SUSTAINABLE HIV PREVENTION INITIATIVE

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Sustainable HIV Prevention Initiative

Post-Convening Report

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Convening Dates: February 18 –19, 2025
Convening Location: Lilongwe, Malawi

 

DAY ONE:

 

The first day of the convening opened with brief remarks from two of the Co-Chairs of the Sustainable HIV Prevention Initiative, Dr. Charles B. Holmes, Director of the Center for Innovation in Global Health at Georgetown University, and Dr. Beatrice Matanje, Chief Executive Officer, Malawi National AIDS Commission. This was followed by a keynote address from Dr. Martias Joshua, Chief of Health Services-Reforms at Malawi’s Ministry of Health. These remarks welcomed participants to Malawi and emphasized the importance of coming together at this challenging time in the HIV response, noting the objectives for the convening:

 

1. Deepen the dialogue to move beyond the WHAT to the HOW of sustainable HIV response, ensuring our efforts are embedded within strong, resilient health systems. 

2. Highlight critical health systems innovations from countries in the region that demonstrate practical, scalable solutions. 

3. To discuss actions that governments, civil society, and others are taking in response to disruptions in U.S. foreign assistance.  

4. Ensure these insights inform national and donor-promoted sustainability dialogues—including through the Lancet HIV and Lancet Global Health series that will follow. 

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The first session, titled “Thinking Differently: National Perspectives on Health Systems
Approaches to Sustainable HIV Prevention,” focused on the integration and sustainability of HIV prevention programs within national health systems across multiple African countries.
Representatives from Tanzania, Zambia, Rwanda, Kenya, South Africa, and Malawi shared
insights into how their countries are embedding HIV prevention within their broader health system. The discussions underscored the importance of a multisectoral, integrated, and data-driven approach to achieving long-term sustainability in HIV prevention.

Several key themes emerged, including experiences with integrating HIV prevention into broader health systems. Panelists discussed embedding HIV prevention into existing health services such as maternal and child health, family planning, and STI screening. To reduce fragmentation and ensure sustainability, South Africa has successfully integrated HIV prevention into its primary healthcare system, with 96% of primary healthcare clinics offering oral PrEP, among other services. Tanzania has established a unified supply chain, eliminating parallel procurement systems for HIV prevention commodities. These commodities, including PrEP, condoms, test kits, and ARVs—are fully integrated into the national procurement system, with quantification, procurement, ordering, and distribution managed within the existing government health system. Rwanda's strong political leadership also prioritizes donor alignment with national health strategies to enhance sustainability.

The use of data-driven strategies was also a central focus, with panelists emphasizing precision targeting, informed decision-making, and program monitoring. Tanzania’s unified data system and Malawi’s Blantyre Prevention Strategy showcased the benefits of harmonized HIV and AIDS data in tracking prevention efforts, guiding resource allocation, and improving program responsiveness across various levels of the health system.

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Decentralization emerged as a key strategy in Kenya, Malawi, Tanzania, and Zambia, enabling local, county, and district-level governments to tailor interventions based on their local population needs and epidemic typologies.

The session also highlighted community engagement and leadership as critical for sustainability. Examples included specialized drop-in centers for sex workers, MSM, and at-risk youth; multisectoral programs for adolescent girls and young women (AGYW); and ‘community labs’ designed to generate insights and create demand for HIV prevention services. Some countries have adopted community-centered approaches, such as Kenya’s ‘communities of practice,’ which engage existing social networks to promote HIV awareness and service uptake.

Multisectoral collaboration was another cornerstone of sustainability. HIV prevention efforts are increasingly integrated into education, social protection, and gender programs to address the structural drivers of HIV transmission. For instance, Zambia has introduced a ‘Life Skills Health Education’ program to equip young people with the knowledge and negotiation skills necessary for safer sexual practices. Its gender ministry has also incorporated HIV prevention into its broader initiatives, including STI screening and condom promotion, ensuring that HIV is addressed alongside gender-related concerns. Similarly, Kenya has expanded workplace-based HIV prevention programs to provide employees with testing and prevention services, while Rwanda has implemented school-based sexual health education to raise HIV awareness.

Despite these advancements, challenges remain. Key barriers include financing constraints for multisectoral HIV prevention, regulatory hurdles for new products, human resource limitations, stigma and discrimination against key populations, and political resistance to integration efforts. Addressing these challenges requires continued advocacy, more diverse financing mechanisms, and more substantial policy alignment to ensure sustained progress in HIV prevention across the continent.

During the second session, a lightning round focused on highlighting systems-based HIV
prevention initiatives that have been incorporated into the national health system,
representatives from Uganda, Malawi, Nigeria, and South Africa made brief presentations.

Dr. Peter Mudiope, HIV Prevention Coordinator, Uganda AIDS Commission, presented on
“Integrated differentiated services delivery for sustainable HIV epidemic control: A case study of the integrated Community Model Implementation in Uganda.” This model seeks to strengthen community health systems for service delivery through community health workers. The model assigns five to ten households with non-suppressed individuals to a community health worker who works to support viral load suppression, case finding, adherence support, and addressing socio-economic barriers. Additionally, it integrates other health services, including malaria management, maternal and child health, reproductive health, non-communicable disease management, and immunization services into HIV prevention efforts.

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Key strategies implemented include targeted follow-ups for non-suppressed individuals, partner-assisted notification for case identification, and linkages to drug resistance testing. The program also emphasized governance and coordination, leveraging community structures and civil society partnerships to enhance service delivery. The approach demonstrated significant success, with 52% viral suppression among children and 48% among adults, alongside improved case finding and efficiency in service delivery. However, challenges were noted, including overburdened community health workers, gaps in data capture, and lack of technical assistance for cost evaluation. Dr. Mudiope emphasized the potential for scaling up the model and called for
continued investment and stakeholder collaboration to enhance community-led HIV prevention and care.
 

Dr. Gift Kawalazira, Director of Health and Social Services, Blantyre District Council, Malawi,
presented on the Blantyre Prevention Strategy (BPS) as an example of a decentralized HIV and AIDS response currently being implemented in Blantyre to enhance effective targeting, demand generation, service delivery, and sustained use of HIV prevention interventions. A core component of the strategy is a real-time, web-based data platform that consolidates multiple data sources to enable front-line and district-based decision-makers to track and respond to HIV risk patterns and to strengthen the allocation/coordination of partner resources within the district. By harmonizing data and improving access to information, the platform has strengthened the availability of data and the use of data for local decision-making. BPS's innovative application of quality improvement to HIV prevention has also improved service delivery in Blantyre, including PrEP. Since BPS began, the district has seen a gradual, sustained decline in new HIV infections and improved ART retention rates. Blantyre’s health system strengthening efforts have received national recognition, with the district achieving a 100% performance score for three consecutive years and being named the best-performing district health office among 29 districts. Lilongwe district is now adapting BPS.

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Ms. Ima John Dada, Head of HIV Prevention, Federal Ministry of Health, Nigeria, presented
on Nigeria's approach to Differentiated Service Delivery (DSD) for HIV prevention, showcasing
how the country has expanded prevention services to reach diverse populations through
community engagement, private sector involvement, and digital health platforms.

Nigeria has leveraged HIV self-testing as a key strategy for expanding access to prevention
services. The Total Market Approach (TMA) has facilitated the distribution of self-testing kits
beyond healthcare facilities, utilizing community pharmacies, patent medicine vendors (PPMVs), and private sector channels. Trained providers offer education, counseling, and linkage to care, ensuring individuals who test positive are connected to treatment and those at risk are referred for preventive services such as PrEP.

PrEP has also been scaled through facility-based and community-based models, including outreach programs led by facility staff and community health workers. These initiatives specifically target adolescents, young people, individuals in custodial centers, and at-risk pregnant and breastfeeding women. PrEP distribution is integrated into community health initiatives, with nurses and peer educators reaching individuals during community outreaches, festive gatherings, and congregational centers to provide HIV education, self-testing, and prevention services.

Nigeria has adopted a combination prevention approach that tailors HIV services to the needs of individuals accessing healthcare services. This integrated approach includes index testing, where sexual and injecting partners of people living with HIV are identified, tested, and linked to appropriate care.

A notable innovation in Nigeria’s HIV prevention strategy is the use of virtual and digital health platforms, such as YAaHNaija, a youth-friendly program initially developed by UNICEF and later transitioned to the National Agency for the Control of AIDS (NACA), to mobilize and engage Adolescents and Young People (AYPs) in Nigeria in comprehensive HIV prevention activities.

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Ms. Getrude Mbhalati, HIV Youth Manager, National Department of Health, South Africa,
presented on Digital Behavioral interventions to improve HIV Prevention Service Delivery in
South Africa. A key initiative, B-Wise, launched in 2015, is the National Department of Health
(NDoH) digital and community-based intervention aimed at improving sexual and reproductive health knowledge and accessibility to care for young people in South Africa.

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The interactive platform offers multiple features, including Sexuality information and youth-
friendly content, a Referral to the LoveLife helpline, a Link to a responsive chatbot (Sister Unath/Health buddy), a Contraceptive method decision tool, a PrEP screening tool, an HIV testing tool, a Relationship health tool, and Condom use demonstration videos. The platform aims to ensure that young people have access to comprehensive, youth-friendly health education before they visit healthcare facilities, thus reducing the burden on the health system. The platform uses quizzes, videos, and gamified elements to enhance user engagement. It also incorporates features that allow users to access information discreetly.

Another digital innovation is MOM Connect, a digital platform that provides pregnancy and
postnatal support to pregnant women, including adolescents. A nurse confirms the pregnancy at a clinic and gives the prospective mom a clinic code to obtain registration on the MomConnect platform and have her pregnancy registered in the national database. The registered mom will receive weekly WhatsApp or text messages to support her through her pregnancy and the first years of her baby's life. Any MomConnect user can send a question to the helpdesk. An automated system suggests answers for frequently asked questions. Unanswered questions go to expert helpdesk operators at the Department of Health, who will address the unique circumstances presented. MomConnect users can send compliments or complaints about the service experienced at public health clinics. The Department of Health's helpdesk operators will follow up on complaints.

The third session,  How are changes in U.S. foreign assistance affecting HIV programs, and
what actions are governments and organizations taking in response?, allowed participants to reflect on the challenges posed by shifts in U.S. foreign assistance. Representatives from Eswatini, South Africa, Malawi, Zambia, and Kenya shared insights into how these funding changes have impacted their HIV prevention and treatment landscapes. They reported significant disruptions in key areas, including specialized services for key populations, community outreach, human resources for health, and data systems.

One of the most affected areas has been services for key populations (KPs), including transgender individuals, men who have sex with men (MSM), and sex workers. The closure of dedicated sites and reductions in tailored services, including gender-affirming treatments and stigma-free testing environments, have left many KPs vulnerable. South Africa reported that, out of 4,000 healthcare facilities, only about 100 are KP-friendly, exacerbating access issues. HIV prevention and outreach services have also suffered, particularly community-based programs that promote HIV testing, distribute condoms, and link individuals to PrEP. This reduction in outreach threatens the uptake of critical HIV prevention tools, particularly for young people and key populations in high-burden areas.

Human Resources for Health (HRH) has been another significant casualty of these funding shifts - with many health workers previously funded by U.S. donors, countries such as Malawi, Zambia, and Kenya described staffing gaps that threatened continuity of care and the quality of services. Malawi reported losing approximately 4,500 health workers, disrupting service delivery. Kenya faces uncertainty regarding the fate of over 41,000 donor-supported health workers who operate parallel to the government system. Data systems have also faced disruptions, as many digital health platforms relied on donor funding for maintenance and licensing. Countries like Malawi and Kenya have reported significant challenges sustaining partner-dependent data systems.

Governments have begun implementing contingency measures to mitigate these disruptions. Some countries have started shifting antiretroviral (ARV) procurement to government budgets to shield treatment programs from donor volatility. Countries are also adjusting lab and data monitoring strategies to adapt to funding reductions. For example, Eswatini has shifted from six-month viral load testing to annual testing to optimize limited resources.

Integration of services and government leadership has also become a priority, with efforts to embed donor-supported services into public health systems. Zambia has begun integrating 11,350 staff previously supported by PEPFAR into the government system. It is also redeploying public health nurses to sustain community wellness centers and developing a costed minimum package for HIV service delivery, allowing certain components to be absorbed into government budgets. National contingency plans, such as ART and PMTCT, have been rapidly implemented to preserve lifesaving treatments. However, these measures often resulted in scaling down or halting PrEP services for non-pregnant, at-risk populations.

Given the unpredictability of donor funding, countries are re-evaluating their sustainability plans to align with national financing structures. Many governments are revising their national sustainability roadmaps to reflect new funding realities. For example, Malawi, which had not yet launched its roadmap, now sees the delay as an opportunity to refine its approach. At the same time, Kenya has convened an inter-ministerial technical working group to reassess its HIV sustainability strategy. Increased domestic financing is also under discussion, with governments exploring ways to boost domestic contributions to HIV programs. Some countries, including South Africa, are considering working with the Global Fund to fast-track the procurement of new HIV prevention technologies, such as long-acting PrEP injectables. Policy and governance reforms have emerged as a key priority, with an emphasis on strengthening country ownership of HIV programs. Speakers underscored the need for greater transparency in donor transitions, improved planning for funding shifts, and ensuring that governments lead service delivery while donors provide support within national frameworks.

With PrEP services scaled down and outreach efforts disrupted, participants voiced concerns that new HIV infections could rise, particularly among key populations. The reduction in targeted prevention efforts leaves vulnerable groups at greater risk, and countries such as Malawi anticipate a surge in new infections in the coming months due to service gaps. These challenges underscore the critical need for governments and stakeholders to accelerate domestic financing efforts, integrate key population services into national health systems, and develop sustainable HIV prevention strategies that are resilient to donor shifts.

The fourth session, Global Perspectives on a Health Systems Approach to Sustainable HIV
Prevention, brought together academics, policymakers, and other expert stakeholders to discuss the core features and functions of a health systems approach to HIV prevention. Several key themes emerged, underscoring the importance of integrating HIV prevention within broader health systems to ensure long-term sustainability and impact.

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A central theme was the holistic integration of HIV prevention within broader health
services. Panelists emphasized that HIV prevention should not be an isolated add-on to already overburdened clinics but should instead be embedded within comprehensive primary health care, as outlined in the Astana Declaration on comprehensive primary health care, to reduce fragmentation and increase efficiency. Closely related to this was the need for integrated, simplified service delivery, including adopting a "one-stop model" where patients receive all necessary services—such as testing, counseling, and medication—from a single provider. Other innovations discussed included training mid-level or non-traditional cadres (for example, pharmacists) to deliver PrEP, distributing commodities through community groups, and leveraging telemedicine to streamline service delivery.

Speakers also highlighted policy, financing, and governance as vital components for the long-term integration of HIV prevention. They cited examples from Vietnam, Uganda, and other contexts where government-led coordination enabled more efficient procurement, supply chain management, and budgeting for HIV services. Incorporating HIV prevention into universal health coverage frameworks, as seen in Cameroon, was also viewed as a means of safeguarding services amid shifting donor priorities.

A crucial distinction was made between service integration (combining multiple services within a single facility) and systems integration (ensuring alignment across financing, policies, supply chains, data frameworks, etc). Panelists emphasized that scaling up integrated systems remains challenging due to weak governance structures and requires long-term investments in system strengthening to ensure effectiveness.

Speakers also stressed that prevention itself is the foundation of sustainability—without reducing new HIV infections, the entire HIV response becomes unsustainable. They addressed biomedical innovations such as injectable cabotegravir and lenacapavir as potentially transformative but emphasized that these innovations require strong government leadership, user-centered approaches, and multisectoral collaboration. To be sustainable, they must be fully integrated into national health systems. While the current global funding crisis presents significant challenges, panelists noted that this disruption also provides an opportunity to accelerate national ownership of HIV prevention programs.

Another key focus was subnational leadership and decentralization. Speakers highlighted the need to build capacity at subnational levels, where critical decisions on resource allocation and policy execution take place. The Blantyre Prevention Strategy (BPS) in Malawi provided a compelling example of how targeted capacity-building efforts at the district level have enhanced district leadership, management, and coordination of the HIV response.

Overall, the session reinforced the importance of a systems-based approach to HIV prevention—one that promotes country-led policy and financing strategies, leverages subnational governance for effective delivery, invests in supply chain and workforce capacities, and embraces differentiated models centered on user needs. Although the current global landscape poses new challenges, panelists emphasized that these disruptions also create opportunities to advance integration, strengthen domestic ownership, and embed prevention efforts within robust national and sub-national health systems for long-term sustainability.

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DAY TWO:

The second day of the convening commenced with the sixth session, A Health Systems
Approach to New Product Introduction for HIV Prevention, which examined the importance of integrating new HIV prevention products within existing national health systems rather than creating parallel structures.

A key theme of the discussion was the need to align new interventions with national
guidelines, policies, delivery channels, and supply chain mechanisms to maximize

efficiency and sustainability. Panelists emphasized that most countries already have well-
established health system components capable of supporting new product rollouts. Instead of building entirely new pathways, they highlighted the benefits of leveraging existing
infrastructure. For example, Zimbabwe’s standardized framework for new product
introduction adopts a coordinated, system-wide approach across all pillars of the
health system, including management, coordination, budgeting, supply chain, strategic
information, service delivery, and demand creation.

Strong political leadership also emerged as a critical enabler of successful product

introduction. Zambia’s success in introducing long-acting injectable PrEP (CAB-
LA) was partly attributed to high-level political buy-in, which facilitated domestic

budget allocations for its procurement. Similarly, South Africa’s successful oral PrEP
rollout was driven by the coordination of researchers, donors, implementing partners, and
communities under a unified vision led by the National Department of Health, preventing
fragmented, parallel efforts.

Beyond political will, panelists underscored the importance of cross-sectoral engagement.
Malawi’s approach included an expert committee that coordinated efforts across government, researchers, and NGOs to ensure that the introduction of long-acting injectable PrEP aligned with the country’s existing prevention framework.

Panelists also emphasized the need to engage end-users and providers early in the process to ensure that product designs and delivery methods align with user preferences, address misconceptions, and adapt service delivery accordingly. For instance, Malawi's injectable PrEP rollout incorporated human-centered design workshops ("community labs") to engage providers and users. Additionally, panelists from Malawi and Uganda discussed leveraging implementation science to identify challenges, enablers, and community preferences in product rollout.

The discussion also addressed regulatory processes, highlighting the need to move away from linear approaches that delay product availability. Panelists suggested encouraging product registration in more local markets and expediting approvals through regional agreements among African regulatory agencies. Furthermore, they emphasized the role of the private sector, particularly in developing alternative financing models to address shifting donor landscapes and conducting a deeper analysis of cost drivers along the supply chain.

Overall, the session reinforced that successful new product introduction for HIV prevention is not just about launching innovative interventions but about embedding them within existing health systems. Case studies from South Africa, Zambia, Uganda, Malawi, and Zimbabwe demonstrated that leveraging existing infrastructure, systematically engaging communities, and ensuring strong government leadership and coordination are critical for sustainability. While donor funding remains uncertain, proactive strategies—such as securing domestic financing, integrating products into routine services, and strengthening regulatory frameworks—can help ensure that HIV prevention innovations reach those who need them most.

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The seventh session, Aligning Donor Priorities with Local Needs: How Can We Do Better?,
examined strategies for aligning donor priorities with national health system needs to reduce fragmentation and promote integrated HIV prevention approaches.

One of the central challenges discussed was the historical fragmentation of donor-funded HIV prevention efforts, wherein elements of programs function nearly independently of national health systems – from target-setting to delivery strategies and accountability. Such funding structures have historically reinforced programmatic silos, making it difficult to adapt and integrate interventions to local contexts. The pressure for rapid results, coupled with a high magnitude of funding, has, in some cases, led to duplication of services in high-burden areas while leaving other populations underserved.

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A shift toward greater government leadership and ownership was highlighted as essential for long-term sustainability. Panelists noted that national governments must forcefully take the lead in the planning, implementation, and resource allocation of HIV prevention programs –ensuring that donor-funded activities align with national strategies, reinforcing health system integration rather than creating parallel service delivery models. Governments must also play a more decisive role in coordinating implementing partners, ensuring their work complements existing health initiatives rather than duplicating efforts.

Panelists emphasized the importance of stronger integration of HIV prevention efforts within
broader health system structures. This includes leveraging existing resources—such as the

healthcare workforce, supply chains, monitoring and evaluation systems, etc—to sustain donor-supported interventions beyond the funding period. Countries that rely heavily on external human resources or parallel supply chains for prevention services risk losing continuity once donor funding is reduced or withdrawn. Co-creation was spotlighted as an effective approach to ensuring local ownership. Malawi’s Blantyre Prevention Strategy supported a donor-supported effort in which partners worked alongside local governments and civil society to co-develop interventions rather than imposing predefined strategies. This co-creation model allowed for locally led solutions that leveraged existing health system structures instead of establishing new, donor-driven service delivery models. Although co-creation can be time-intensive, panelists emphasized that the long-term benefits—such as greater program effectiveness, more substantial local ownership, and better alignment with national priorities—far outweigh the initial challenges.

Panelists further stressed the need for clear pathways for scaling and sustaining new HIV
prevention tools. Innovative products—such as long-acting injectable PrEP (CAB-LA), the
dapivirine vaginal ring, and lenacapavir—must be introduced with well-defined financing
mechanisms, service delivery integration plans, and health system readiness strategies. The
following UNITAID enablers for innovative product scale-up were highlighted for their emphasis on:

 

• Prioritizing stakeholder engagement and consultations to ensure broad buy-in;

• Supporting product readiness for scale-up and long-term sustainability;

• Ensuring country health systems' preparedness to integrate new prevention tools; and

• Developing a compelling investment case that demonstrates significant public health value and cost-effectiveness.

 

Overall, the discussion underscored the urgent need for a paradigm shift in how donor funding is structured and aligned with local needs. Moving forward, success in HIV prevention will depend on government leadership and accountability in planning, implementation, and funding decisions, more flexible donor approaches that prioritize co-creation, local ownership, and sustainability, and greater integration of HIV prevention into national health systems to avoid duplication.

The eighth session, Enhancing HIV Prevention through Systematic Community Engagement, Learning, and Response, explored how iterative feedback loops between communities and health systems can enhance the effectiveness, relevance, and sustainability of HIV prevention strategies. Several key themes emerged from the discussion.

One primary focus was community-driven HIV program development. Panelists discussed how co-creation and co-research initiatives empower community members, particularly youth groups and advisory councils, to generate data and advocate for policy changes at the local level. Community Quality Improvement (QI) teams embedded in subnational health offices were also recognized as effective mechanisms for identifying service gaps and advocating for improvements.

Another critical theme was the importance of two-way feedback between communities and health systems, ensuring that community input is not only collected but also acted upon. Panelists discussed best practices for systematic engagement and feedback mechanisms that foster open dialogue and accountability. These include establishing trust, building the capacity of community members to participate effectively in decision-making, addressing stigma by creating safe spaces for individuals to share concerns, ensuring that feedback translates into concrete policy changes, and maintaining transparency and accountability in decision-making processes. These approaches increase trust in health programs and shape them to more efficiently meet the actual needs and preferences of communities.

The role of community-led advocacy was also emphasized. Panelists noted that community-led organizations—particularly those formed by women, youth, and people living with HIV—are uniquely positioned to assess genuine needs and ensure that interventions align with local priorities. Examples of successful advocacy included efforts by women living with HIV to expand access to treatment and prevention options such as dolutegravir and the dapivirine vaginal ring. Additionally, panelists highlighted the value of community-led monitoring, which enables real-time feedback on service quality and directly influences resource allocation and policy decisions. Strengthening the capacity of local organizations to manage and utilize resources was also considered essential for long-term sustainability.

The discussion further underscored the need for sustained investments in community-led
structures. Governance models must move beyond symbolic representation and grant community leaders and civil society meaningful decision-making power rather than merely observer status. Furthermore, adequate resources should be allocated to ensure communities can actively participate in policy spaces, collect and analyze data, and disseminate findings within their constituencies.

Overall, achieving meaningful engagement requires embedding community voices at every stage of program design and implementation, securing sustained financing for community-led structures, and institutionalizing transparent mechanisms for two-way feedback that translate community insights into policy and service delivery improvements.

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The final session, Recommendations and Call to Action for Sustainable HIV Prevention
Programming provided actionable recommendations for achieving long-term, sustained control of the HIV epidemic. Several key themes emerged.

Panelists emphasized the need for governments to take greater ownership of HIV prevention
programs, reducing reliance on donor-driven initiatives and integrating services within national health systems. Many countries continue to operate parallel HIV prevention programs supported by external donors, leading to inefficiencies and fragmentation. Panelists emphasized that national governments must allocate domestic resources for critical components such as human resources, essential products and services, and health information systems to ensure sustainability. Task-shifting was also identified as a crucial strategy to expand service provision at lower levels of care, ensuring that preventive services are widely accessible.

Another central theme was the integration of HIV prevention within primary healthcare systems. South Africa was highlighted as an example of a country that has successfully embedded prevention and treatment services within its primary healthcare system. However, challenges remain, particularly in ensuring retention and preventing drop-offs in treatment and prevention services. Long-acting HIV prevention products were identified as a promising strategy to improve adherence and retention rates.

Strengthening health information systems to track epidemiological shifts and utilizing data-driven targeting strategies to identify at-risk populations were also highlighted as crucial. Panelists stressed the need for robust monitoring and evaluation frameworks to ensure that prevention interventions are directed toward populations at the highest risk and achieve the desired impact.

Community engagement was recognized as essential in ensuring the accessibility and acceptability of services. Strategies such as community advisory boards, community-based participatory research, and community quality improvement approaches were highlighted as best practices for placing communities at the center of program design and evaluation. Ensuring choice in HIV prevention—by advocating for a diverse range of prevention options tailored to community preferences and epidemiological realities—was also emphasized as a key factor in improving uptake and effectiveness.

Panelists also discussed the need for diversified financing for HIV prevention. In addition to
increased domestic investment, market-shaping strategies that include leverage, such as volume guarantees for essential products, were proposed as a means to lower the cost of emerging HIV prevention tools, including long-acting PrEP. Panelists suggested greater engagement with development banks and other sources of concessionary funds, in addition to emerging foundations with an interest in building healthier, more stable societies. Governments were also encouraged to integrate HIV prevention into national social health insurance schemes to ensure equitable access and reduce costs.

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