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HIV Care in Resource Limited Settings
IAS 2025 in Kigali: Critical Evidence for HIV Care in Resource-Limited Settings

Released: August 15, 2025

Gashaija Absolomon
Gashaija Absolomon, MPH
Jeanine Condo
Jeanine Condo, MD, PhD
Felix Kitema
Felix Kitema, PhD
Eric Remera
Eric Remera, MSc, PhD
Gallican N. Rwibasira
Gallican N. Rwibasira, MD
Activity Information

Activity

Key Takeaways
  • I think the most important studies from Africa presented at IAS show:
    • Support for prioritizing long-acting injectable programs for adherence-challenged patients
    • Definitive evidence against short-cycle therapy for adolescents regardless of supply pressures

Reminders that clinical advances mean nothing without sustainable funding mechanisms

The timing of International AIDS Society (IAS) 2025 in Kigali couldn't be more relevant for those of us practicing in East Africa. The studies presented provide a stark contrast between encouraging advances and sobering realities that will directly shape our clinical practice.

LA ART: A Potential Solution for Our Most Challenging Patients
The IMPALA trial results represent exactly what we've been waiting for in sub-Saharan Africa. This multicenter study across Uganda, Kenya, and South Africa specifically enrolled people who previously struggled with oral antiretroviral therapy (ART) adherence—our most challenging population.

With 91% of participants achieving viral suppression with long-acting (LA) cabotegravir plus rilpivirine, compared to 89% of participants on oral therapy, the results speak directly to our daily practice challenges. What impressed me most was the 94% preference for injectable treatment and the superior performance when considering transmission-relevant viral loads >1000 copies/mL.

For my practice in Rwanda, this offers hope for mobile populations like cross-border traders and seasonal workers who struggle with daily oral therapy. The monthly or every other month dosing aligns perfectly with our existing clinic visit schedules.

BREATHER Plus: Clear Guidance Against Short-Cycle Therapy
The BREATHER Plus trial delivers unambiguous results that will influence policy across the region. Following 470 adolescents for 96 weeks across four countries, the study compared short-cycle therapy (5 days on, 2 days off) with daily ART for 96 weeks.

The findings are definitive: 10% of adolescents on short-cycle therapy experienced virologic rebound vs only 5% on continuous therapy. This 5% absolute difference may seem modest, but it represents a significant safety concern that outweighs potential cost savings from reduced drug consumption.

For resource-constrained settings where short-cycle therapy might seem attractive for stretching limited supplies, these data provide clear evidence against this approach in adolescents.

Prevention Advances: MK-8527 Shows Promise
The MK-8527 study offers encouraging news for PrEP delivery. This once-monthly oral option demonstrated similar safety profiles to placebo across 350 participants, with dose-proportional pharmacokinetics supporting continued development.

For East African settings where daily PrEP adherence remains challenging, monthly dosing could significantly improve prevention coverage, particularly among key populations who face barriers to frequent clinic visits.

The Funding Crisis: Real-world Impact Data
The Mozambique funding interruption study provides the most comprehensive real-world evidence of what happens when HIV programs lose support. Within just 1 month of US funding suspension, there was a 25% reduction in ART initiation, a 38% drop in viral load testing, and a 33% reduction in viral suppression.

The pediatric population was disproportionately affected, with a 44% reduction in viral load tests performed and a 43% reduction in viral suppression. The modeling predicts over 80,000 additional HIV infections by 2030—numbers that represent real families and communities.

In Rwanda, where external funding supports the majority of our HIV program, these findings serve as an urgent call for funding diversification strategies while maintaining program quality.

Implications for Practice
These studies provide clear guidance for immediate implementation in East Africa. The IMPALA results support prioritizing LA injectable programs for adherence-challenged patients, while BREATHER Plus definitively rules out short-cycle therapy for adolescents regardless of supply pressures.

The Mozambique data remind us that clinical advances mean nothing without sustainable funding mechanisms. We must advocate urgently for funding diversification while implementing the effective tools these studies have demonstrated.

Your Thoughts?
How are you preparing to implement LA therapies in your setting? What strategies are you considering for funding sustainability? Share your thoughts in the discussion section.