportionate HIV/AIDS burden in SSA by generating local evidence. The International Conference on HIV Treatment, Pathogenesis, and Prevention Research (INTEREST) is a premier conference on HIV that focuses on building capacity among early career scientists in Africa to develop the next-generation implementers and researchers to advance HIV and other related diseases in the African region. ⁹ The annual INTEREST Conference brings together scientists involved in HIV treatment, pathogenesis and prevention research in Africa to share pivotal findings, promote collaboration and transfer experiences across diverse fields and settings. The Conference showcases cutting-edge knowledge in HIV diagnosis, treatment and prevention of HIV infection.

The 16th conference (INTEREST 2022) was held in Kampala, Uganda, the birthplace of INTEREST, and was attended by almost 600 in-person and virtual attendees from 45 countries. ¹⁰ INTEREST 2022 featured exciting updates on long-acting ARTs, HIV cure research, pre-exposure prophylaxis (PrEP) and innovative programming interventions to realise the 95-95-95 UNAIDS targets. The conference also featured presentations on the impact that the COVID-19 pandemic has had on HIV programming. An excellent reflection on the conference proceedings has been recently published by Akello and colleagues. ¹⁰

In this special issue on New Perspectives in HIV Treatment, Pathogenesis and Prevention in Africa, we feature original research articles from some of the presentations at INTEREST 2022. These papers highlight contextual challenges in HIV care and treatment and innovative strategies to overcome them. Masiano and colleagues ¹¹ highlight the association between adverse childhood experiences and intimate partner violence among pregnant and breastfeeding women living with HIV in Malawi. They add to our understanding of the drivers of intimate partner violence which has long been known to adversely affect mental health and ART adherence in prevention-of-mother-to-child-transmission settings. ¹² Rotsaert and colleagues ¹³ report that a strawberry-flavoured fixed-dose combination of Abacavir/Lamivudine/Lopinavir/Ritonavir (30/15/40/10 mg) as granules in a capsule (4-in-1) was found to be easy to use and acceptable by caregivers of children in Uganda in comparison to other formulations (syrups, pellets and tablets). This was among children weighing between 3 and 19.9 kg enrolled from three centres of excellence in Uganda. Treatment outcomes among children tend to lag their adult counterparts. In fact, 7% of children with HIV in SSA die while on ART within 2 years. ¹⁴ Better formulations of ART could overcome adherence barriers among children, although there is need to ensure affordability of these fixed-dose combination formulations in addition to improving uptake and access in these settings. By leveraging on strong stakeholder engagement, the APIN health programme has implemented a state-wide surge campaign that dramatically increased uptake of viral load testing and suppression in Nigeria as reported in this issue. ¹⁵ Similarly, Nwanja and colleagues also report how working with traditional birth attendants and other informal health care providers increased the rate of HIV testing and detection in Nigeria. ¹⁶ Similar work has recently been reported in Uganda where uptake of HIV testing increased by 77% when offered by traditional healers. ¹⁷ Traditional, complementary and alternative medicine practitioners provide care to a large proportion of people in SSA. As many as 45% of people in SSA seek HIV/AIDS services from these practitioners. ¹⁸ Utilising this alternative health system for delivery of HIV programmes could increase uptake of interventions although this needs to be weighed with patient safety. Finally, Laborde-Balen and colleagues ¹⁹ report on sexuality among adolescents born with HIV in Senegal. Their survey of adolescents, parents/guardians and health workers found several social and cultural constraints in discussing sex, access to contraception and sexual reproductive health information and stigma related to pre-marital pregnancy and HIV. These constraints could lead to de-emphasising and avoidance of sensitive sexuality-related topics which denies adolescents critical information on sex, condom use and contraception. ²⁰

In conclusion, these articles by early career scientists in SSA showcase the burden of salient drivers of adverse outcomes among PWH and demonstrate pragmatic strategies which if adopted could foster the realisation of the 95-95-95 targets in these populations.