Hosted by the University of Miami’s Public Health Policy Lab and the AHF Global Public Health Institute, the event featured insights from Pedro Cahn, M.D., Ph.D., Monica Gandhi, M.D., M.P.H., Sten Vermund, M.D., Ph.D., and Michael Weinstein, with Maria Luisa Alcaide, M.D., F.I.D.S.A. leading the discussion.
Long-Acting HIV Therapies: A Paradigm Shift
Dr. Cahn opened the discussion by highlighting the shift toward long-acting antiretroviral therapy (ART) as a breakthrough in HIV treatment adherence.
“Achieving viral suppression is no longer a scientific challenge—it’s an implementation challenge,” he said. “We have the tools, but adherence remains a critical issue.”
Current long-acting regimens, such as injectable cabotegravir and rilpivirine, provide an alternative to daily oral ART, reducing stigma and improving adherence. Studies show that patients overwhelmingly prefer these treatments due to their convenience.
However, while effective, frequent clinic visits required for administration pose barriers—especially in low-resource settings. “In many parts of the world, a transition to long-acting therapies would require major system changes, including staffing, supply chains, and training,” Dr. Cahn noted. “The need is there, but the infrastructure must catch up.”
Addressing Adherence Challenges in High-Risk Populations
Dr. Gandhi emphasized the potential of long-acting ART for individuals with adherence challenges, particularly those facing housing instability, substance use disorders, and mental health concerns.
“Our data show that long-acting therapy is not only effective for those already virally suppressed but also for individuals who have struggled with adherence to daily oral medication,” she said.
Recent clinical trials demonstrated that even patients with detectable viral loads at initiation achieved viral suppression with long-acting ART, supporting a shift in guidelines toward broader eligibility.
However, she cautioned that access remains a major issue. “We are at risk of creating treatment disparities. Long-acting ART is available in high-income countries, but in many parts of the world, these options are still out of reach,” she said. A major initiative is now underway to study lenacapavir-based regimens—requiring only twice-yearly injections—potentially simplifying treatment further.
Prevention Strategies: Moving Beyond Traditional Models
Dr. Vermund provided a global perspective on HIV prevention, underscoring the importance of combination strategies that integrate biomedical, behavioral, and structural interventions.
“No single approach will end HIV,” he stated. “We need long-acting PrEP, robust STI screening, voluntary medical male circumcision, and harm reduction strategies for people who inject drugs. Prevention must be comprehensive and adaptable.”
Despite the availability of oral PrEP, its uptake remains low in many regions due to adherence challenges and stigma. “People are less motivated to take a daily pill if they don’t feel sick,” he explained. The next frontier, he argued, is injectable PrEP options like cabotegravir, which could improve uptake among high-risk populations.
Bridging the Treatment Gap: A Call for Systemic Change
Michael Weinstein, President of AIDS Healthcare Foundation, addressed the persistent gap in HIV treatment retention, calling for a fundamental rethinking of healthcare delivery models.
“If we don’t close the retention gap, we will not achieve HIV control,” he said.
Retention in care remains a significant hurdle. “Globally, we see patients initiate treatment but fall out of care due to systemic barriers,” Weinstein explained. He called for greater investment in community health workers, telehealth services, and patient navigation programs to ensure continuity of care. “It’s not just about getting people on treatment—it’s about keeping them engaged.”
Weinstein also raised concerns about the slow adoption of long-acting ART in the U.S., despite its approval. “We have the medications, insurance covers them, yet uptake is under 5%,” he noted. “We need to rethink how we educate both providers and patients to facilitate better access.”
Policy and Advocacy: The Path Forward
The panelists agreed that advocacy will be key to overcoming financial and logistical barriers to scaling up long-acting therapies and prevention efforts. Dr. Alcaide closed the discussion by emphasizing the importance of continued research, policy engagement, and community-driven solutions.
“We have the science, and we have the tools. Now, it’s about ensuring equitable access,” she said. “It will take a concerted effort from researchers, clinicians, policymakers, and advocates to make the next generation of HIV care a reality.”
Written by Deycha Torres Hernández, published on March 21, 2025.
