Future directions: ending HIV in Africa-a call to action for sustainable and nationally led prevention.

Abstract

Although substantial progress has been made with the global scale-up of antiretroviral therapy, primary prevention efforts remain fragmented, underfunded, and susceptible to external shocks. Programmatic approaches that prioritise isolated interventions over strengthening the health system functions and infrastructure needed to deliver primary prevention at scale have increasingly proven inadequate, especially given recent funding disruptions. Together, these challenges underscore the urgent need for new thinking. The Sustainable HIV Prevention in Africa Series draws links between what had often been verticalised, partner-driven HIV prevention efforts and their corresponding health system functions. It also examines how HIV prevention links with primary health-care frameworks, and how strengthening integrated systems, supported by enablers such as digital health and artificial intelligence, systematic community engagement, and systems approaches to new product introduction, can enhance HIV prevention. This Series paper synthesises lessons from the Series and puts forward a call for an urgent action agenda on practical, short-term opportunities to strengthen HIV prevention, especially considering the funding and governance disruptions that many countries are facing.