Njambi Njuguna, FHI 360
Adaobi Olisa, FHI 360

The Conference on Retroviruses and Opportunistic Infections (CROI) is a forum for scientists and clinical investigators to present, discuss, and critique their investigations into the epidemiology and biology of human retroviruses and associated diseases, including HIV and AIDS. It was the 30^th year of the conference, but our first time attending. In this post, we reflect on what we learned and how we might apply key takeaways to our work on MOSAIC.

What is one key takeaway from CROI that resonated with you? How do you plan to apply this message to your specific role and work on MOSAIC?

Njambi: A key takeaway for me was the data from Dr. Jeanne Marrazzo and her colleagues, who consolidated data from more than 6,000 women enrolled in demonstration studies in multiple countries, predominantly in sub-Saharan Africa. They showed that women who took four or more doses of TDF-based pre-exposure prophylaxis (PrEP) per week and those who took seven doses per week had comparable protection against HIV — a finding that is being considered in the analysis plan for prevention effective use in MOSAIC’s CATALYST study. The downside of the analysis is that adherence declined over time. This analysis really highlighted the need for additional HIV prevention options for women. For me, it also underlined the importance of CATALYST in providing answers to questions about the impact of choice on adherence for women. 

Adaobi: The sad news that results from doxycycline post-exposure prophylaxis (Doxy-PEP) studies are revealing its ineffectiveness to prevent sexually transmitted infections (STIs) in cisgender women sparked an uproar on the need to explore new methods for STI prevention for women. Also, the need to include pregnant and breastfeeding people in HIV research studies was emphasized, because their exclusion from research has led to inadequate or complete absence of safety information, which often delays rollout of new medicines and interventions to this priority population. These takeaway messages resonate with me because MOSAIC is designed to ensure that women of all populations are not left behind and are provided with options to meet their changing HIV prevention needs.

Did you attend a session that surprised you, challenged you, or made you think in a new way about the work MOSAIC is doing?

Njambi: One particularly interesting presentation by Dr. James Ayieko was on positive outcomes for participants in a cluster randomized study where participants got to choose the location of service delivery (facility or community, including home delivery), the provider (health worker or community worker), the product (PrEP or PEP), and the HIV testing modality (HIV self-testing or rapid testing). This was compared with clusters where they provided standard of care without the option of choice. The study results showed better coverage for HIV prevention among the intervention group, again highlighting that people do want choice in their services and tend to be better adherent to an intervention they select.   

Adaobi: I was inspired by the presentation by Dawn Averitt, who emphasized the importance of community engagement in all stages of research. She said, “We have to move away from the subject mentality… seeing people participating in research (not) as subjects but as partners and contributors.” This really resonated with me because of the level of community engagement in the CATALYST study, which I’ve experienced firsthand as a member of the MOSAIC NextGen Squad. The NextGen Squad, representing the voices of young people from African countries, has been meaningfully involved in the design of CATALYST to ensure the needs, perspectives, and lived experiences of adolescent girls and young women, in all their diversity, are captured. The NextGen Squad reviews the protocols and even the language that will be used in the interviews and focus groups discussions to ensure the participants are supported to contribute meaningfully to the study.

Did you leave the conference feeling optimistic about the future of HIV prevention? Why or why not?

Njambi: Yes I did, particularly during the opening session, where we got to reflect on CROI at 30 and listen to Dr. Fauci’s speech on how far we have come and Dr. de Cock’s N’Galy-Mann lecture on HIV and global health in a pandemic era. It was amazing to hear from the people who were actually there at the beginning. We have come so far, with most of the new interventions really coming into play over the last 15 years. Researchers are still looking for more methods to not just treat HIV, but also prevent people from acquiring it. It gives me hope for the future and I am excited to be part of efforts through MOSAIC to accelerate access to these prevention products as they become available.

Adaobi: Yes, I did. There were numerous sessions on ongoing research for various new HIV prevention methods, including vaccine trials. Scientists are conducting trials on the efficacy and safety of various new products and the best ways to monitor, detect, and ultimately prevent breakthrough infections and drug resistance. The conference gave us an opportunity to reflect on the journey so far and to see how interventions for other pandemics like COVID rely on the infrastructure that has been built over time for the HIV response. Now more than ever, I strongly believe that epidemic control is within reach as we continue to follow the science while using a human-centered approach. As Dr. Peter Hunt said in a video presentation about CROI at 30, “If we are going to cure HIV, we need all hands on deck — community, researchers, government, private foundations, industries, everyone needs to be working together towards that goal — which is the same collaborative spirit that CROI displays, we need that collaborative spirit to cure HIV.”

Finally, as a community scholar, CROI provided a unique opportunity for me to meet with the highest levels of leadership in the HIV space, learn from them, form new connections, and take the lessons back to my community. This is very important, as it is the exchange of knowledge that prepares and inspires the next generation of leaders.

Featured Images: Our co-authors, Njambi Njuguna and Adaobi Olisa, at CROI in Seattle, Washington (Adaobi Olisa/MOSAIC).