Africa is home to the majority of people living with HIV and the region hardest hit by the donor funding crisis. At this year’s Conference on Retroviruses and Opportunistic Infections (CROI 2026) in Denver, there was promising science – from community-level prevention to cure research with children. Here are five highlights.
The scale and nature of disruption to HIV services following the withdrawal of US funding is becoming clearer, even as the data systems that would normally capture it have themselves been dismantled. A rapid survey of clinics and programmes across 32 countries found widespread disruption, especially in laboratory services, adherence support, patient tracing, record management staffing and other operational requirements. These ‘silent’ functions ultimately impact clinical care even when medications remain available.
A community-based intervention combining quarterly home visits, home-based HIV testing and a range of prevention options cut HIV incidence by 70% over two years in rural Kenya and Uganda. Participants could choose between oral PrEP, the dapivirine vaginal ring and PEP supplied in case of future need, and switch between options as their needs changed. The incidence reduction was driven primarily by a fourfold increase in prevention uptake, rather than improvements in treatment coverage, which was already high among the 84,000 participants.
A study from Rakai in Uganda calculated a small but quantifiable risk of HIV transmission at viral loads between 200 and 1000. This appears to challenge the threshold used in ‘Undetectable equals Untransmittable (U=U) messaging. The findings generated considerable debate, with other researchers questioning the assumptions underlying the estimates and whether advice clinicians to people living with HIV should change.
African research teams presented several innovative approaches to treating children with HIV, with two studies aiming for remission – long-term viral control without antiretroviral therapy. A South African study showed that a subset of children given antiretroviral therapy very early after birth were able to maintain viral suppression after stopping treatment. Researchers in Botswana gave a similar group of children three broadly neutralising antibodies before stopping antiretrovirals. All ten children assessed maintained undetectable viral loads on the antibodies alone, and the next phase of the research will see what happens when they stop the antibodies too. Separately, the final two-year results from the MOCHA study confirmed that injectable cabotegravir/rilpivirine safely maintained viral suppression in adolescents – a group that often struggles with daily pills.
One in seven men living with HIV in eastern and southern Africa do not know they have the virus, with younger men and those who migrate for work especially likely to be undiagnosed. Drawing on nationally representative survey data from seven countries, the study found that men also experience larger drop-offs at each step of the treatment cascade, from testing through to viral suppression – a persistent gap that poses a challenge for reaching 95-95-95 targets.
