Track scope and objectives
Basic and translational research
Track A will focus on recent advancements made through both basic and translational research to further our understanding of HIV transmission, pathogenesis and persistence. Highlights will include advances in: understanding host-viral factors impacting HIV transmission and acquisition; mechanisms of reservoir establishment and HIV persistence; accurately measuring and targeting reservoirs of HIV infection; B cell engineering and manipulating B cell immunity as treatment and prevention; and understanding the ramifications of co-morbidities with HIV. Recent findings will be linked to clinical research (Track B) where appropriate. The following topics will be emphasized in Track A:
- Broadly neutralizing antibodies as prevention and treatment. From B cell engineering to antibody stabilization: We will look at new ways to elicit long-term expression of broadly neutralizing B cell immunity against HIV, from recent progress in B cell receptor engineering that changes antibody specificity to production of stabilized immunoglobulins that require fewer infusions.
- How early is early? Lessons learned from treating acute infections. When and where is the viral reservoir established? Correlates to define successful remission after early treatment.
- Novel technologies to understand, measure and eliminate the viral reservoir. From single-cell RNA sequencing to single molecule detection, to novel assays and latency-reversing agents, we will explore how novel concepts and technologies are reshaping our understanding of the landscape of HIV persistence.
- The emerging biology and pathophysiology of HIV co-morbidities. How persistent infection affects life and health span of people living with HIV. From the molecular biology of tissue immunity and the causes of chronic immune activation to exploring the consequences of living with HIV into older age.
Track B will focus on clinical care of people with HIV, highlighting the controversies and complexities of clinical treatment and management with a particular focus on antiretroviral therapy. Attention will be paid to vulnerable populations, such as young people and women, including transgender women, where HIV incidence remains high. Non-communicable diseases (NCDs) remain an important additional focus against a background of ageing populations living with HIV. Latest clinical research will be presented on:
- Antiretroviral therapy and strategies for cure
- Investigational antiretroviral drugs: existing and new mechanistic classes (for example, nucleoside reverse transcriptase translocation inhibitor, entry inhibitors, capsid inhibitors, maturation inhibitors)
- New strategies: long-acting injectable regimens: implantable devices: dual (two-drug) therapies; weekly/intermittent regimens; same-day initiation; non-drug retention strategies
- Drug-related toxicities, drug-drug interactions; ARV-associated weight gain, its mechanism, management
- INSTIs in women, during pregnancy and in children
- Investigational immune-based therapies and gene therapy (for example, broadly neutralizing monoclonal antibodies, therapeutic vaccines, anti-PD-1 antibodies, TLR7-agonists, IL-15 superagonists and combinations of these agents)
- HIV and ageing-related inflammation and immune activation, and related drug interactions. Malignancies and chronic diseases in people living with HIV at all ages; effects of NCDs on the ageing HIV population, including their prevention and management, as well as polypharmacy
- Young people. Treatment adherence, drug resistance and engagement in and transitions in care
- Tuberculosis: novel diagnostic tools, treatment and prevention regimens
- Viral hepatitis: new treatment regimens for HCV and strategies to cure HBV infection
- Sexually transmitted infections: resurgence of syphilis and drug-resistant gonorrhoea and chlamydia
- Important key opportunistic infections and new emerging infections
- Antiretroviral drug interactions
- Efficacy and safety of specific vaccines in people living with HIV.
Epidemiology and prevention research
This track will address the development of new prevention tools, the delivery of currently available prevention strategies, and the impact of expanding prevention options on the global HIV epidemic. With expanded implementation of existing prevention tools, countries and cities are seeing sustained declines in new HIV infections. However, while there is tremendous global opportunity for HIV prevention in 2020, there are also substantial challenges. The UNAIDS 2019 Global Update revealed that HIV prevention services reached less than 50% of members of key populations in more than half of the countries that reported on prevention. The results of large-scale universal test and treat trials were not consistently positive in terms of reducing new HIV infections, highlighting prevention/treatment gaps.
For oral PrEP, insufficient uptake and adherence are key barriers to potential impact, and novel approaches to maximizing PrEP knowledge and use are clearly an essential need. HIV prevention interfaces strongly with sexual and reproductive health, and optimizing prevention success will require more comprehensive prevention. This includes: attention to prevention for pregnant and lactating women; the interaction between HIV prevention and control of sexually transmitted infections; and HIV prevention within a larger context of reproductive justice.
The HIV prevention successes that have been seen at scale are not being shared equally, with the greatest impacts to date occurring among men in urban centres of the global North. An important cross-cutting priority for this track is strategies to expand prevention success to those in the global South, adolescent girls and women, marginalized populations worldwide, people who use drugs and other key groups.
Finally, the success of HIV prevention implementation poses logistical challenges to testing new prevention modalities, and creative approaches to new trial designs are required. Areas of special interest include:
- Treatment as prevention. Critical review of universal test and treat trials; optimized interventions to improve access and use by adolescents, key populations, men; improving U=U community awareness
- PrEP implementation and development. Scale up and impact on global HIV epidemiology, with a focus on countries furthest ahead in oral PrEP delivery; strategies to simplify PrEP delivery and expand access; successes and challenges among important populations (men who have sex with men, transgender women, adolescents, young women); pharmacokinetics/pharmacodynamics of PrEP agents (including tenofovir alafenamide); new PrEP agents and delivery approaches (including injectables, long-acting formulations, implantables, vaginal rings, vaginal films and novel topical agents)
- Broadly neutralizing antibodies and vaccines. Current state of trials and looking ahead to outcomes; anticipating realistic consideration of delivery challenges for these strategies
- Integrated prevention approaches. Impact at scale of combination prevention delivery across settings; promising supportive interventions (for example, community-based delivery, lay health worker engagement, m-health applications) to facilitate scale up and access to prevention; evaluation of social, behavioural and structural interventions that address co-morbidities, including poor mental health and substance use
- Key populations and the intersection with larger issues of sexual and reproductive health. Interface of prevention scale up and the global STI epidemic and strategies for STI prevention; PrEP options and choices, including analogies to contraceptive choice; drug interactions and engagement in prevention for transgender populations; new prevention interventions for drug users; HIV prevention in the context of contraceptive delivery and the interaction of hormonal contraception and HIV risk
- Novel trial design and monitoring strategies. New trial designs for prevention studies, including those that model drug levels as a surrogate for efficacy; monitoring prevention impact using routine programmatic data; population-level assessment of HIV incidence; HIV phylogenetics for prevention monitoring and intervention; ethical and community considerations about new trial designs.
Social and behavioural research
This track will focus on the social and behavioural factors that influence HIV risk, vulnerability, clinical outcomes and intervention impact as assessed in rigorous scientific studies. Sessions in this track will present qualitative and quantitative assessments of social and behavioural factors influencing HIV epidemics and the responses to them. This includes: the effectiveness of treatment, care and support strategies for people living with HIV and HIV prevention methods for those at risk of HIV; structural interventions for HIV prevention and treatment, including advances in measuring and supporting adherence; and factors that promote or impede the translation of social, behavioural and structural evidence into practice at all levels (global, national, local, community and individual).
Attention will also be placed on ethical and human rights issues related to clinical trials. Submissions will be invited from the full range of social and behavioural science disciplines, including operational research by community-based implementers who are translating results of sociobehavioural research into programme practice. Latest conceptual thinking and empirical results are specifically expected in relation to:
- Social capital, social movements and health-enabling contexts for marginalized communities
- Resilience, community systems strengthening and effective strategies in overcoming stigma
- Experiences of stigma, and measurement and evaluations of interventions that reduce or mitigate its effects
- Perceptions of risk/vulnerability and links to sexual behaviours and prevention practices, for example, PrEP uptake, adherence and persistence
- Personal and public health approaches towards attitudes and behaviours associated with increased vulnerability to HIV, such as chemsex, sex work and multiple concurrent sexual partners
- Quality of integrated service provision and uptake, including differentiated models of delivery and implications for quality and health outcomes
- Pathways to care, retention and adherence for HIV co-infections and co-morbidities, such as mental health, TB preventative therapy and harm reduction
- Redress/reparations in response to structural issues (discrimination, violence, other human rights violations)
- Ethical considerations in relation to research, including the involvement of certain communities in clinical trials (such as pregnant and lactating women, people living with HIV, people with TB and transgender women)
- Innovations in community-driven solutions, including entrepreneurship and livelihoods approaches, as well as evidence generated from participatory and action research methods.
Implementation research, economics, systems and synergies with other health and development sectors
Implementation science is an emerging and powerful field focused on evaluating processes of translating scientific evidence into impactful HIV interventions and on the various factors affecting these processes. It is key to demonstrating how interventions proven to be efficacious in trial settings succeed and can be implemented more effectively under different real-world conditions. These trial settings include ART for those living with HIV, clean needles and substitution therapies to prevent HIV transmission among people who inject drugs, and condom use or PrEP for those vulnerable to HIV acquisition.
While implementation science can provide insight into particular elements of intervention packages that are essential, the sustainability of these interventions is driven by econometric measures and the ability to practically integrate into existing health systems. Although interest in implementation research and econometric assessments focused on HIV has increased significantly, gaps in applying the full range of available qualitative, quantitative and modelling methods and tools in the HIV field remain.
Track E will help close these gaps with a focus on promoting a balance of contextually specific and standardized approaches of implementation science, econometric study and health systems research to enhance interpretation, transferability and assessment of sustainability. Specific emphasis will be on: better ways of describing strategies for operationalizing evidence-based interventions and evaluating their sustainability; evaluating best-practice methodologies; assessing different stages of implementation; identifying key drivers (capacities) needed for change; deploying relevant implementation teams at different levels of the health system; and using measurable quality improvement cycles and policy-practice communication approaches.
Key areas of interest include:
- Novel methods and tools, including: use of econometric methods versus randomized trials; applying qualitative approaches to broader implementation problems; and bringing adaptivity and network analysis into the research framework to generate data that is more relevant for practice
- Improving modelling by: using large-scale public datasets to model macroscopic health, costs and social effects of global HIV policies and investments; using the transportability framework to elucidate understanding of both scientific findings and how they are used to shape the global public health response to the HIV epidemic; and integrating implementation considerations and costs into modelling of strategies for effective and cost-effective policies and practices in the HIV response
- New opportunities and ethical and practical factors associated with research embedded in public health systems, community, religious organizations, etc.
- M-Health. Advances in implementation science and cost effectiveness related to the use of ICT in delivering HIV interventions; using m-Health for deeper reach to enhance generalizability to desired target populations; and m-Health as an implementation research tool
- Adapting research to serve programmatic needs. Studies into health systems and local contexts to support local and national programmes in identifying opportunities to reduce HIV incidence using available tools.
Political research, law, policy and human rights
This track will focus on describing the interdependence of structural factors that enhance or detract from accessing services and impact differently on high-risk groups and communities left behind in the HIV response. The importance of understanding the “relative impact” of access and retention for each population is a critical ingredient for maximizing positive outcomes on the target population. Sessions in this track provide opportunities to demonstrate best practices and highlight needed reforms from a wide range of perspectives, including community-led interventions to remove structural, legal and policy barriers to comprehensive HIV services, particularly for the most underserved, unreached, left behind and marginalized communities. Research talks, debates and panels will focus on:
- Understanding the variable access to prevention, care and treatment services for different groups vulnerable to HIV
- Structural and programmatic methods to address inequities in access/retention for marginalized groups
- The role of legal, policy and advocacy tools to integrate human rights principles and standards into HIV prevention, care and treatment services
- Demonstrating mechanisms/strategies that ensure community inclusion in planning, allocation decisions and implementation of HIV services
- The role of diplomacy in defining and correcting structural, legal and cultural barriers to services
- Strategies for delivering comprehensive services to marginalized communities in settings where sexual/gender identity, HIV exposure and/or transmission, choice of abortion and drug use or injection are criminalized
- Integrating HIV services into a sustainable, resilient and inclusive service package for universal health coverage.