We thankfully started to put COVID19 and all of its trials and tribulations behind us in 2022. Whilst the clinical and site teams had pivoted so effectively to embrace the urgent needs and opportunities that the pandemic offered, we have all been very relieved to return to our core mission and once again move the HIV, TB and related topics forward.

We remain, however, very proud of the impact we made on the COVID19 pandemic locally through contributions to vaccine science, new treatment modalities and through service. In particular the role we played in vaccinating health care workers through the Sisonke and related trials and then people living with HIV through the Ubuntu trials will stand out for me as a time when we really showed we are #strongertogether and I want to pay tribute to many of our teams, staff, colleagues and partners who worked long hours, at the weekends and made personal and family sacrifices. We also want to remember the family, friends and colleagues we lost to COVID19 during this difficult time.

Many lessons were learned during COVID19.

Yet, it is not to say that we did not see progress in HIV and TB during this time. Despite the added challenges of COVID19 and the related closures and lock downs, the HPTN 084 study read out with truly unprecedented trial results. The reduction in HIV incidence in the group of women who received long acting Cabotegravir PrEP injectable was 89% less than that seen in the comparison group of women who received the oral PrEP pill. Overall, incidence was less in both but the trial gives us a sense of the impact a 2 monthly HIV prevention injection could have if it was rolled out in our region. We know from a previous study called HPTN 083, which we also participated in, that this also has a good outcome in men who have sex with men and transgender people. Unfortunately, roll out has been delayed due to manufacturing bottle necks and cost although we are all strongly advocating in all forums to see access begin to happen. Happily, ViiV Healthcare, the originator pharmaceutical company has given the license for manufacture to the Medicine Patent Pool and three generic companies have stepped forward to receive the voluntary license. We have been selected to be one of a handful of vanguard pilot studies in the meantime and are very excited to gain some real-world experience.

Longer acting antiviral therapy has also made its way into treatment. The long acting Cabotegravir injection is paired with an equally long acting second agent and together they are administered also two monthly for people who are stable on their treatment but would like to take a break from daily pill swallowing. We think there is a real need among adolescents living with HIV because they often really struggle with the stigma and chore of taking their treatment daily. We are also very glad to be testing this novel therapy in young people in Cape Town in the AFINAty study.In terms of real-world experience, there is none so expansive nor as exciting as the Bill and Melinda Gates Funded project known as FASTPreP. This implementation science program seeks to understand what it would take to really bring sexual and reproductive health services, including HIV prevention, to all the young people in a single health district. Co-created with young people, this project seeks to emulate Fast Food outlets, by basically ensuring there are PrEP outlets in convenient public rowdy places but also discreetly through courier and Postbank services, at schools, mobile clinics and everything in between! Now in its second year, this fleet of DTHF mobiles partnered with public sector clinics and an army of terrific committed staff and young people have reached half of their target population and are continuing to fly the flag of better sexual and reproductive health among our youth. We are really excited now to start to see many learnings and data for numerous PhD scholars in the next few months.

Throughout COVID19 the tuberculosis aerobiology unit at our Masiphumelele site continued to conduct their novel and groundbreaking experiments. Their quest is to understand why TB remains a generalised epidemic in South Africa despite all efforts to increase case findings and treatment – what are the drivers of the high rates of infection we see in our communities where there is crowding? This work is starting to yield fruit now, with the first of the high impact peer reviewed papers starting to be published. We think this is potentially paradigm shifting and so we encourage all to watch this space!

Also down in Masi, we were happy to reclaim the youth centre space with the winding down of COVID vaccination. During COVID the youth centre served as an urgent temporary vaccination centre. It has now been able to move on to the planned Mpilo Health Park – an integrated sexual, reproductive and HIV prevention health centre together with opportunity for physical fitness and activity in a fun colourful and youth friendly environment. We look forward to what the Mpilo Health Park can teach us about the new epidemic of non- communicable diseases such as diabetes, hypertension, obesity and related syndromes. These usually manifest in adults but we think there is a real opportunity to intervene on the prevention side in adolescence and young adulthood, a time during which habits and behaviours are shaped. Integrating this with sexual and reproductive health we think will attract young men and young women to try to realise their best healthy selves bringing a triple dividend to South Africa- healthy adolescents, healthier adults and therefore healthy parents for the next generation of South Africans!

These describe just a few highlights from an organisation that has at its heart an incredible staff who remain as committed and enthusiastic as ever to live out the values we believe encompass what the Arch stood for:

PROGRESS   EXCELLENCE   RESPECT   COMPASSION   INTEGRITY   PASSION

We also extend a warm and heartfelt thanks to our Board of Directors who have stood by us throughout and continue to give sage guidance and support. Also, warm thanks and salutations to an extraordinary array of friends, funders and supporters. We are stronger because of your support. Ubuntu!