Specially trained pharmacists will be allowed to dispense HIV treatment and prevention medicines without a doctor’s script. (Photo: Unsplash)
By Catherine Tomlinson for Spotlight
Ten months after an enabling court judgment, some pharmacists in South Africa can finally start applying for permits that allows them to dispense HIV prevention pills without a script from a doctor.
Specially trained pharmacists can now begin applying for permits to dispense antiretroviral medicines for HIV prevention without a doctor’s prescription. The long-awaited permitting process was announced to pharmacists in a South African Pharmacy Council (SAPC) e-Note on 13 August.
PIMART is a form of task-shifting that allows pharmacists to provide some limited HIV services that are currently only provided by doctors and nurses.
It is intended that, under the PIMART programme, pharmacists that have completed a dedicated training programme and have received a special permit from the Director-General of Health will be authorised to provide first-line antiretroviral treatment to people with uncomplicated HIV without a doctor’s script.
They will also be allowed to dispense HIV prevention medicines without a doctor’s script – this includes both pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). PrEP is taken prior to sex to prevent potential infection while PEP is taken shortly after a possible HIV exposure to prevent infection.
PIMART’s long road to implementation
The SAPC first proposed PIMART to the health department in 2018. The proposal was in response to a request from the department for pharmacists to take on a larger role in the country’s HIV response.
In 2021, Spotlight reported the imminent launch of PIMART services in South Africa’s pharmacies, but then a court challenge against PIMART by a group of general practitioners blocked the programme’s implementation.
Four years later, in October 2025, a ruling by the Supreme Court of Appeal finally cleared the way for SAPC to launch PIMART. Following the court ruling, Vincent Tlala, CEO and Registrar of the SAPC, told media that the SAPC would issue a memo in November 2025 inviting pharmacists to apply for PIMART permits. But this would in fact only materialise in August 2026.
The SAPC’s 13 August memo to pharmacists, said that certain pharmacists can now begin to apply for temporary PIMART permits to provide PEP, PrEP, and HIV testing services – but not yet HIV treatment services. The temporary permits will be valid for 24 months.
Also, only pharmacists that completed the South African HIV Clinicians Society’s (SAHCS) previous PIMART training course can apply for the limited-scope, temporary PIMART permits.
Pharmacists that have not completed this course will have to wait for a new training course to be accredited and launched before they can apply for permits to provide PIMART services.
How long will it take to get a permit?
Tlala told Spotlight that the granting of the limited-scope, temporary PIMART permits by the Director-General and their recording by the SAPC may take a few months.
“The Department of Health processes applications for permits within 90 days (maximum),” said Tlala, adding that “[t]he PIMART permit recording process with the South African Pharmacy Council then takes between 72 working hours and 14 days, depending on the completeness of the application.”
The permits will only be granted to pharmacists who have already completed the Southern African HIV Clinicians Society’s (SAHCS) continuous professional development (CPD) PIMART course. Pharmacists that did not complete this course will need to wait for an updated PIMART course to become available before they can undertake the required training to be permitted.
Fiona Story, CEO of SAHCS, told Spotlight that nearly 800 pharmacists have completed the course.
Taken together, all of this suggests that toward the end of the year, a few hundred pharmacists in South Africa might be dispensing HIV prevention medicines without doctors’ scripts.
When will the updated training course be available?
Currently, there is no PIMART training course available for pharmacists, as the previous PIMART training course provided by SAHCS is on pause, while the updated course awaits accreditation. Based on dates provided by SAHCS, the updated course might only be available early next year.
However, once the updated course is available, it is anticipated that pharmacists that complete it will be able to apply for full-scope PIMART permits that allow them to dispense first-line antiretrovirals to people with uncomplicated HIV without a doctor’s script, in addition to PEP and PrEP.
“The CPD-accredited PIMART course is no longer available as it was reviewed and updated in line with the requirements for accreditation as a supplementary training course,” Story told Spotlight.
She said that the SAHCS is seeking accreditation of its updated PIMART training course from the SAPC. “SAHCS anticipates the PIMART supplementary training course accreditation process will conclude before the end of 2026,” said Story. She added: “SAHCS has prepared to launch the PIMART supplementary training course as soon as accreditation has been received.”
When will pharmacists be able to dispense HIV treatment without a doctor’s script?
The timeline for when pharmacists will be able to provide the full scope of services intended under PIMART, including HIV treatment for uncomplicated cases, remains unclear. Before this can happen, the SAPC must accredit the SAHCS’ updated supplementary training course and the SAHCS must launch this course.
After this, the permits granted to pharmacists by the Director-General will need to be expanded to include the provision of first-line antiretroviral therapy for treatment of uncomplicated HIV.
In the meantime, the around 800 pharmacists who completed the SAHCS’s previous PIMART training course can now start applying for permits to provide PrEP, PEP, and HIV testing services.
Hepatitis B remains one of the world’s most underdiagnosed infections.[1]
Untreated hepatitis B can remain silent for years while increasing the risk of severe liver disease and preventable infant infection.[1,2]
Integrated point-of-care testing during antenatal care visits presents an important opportunity to identify undiagnosed infections and support measures aimed at reducing transmission to newborns.[2,3]
A pregnant woman attending her first antenatal care (ANC) appointment will often be screened for conditions that could affect her health and the health of her unborn child, including HIV and syphilis, but not always for hepatitis B virus (HBV) infection. This is not because hepatitis B is rare; in fact, quite the opposite. Millions of people worldwide are living with chronic hepatitis B infection, yet many remain unaware of their infection because the disease can progress silently for years without symptoms.[1] As a result, infection is often diagnosed only after serious liver complications develop.[1]
Late diagnosis increases healthcare costs, may limit treatment options and contributes to preventable illness and death.[1] For pregnant women, delayed diagnosis creates an additional risk of vertically transmitting the virus to their babies during childbirth.[2] That missed opportunity is why hepatitis B needs to be seen not only as a liver disease, but as a maternal and child health priority. For healthcare companies such as Abbott, there is an opportunity to help health systems make every ANC touchpoint work harder by bringing reliable, rapid and integrated testing closer to the point of care.
The central question is no longer whether hepatitis B can be detected, prevented or managed. It can. The question is whether health systems are using routine moments of care, especially pregnancy, to find the infection early enough to enable interventions that can improve outcomes for mothers, infants and families.
Hepatitis B is often silent, but its consequences are not.[1]
ANC offers a critical window to prevent mother-to-child transmission through timely immunoprophylaxis.[2,3]
Integrated testing can help expand access while reducing practical barriers for patients and frontline healthcare workers.[3]
Africa has the tools to change the trajectory; now systems must scale them.[1,3]
The cost of not knowing
Hepatitis B remains one of the world’s most significant infectious diseases despite being preventable and treatable. According to the World Health Organization’s (WHO) Global Hepatitis Report 2026, an estimated 240 million people were living with chronic hepatitis B in 2024, and the WHO African Region accounted for 68% of new hepatitis B virus infections globally.[1]
Behind these numbers are people who may be asymptomatic for years while the virus quietly damages the liver. When hepatitis B is not detected, the first sign of illness may be cirrhosis, liver cancer or liver failure.[1] For families, delayed diagnosis may contribute to repeated clinic visits, rising treatment costs, lost income and the emotional burden of managing a condition that could have been identified much earlier.
“Hepatitis B challenges health systems because it is often invisible until the consequences are severe,” says Dr Evans Mathebula, Senior Medical Affairs Manager at Abbott’s rapid diagnostics business in Africa. “If we wait for symptoms, we have waited too long. The priority should be to make hepatitis B screening routine, accessible and connected to care, particularly at moments when people are already engaging with the health system.”
This is especially important in maternal care. Pregnancy represents one of the most important opportunities to identify previously undiagnosed hepatitis B infection. For many women, ANC is among the few periods of regular engagement with the healthcare system.[2] This visit already serves as an important screening and health education opportunity and can facilitate preventive interventions. Many African countries have made important progress in preventing mother-to-child transmission of HIV. That progress shows what is possible when testing, treatment, policy and community trust are aligned. Hepatitis B now needs the same systems discipline, because the antenatal care clinic may be one of the few reliable points of contact between a pregnant woman and the health system.
This approach aligns with the WHO’s triple elimination initiative, which encourages countries to eliminate mother-to-child transmission of HIV, syphilis and hepatitis B together, rather than through fragmented disease-specific programmes.[3] It recognises a simple reality: healthcare systems across Africa continue to face constraints, workforce pressures and laboratory challenges. In this context, adding new screening priorities must be practical and sustainable. Additionally, pregnant women should not have to navigate three separate pathways when one integrated screening moment can support identification of multiple risks and enable timely care during a single encounter.[3]
An integrated antenatal panel that screens for HIV, syphilis and hepatitis B from a single finger-prick is one example of how health systems can simplify access while maintaining a comprehensive standard of care.[3] For mothers, it can help reduce the risk of missed results and clarify next steps. For healthcare workers, it can support faster decision-making at the point of care when linked to appropriate follow-up pathways. For newborns, timely identification of maternal hepatitis B can support measures that reduce the risk of exposure and enable timely preventive action.
“The most powerful public health interventions are those that fit naturally into the realities of existing care,” adds Mathebula. “The easier it is for healthcare workers to identify hepatitis B during a single antenatal visit, through the use of an integrated panel, the sooner patients can be considered for appropriate follow-up care. We are not only improving diagnosis; we are giving clinicians the information they need to support mothers, help reduce the risk of infant infection and strengthen confidence in the health system.”
A hopeful path to elimination
For too long, hepatitis B has remained overshadowed by other infectious diseases despite its scale and impact. The tools needed to prevent transmission, diagnose infection and support long-term management already exist.[1] What remains is the challenge of finding the millions of people who are living with this virus without knowing it, starting with those accessing maternal and primary healthcare.
To move from awareness to action, policymakers and healthcare leaders should prioritise routine hepatitis B screening in antenatal care, support point-of-care testing in decentralised settings, strengthen linkage to treatment and ensure newborns receive timely protection.[1,3] These are practical steps that can turn a silent infection into a manageable health issue and help prevent transmission to the next generation.
Eliminating hepatitis B as a public health threat will require more than technology alone. It will require political will, domestic investment, continued education to increase awareness, trusted community engagement and health systems designed around people’s real lives. But the path is clear: if one antenatal care visit can identify risk, enable timely care and support measures that help reduce a child’s risk of infection, then it is one of the most powerful opportunities public health has to change two lives at once.
References:
[1] World Health Organization. (2026). Global hepatitis report 2026. Geneva: World Health Organization.
[2] Afolabi, I. B., Phillips, J. C., El-Chaar, D., Bainbridge, S. A., & Phillips, K. P. (2026). Preventing vertical transmission of hepatitis B in sub-Saharan Africa: protocol for a systematic review and meta-analysis on vaccination uptake and determinants among pregnant women. BMJ Open, 16(1), e113229. https://doi.org/10.1136/bmjopen-2025-113229
[3] World Health Organization & United Nations Children’s Fund. (2025). Country guidance for planning triple elimination of mother-to-child transmission of HIV, syphilis and hepatitis B virus programmes. Geneva: World Health Organization.
Researchers explore how a key factor can mitigate or promote tuberculosis transmission.
Tuberculosis bacteria. Credit: CDC
Tuberculosis (TB) is a leading cause of infectious disease deaths, claiming over 1 million lives every year. It spreads through the air when an infected person coughs, sneezes, or exhales, and drug-resistant strains and asymptomatic spreading are growing concerns. Curbing TB transmission is an urgent public health challenge, yet scientists still don’t understand how airflow and other environmental factors influence that spread.
One problem is that studies of infectious disease transmission have focused mainly on population-level assessments or individual immune responses. But understanding how airflow and mixing influence transmission in indoor spaces requires expertise in fluid physics and computational modelling.
An interdisciplinary team including researchers at MIT and the University of Texas Southwestern Medical Center has now combined animal transmission experiments with quantitative particle tracking and flow modelling to understand how some lab-based environments can promote the spread of respiratory infectious diseases such as TB, while others mitigate that spread.
A key factor in predicting infectious transmission was not just the total ventilation rate but, more importantly, the local pattern of airflow driven by the design – such as air leakage, inflow and outflow locations, and forces created by an infected individual.
“The local airflow patterns turn out to be pivotal,” says Lydia Bourouiba, the Japan Steel Industry Chair Professor at MIT and faculty lead of the Fluid Dynamics of Disease Transmission Laboratory, part of the Fluids and Health Network within the Institute for Medical Engineering and Science (IMES). “Our team’s findings provide some of the clearest evidence I’m aware of showing the importance of accounting for [airflow] inhomogeneity and its effects when designing for airflow detailed patterns. This insight is critical when building or retrofitting an indoor space to mitigate airborne transmission, or when designing an airborne transmission study.”
The research is an important step toward connecting laboratory infectious disease studies with how people spread such diseases in the real world. The team hopes their insights can extend beyond their model system and show the importance of flow physics in building designs to prevent the spread of airborne diseases indoors.
“Despite recent pandemics and epidemics, there is still resistance to incorporating airflow in routine infectious disease prevention tools,” Bourouiba says. “Infrastructure could be retrofitted at relatively low cost, but the paucity and difficulty of gathering direct evidence prevents broader adoption of flow physics as a tool for indoor health. This study helps provide such evidence.”
Joining Bourouiba on a paper about the work are Yash Kulkarni, a postdoc at IMES, who led the fluid and aerosol physics components; Kubra Naqvi, lead author and a postdoc at UT Southwestern; Michael Shiloh, a professor at UT Southwestern, who led the multiyear effort to reestablish a classic tuberculosis transmission model; Hui Ouyang, an assistant professor of aerosol engineering at UT Dallas; Yuhui Guo, Deepak Sapkota, and Arabella Martin, all UT Southwestern PhD students; Pei Lu and Victoria Ektnitphong, research associates at UT Southwestern; Shibo Wang, a University of Minnesota researcher; Beatriz Dias, a UT Southwestern instructor; Bret Evers, an associate professor at UT Southwestern; and Lenette Lu, assistant professor at UT Southwestern.
Opening the black box
When people exhale, talk, cough, or sneeze, tiny microdroplets and bioaerosols launch from their mouths, carried forward by a cloud. If infected by a respiratory disease, these bioaerosols can contain pathogens that can infect others. Disease transmission depends on pathogen survival in the air, which is influenced by temperature, humidity, and ventilation.
In 1882, German physician and microbiologist Robert Koch first established an animal model for the study of tuberculosis pathogenesis. Decades later, researchers demonstrated airborne transmission of tuberculosis between people and animals.
These early experiments have proven difficult to replicate in today’s modern, biosafety-grade facilities. This new study reveals the difficulty comes from stringent containment and ventilation requirements, which can dramatically influence airflow in experiments.
“Host-to-host transmission is an obligatory evolutionary phase of respiratory pathogens, yet it has been considered too intractable or complex to be amenable to systematic investigation, hence is commonly relegated to a black box. Our work opens that black box,” says Bourouiba, who is professor in MIT’s departments of Mechanical and Civil and Environmental Engineering, and an IMES core faculty member.
To quantify how local airflow patterns impact infectious disease transmission, the researchers redesigned and modelled the early studies for modern high-containment lab facilities — including their seal, inflow, outflow, and exhaust pathways — and quantified particle and bacteria-laden particle release and dispersal. They released tracer particles and bacteria into a compartment and modelled recovery from air sampled on the other side under differing airflow rates, designs, and leak configurations.
The MIT team carried out computations, benchmarked against particle release experiments. The results revealed how important seemingly small details such as leakage paths could be.
“Even a small leak could short-circuit the airflow by drawing fresh air directly toward the exhaust, rather than drawing contaminated air across the containment chambers,” says Kulkarni.
Advancing TB research
To date, uneven indoor airflow patterns have not been fully harnessed as part of a risk mitigation strategy.
“By systematically defining how airflow and design influence biological exposure, we were ultimately able to restore transmission and create a system that can now be used to ask fundamental questions about the bacterial, host, and environmental factors that determine tuberculosis spread,” says Naqvi.
“I began working to reestablish this seminal TB animal transmission model nearly 10 years ago, and it proved far more challenging than I anticipated,” says Shiloh. “I hope this work serves as a reminder that meaningful scientific advances often require patience and perseverance.”
“This work illustrates how crucial it is to support synergistic collaborations integrating complementary disciplines to tackle research bottlenecks – and to standardise reporting norms across laboratories,” Bourouiba says. “If different labs have varying airflow patterns from uncontrolled leaks or seal details, that physical variability can overwhelm the biological signals researchers seek. Beyond its foundational impact for TB transmission studies, our work shows that opening the black box of transmission provides mechanistic insights: Detailed airflow pattern control can enhance or mitigate airborne transmission – making it exploitable as a prevention measure in crowded gathering spaces.”
This work was supported, in part, by the National Institutes of Health, the National Science Foundation, the Burroughs Wellcome Fund, MathWorks, and the Translational Research Institute for Space Health.
Adolescent metabolism may remain flexible enough for early weight loss interventions to prevent lasting health damage
Photo by Andres Ayrton on Pexels
Obesity doesn’t look the same at age 15 as it does at age 45 and Duke University School of Medicine researchers are learning why.
A study published in the Journal of Clinical Investigation showed teenagers retain a degree of metabolic flexibility that’s largely lost in adulthood. The study suggests that the way teenage bodies respond to excess weight is fundamentally different and potentially more reversible.
By showing that obesity’s biology changes with age, the discovery points to a potential window when the metabolic damage linked to obesity can be halted, or even reversed, before it becomes a lasting health burden.
“For a long time, medicine has tended to treat adolescents as little adults,” said John Rawls, PhD, a professor of molecular genetics and microbiology and member of the Duke Microbiome Center. “But teenagers are still growing, building muscle and bone, and using energy in ways that are very different from adults. We wanted to understand how those differences shape obesity.”
Nearly 1 in 5 U.S. children has obesity, a condition associated with higher risk for heart disease, diabetes, asthma, and some cancers later in life.
Without intervention, most children with obesity will continue to have obesity into adulthood, said study co-author Sarah Armstrong, MD, a pediatrician and medical weight management specialist at Duke Health.
The change from adolescence to adults happens in late teens to early 20s for women and early-to-mid 20s for men.
But researchers are increasingly asking when those risks become biologically embedded and whether adolescence offers a chance to change course.
The microbiome tells a different story in teens
The Duke team focused on two systems often linked to obesity: the gut microbiome which is the community of microbes living in the digestive tract, and the metabolome, the collection of chemicals produced as the body and microbiome process food and energy.
First, using gut microbes collected from 287 teenagers in the Pediatric Obesity Microbiome and Metabolism Study, they confirmed that teens with obesity have microbiomes that differ compositionally from those of teens at a healthy weight.
Next, Jessica McCann, PhD, a senior research associate in molecular genetics and microbiology, transplanted microbiome samples from adolescents with and without obesity into germ-free mice.
Unlike what researchers often see in adult obesity studies, the mice did not gain extra weight after receiving microbiota from adolescents with obesity.
The findings indicate that while obesity-related differences in the microbiome are beginning to emerge during adolescence, those microbes may not be driving disease the waythey do in adults.
“This suggests there’s a developmental window in which the microbiome becomes involved in obesity,” McCann said. “The relationship between the host and the microbiome may still be developing during adolescence, which means there may be an opportunity to change its trajectory.”
Warning signs appear, but so does resilience
Working in collaboration with the Duke Molecular Physiology Institute, the research team also found differences in how adolescents process nutrients. Adults with obesity often have elevated levels of branched-chain amino acids, as well as related compounds called branched-chain keto acids (BCKA), which are linked with insulin resistance and Type 2 diabetes.
The adolescents showed a different pattern. While branched-chain amino acids were elevated, BCKA levels remained relatively low.
The warning signs are there, McCann said, but teens’ bodies still appear capable of adapting to the metabolic strain of excess weight. “The metabolome is showing early signs of disease progression, but it’s also showing evidence of adaptive plasticity.”
At this stage they may be more responsive to weight management through diet, medication or microbiome-based therapies.
“The evidence increasingly supports intervening as early as possible,” said Armstrong, a professor of pediatrics at Duke.
Researchers hope the work would eventually lead to more personalised obesity treatments, using a child’s microbiome or metabolic profile, to help determine which weight loss therapies are most likely to succeed.
The study was supported by the American Heart Association and the National Institute of Diabetes and Digestive and Kidney Diseases.
Older adults who typically had longer intervals between meals accumulated chronic diseases more rapidly over time than those with shorter intervals, according to a study from Karolinska Institutet published in the Journal of Internal Medicine. The association was most pronounced among people aged 78 years and older.
Interest in fasting has increased in recent years, but relatively little is known about how meal timing affects health in older adults. In this new study, researchers investigated whether the duration of the longest daily interval between meals was associated with the accumulation of chronic diseases over time.
The researchers used data from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K), which includes 2,981 people in Stockholm who were aged 60 years or older at the start of the study. Participants were followed for up to 15 years. The duration of intervals between meals was estimated from participants’ self-reported information about when they typically ate during a 24-hour period.
Association seen across disease types
Longer intervals between meals were associated with faster accumulation of chronic diseases over time. In particular, people whose longest interval between meals during a typical day was 14 to 24 hours accumulated chronic diseases more rapidly than those whose longest interval was 6 to 11.5 hours. The association was observed for the total number of chronic diseases, as well as for cardiovascular and neuropsychiatric diseases, but not for musculoskeletal diseases.
“Much of the research on fasting has been conducted in younger or middle-aged populations. Our findings suggest that the associations may be different in older adults, particularly among the oldest age groups”, says Adrián Carballo Casla, last author of the study and postdoctoral researcher at the Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet.
The researchers emphasise that the study cannot determine cause and effect. Although longer intervals between meals were linked to faster disease accumulation, the study cannot establish whether the fasting pattern independently contributed to this outcome.
For information on funding and any potential conflicts of interest, please see the study.
A controlled trial across 13 countries found that a self-guided digital program and a version paired with telephone support both outperformed usual care for anxiety and depression
Photo by RDNE Stock project: https://www.pexels.com/photo/an-elderly-man-standing-on-one-leg-on-a-yoga-mat-8173497/
A digital program combining guided movement, breathing and meditation exercises, and coping-skills training reduced anxiety and depression symptoms in adults with chronic medical conditions, according to a new study published August 20th in the open access journal PLOS Medicine by Puneeta Tandon of the University of Alberta, Canada, and colleagues.
More than half of adults living with chronic physical conditions experience anxiety, depression, or fatigue, which can significantly reduce quality of life. Access to effective symptom management support is limited by mobility barriers, geography, cost, and shortages of trained clinicians. Digital programs may offer a scalable way to address this burden, but clinical trial evidence backing these interventions has been limited, and the role of human support in their efficacy is unclear.
Researchers conducted a fully remote, three-arm randomised controlled trial across 13 countries, involving 825 adults with self-reported chronic medical conditions including Primary Biliary Cholangitis, chronic digestive diseases, cirrhosis, and heart failure. Participants were assigned to a waitlist control group, a self-directed digital program (eMPower), or the same program supplemented with weekly telephone check-ins from trained non-clinicians. The program included movement, breathwork/meditation, coping skills, and disease education. Anxiety and depression symptoms were measured using a standard symptom scale ranging from 0 to 42.
At 12 weeks, participants receiving the digital program with telephone support showed significantly greater improvement in anxiety and depression scores than the control group (2.9-point greater improvement; 95% CI, 2.0–3.8). They also reported improved quality of life and less fatigue. In exploratory analyses, the self-directed program alone also significantly improved symptoms compared with control (2.6-point greater improvement; 95% CI, 1.8–3.5), and no significant difference was found between the two program formats, although the trial was not designed or powered to directly compare them.
The study primarily included women with higher education and only measured outcomes for 12 weeks, so longer-term impact and generalisability to other populations remain unclear. However, the authors say the data suggest a path forward for digital mental health interventions.
“Taken together, the eMPower clinical trial provides robust evidence that a fully digital, multicomponent intervention reduced anxiety and depression symptoms and was associated with improvements in fatigue, and quality of life across a range of chronic disease populations,” the authors say. “Rather than developing separate digital programs for each condition, a single cross-condition approach with tailoring for disease-specific education is effective in addressing shared symptoms.”
Corresponding author Dr. Puneeta Tandon states, “As clinicians, we are good at treating organ-specific problems, but the whole-person burden of chronic illness – the anxiety, low mood and exhaustion – that is often where patients have fewer practical options. People often leave the clinic without much they can try, but it doesn’t need to be that way. While these skills don’t replace medication or mental health care when those are needed, they do give people a practical place to start at home.
“What was surprising was that, in an exploratory analysis, we did not find a significant difference between the fully self-directed program and the program with brief weekly check-ins from a trained team member. This does not prove that the two approaches are equal, but it suggests that a program like this may be able to reach far more people without requiring one-to-one support for everyone. Support could then be focused on those who need it most.
“Because the study was entirely online, people could take part from home. The average age was 56, almost one in four participants was over 65, and 84% completed the 12-week follow-up – a strong result for a fully online study. We’re very grateful to the patient partners and organisations representing heart, kidney, liver, transplant and digestive communities who helped shape the program from the beginning. Their involvement was an important part of the study’s success.”
“The 12-Week eMPower program has demonstrated meaningful improvements in quality of life for people living with primary biliary cholangitis (PBC), the largest group enrolled in the eMPower study,” said Gail Wright, a PBC patient and President of the Canadian PBC Society. “Participants living with a significant symptom burden reported clinically meaningful improvements in fatigue and overall quality of life. The success of this program represents an important milestone for the PBC community, providing clinicians with evidence to support more personalised care that combines pharmaceutical treatment with an evidence-based self-management program for people living with PBC.”
First author Emily Johnson, MD/PhD Candidate, notes, “Running the trial entirely online meant we could reach people who are often left out of research – including people managing severe fatigue or mobility limitations, people living far from a specialist centre, and people who can’t add another appointment to their week. What struck me most was that they stayed. Patient partners shaped this program from the first draft, and I think that’s why it held people’s attention for 12 weeks. I look forward to continuing with this work and helping even more people.”
If you’re 70 or older, or 50 or older with underlying health conditions, and have tested positive for COVID, you might have been offered free or subsidised antivirals.
Earlier in the pandemic, these medicines were an important way to reduce the chance of people becoming severely ill with COVID, needing to be hospitalised or dying.
But our new research suggests that with high levels of vaccination and immunity from previous infections, COVID antivirals are no longer working as well.
From no treatment to an effective one
When SARS-CoV-2, the virus that causes COVID, first emerged in late 2019, no treatment was available. Existing influenza antivirals, which had been stockpiled by governments, were ineffective and couldn’t be used.
Scientists rapidly tried to figure out which existing or new drugs could be used. In 2021, two industry-sponsored clinical trials reported promising results.
One was for nirmatrelvir-ritonavir (Paxlovid), which reported an 89% reduction in severe illness. The other was a trial of molnupiravir (Lagevrio), which reported a 30% reduction.
Paxlovid and Lagevrio work by stopping SARS-CoV-2 from replicating. So they need to be taken early in the course of illness – within five days – to be effective.
Both drugs became available in Australia and were listed on the Pharmaceutical Benefits Scheme (PBS) in early and mid-2022. This ensured people most at risk of severe illness had access to drugs at low or no cost.
Paxlovid and Lagevrio are expensive. A course of treatment cost the government around A$1,100 from 2022 to 2025, much more than treatment for influenza, oseltamivir (Tamiflu), which costs only around $40.
Between mid-2022andmid-2025, the Australian government spent more than $2 billion on Paxlovid and Lagevrio.
The virus itself has also changed, with the original variants replaced by new ones that appear to be less severe than early in the pandemic.
These changes prompted us to evaluate the more recent evidence.
What did we study and find?
First, we examined randomised controlled trials—the gold standard of evidence. We found eight trials of Paxlovid and Lagevrio, but most were done before people were vaccinated.
The Lagevrio trial reported no statistical difference in hospitalisation or death in people who did and didn’t receive treatment.
The other was a trial of people in hospital who were treated with Paxlovid. It found no difference between people who were treated and those who were not.
There were some nuances to these findings. Randomised controlled trials are expensive and resource-intensive. As COVID went from being the leading cause of death worldwide in 2021 to the 20th in 2023, it became more difficult to justify the costs and recruit enough participants, so some trials were stopped early.
However, two randomised controlled trials of Paxlovid have been published since our work, and neither reported a reduction in hospitalisation or death.
In phase two of our research, we looked at the 35 observational studies, in which researchers can include many more people but can’t control who gets the treatment. We pooled the results from the studies to estimate the effectiveness of each drug against hospitalisation and death.
This meta-analysis found Paxlovid, but not Lagevrio, reduced hospitalisation and death.
Paxlovid was associated with a 40% reduction in hospitalisation and a 67% reduction in death.
Lagevrio wasn’t associated with a significant reduction in hospitalisation, and the results for death were mixed.
Because treatment wasn’t randomised, there may be differences between people who received treatment and those who didn’t. People accessing treatment, for example, may have greater health literacy or access to other health services.
While some studies use methods to adjust for differences in people who do and don’t receive treatment, it’s usually not possible to adjust for every difference.
COVID is still a concern for at-risk groups
SARS-CoV-2, like influenza and respiratory syncytial virus (RSV), remains a common cause of acute respiratory illness in Australia. In 2025, there were:
186,000 cases of COVID reported
178,000 cases of RSV
503,000 cases of influenza.
But the number of COVID, RSV and influenza cases reported is well below the true number, as most people don’t get tested.
The rates of COVID-related hospitalisations so far this year have been lower than last year, with 839 admissions at “sentinel hospitals” (those chosen to monitor disease trends) in the first half of this year. This compares with 1,740 in the same period last year.
What does this mean?
COVID can still cause severe illness, hospitalisation and death, particularly in older people.
If you test positive for COVID, talk to your primary care doctor about whether antivirals may be appropriate for you.
Our work shows there may be some benefit from Paxlovid. But as the number of cases and the risk of severe illness continue to fall, this benefit is becoming very small.
Given how little evidence there is for Lagevrio, its role in treating COVID should be carefully considered.
Harms of antivirals can include side effects – such as taste changes, nausea and vomiting – and allergic reactions.
Paxlovid can also interact with other drugs, causing serious reactions. It should be avoided, or the dose adjusted, in people with severe liver or kidney disease because it can make these conditions worse.
Australia’s independent Pharmaceutical Benefits Advisory Committee (PBAC) is set to review COVID antivirals later in 2026. It will assess the costs and benefits of Paxlovid and Lagevrio, and it may change its recommendations about who can access the drugs on the PBS.
Sickle cell disease. Credit: National Institutes of Health
A daily 20 milligram dose of zinc reduced infections by nearly 40% among Ugandan children younger than 5 with sickle cell anaemia, according to new research led by scientists at the Indiana University School of Medicine and their study partners in Uganda. The findings, recently published in the Journal of the American Medical Association (JAMA), point to an affordable, well-tolerated strategy to decrease hospitalisations and save more lives of children living with the genetic blood disorder.
Sickle cell anaemia causes misshapen red blood cells that block oxygen from smoothly travelling through the body, which can lead to serious health complications. Zinc deficiency is common in affected children, and because zinc supports the body’s immune response, this deficiency leaves children with the disease especially vulnerable to infections that can cause illness, hospitalisation and even death.
“At large volume prices, it can cost less than $3 a year to give a child daily zinc supplementation,” said Chandy John, MD, the Ryan White Professor of Pediatrics at the IU School of Medicine and co-lead investigator on the study. “If further studies confirm our latest research, this could be an important new intervention for children with sickle cell anaemia that is so low-cost and safe that it’s rapidly implementable in almost all health settings.”
In a randomised, double-blind, placebo-controlled pilot study, the team evaluated 100 children between 1 and 5 years old with sickle cell anaemia who received care at Jinja Regional Referral Hospital in Uganda. This clinical trial followed an earlier report that tested a 10 mg daily dose of zinc and found no reduction in infections, indicating the lower dose was insufficient.
Over six months of follow-up, children treated with 20 mg of daily zinc experienced a 38% reduction in all-cause infections – like upper respiratory tract infections, diarrhoea and bacterial infections – compared to the placebo group.
“Zinc given at 20 mg daily provides a readily available and safe medication with the potential to reduce the suffering and deaths of thousands of children in Africa,” said Ruth Namazzi, MMEd, lecturer in the Department of Pediatrics and Child Health at Makerere University in Uganda, research director at Global Health Uganda and co-lead investigator on the study. “However, while our study shows a 38% reduction in all-cause infections, we are not yet recommending this as standard of care for children with sickle cell anaemia as our results need to be validated in larger multi-site studies.”
Moving forward, the researchers expect to confirm their findings in a larger population across multiple sites. Future trials will also include older children with sickle cell anaemia and test the most effective zinc dosage with the fewest side effects.
If validated, researchers believe incorporating low-cost zinc into standard clinical care could be rapidly implemented in health settings globally.
IU researchers who contributed to the study include John, Kagan Mellencamp, Andrea Conroy, Michael Goings and Jie Ren. They collaborated with Namazzi, Irene Bagala, Charles Kato, Isaac Birungi, Priscilla Kasembo and Gloria Kyarisiima of Global Health Uganda; Emmanuel Tenywa of Jinja Regional Referral Hospital and Sarah Cusick of the University of Minnesota Medical School.
This research was supported by funding from the Riley Children’s Foundation, IU Dance Marathon, the Herman B Wells Center for Pediatric Research and Cures Within Reach.
Research published in Diabetologia by Amsterdam UMC and the University of Ghana reveals that type 2 diabetes manifests in two fundamentally different ways depending on a patient’s body mass index (BMI). While type 2 diabetes in patients with a higher BMI is primarily driven by insulin resistance, the study demonstrates that in individuals within a lower BMI range, the condition is caused by the pancreas failing to produce sufficient insulin. Despite these opposing biological mechanisms, medical professionals currently treat both groups with the exact same medications.
Type 2 diabetes is generally seen as a disease associated with being overweight. In wealthy countries that picture holds true: nine out of ten people with type 2 diabetes are overweight. In Africa the situation is different. Almost four in ten African adults with type 2 diabetes are lean, with a normal or even low body weight. In some rural areas, such as in Ghana, it is as many as six in ten. First Author Sabrina Esmail: “This means that there are an estimated ten million lean patients on the African continent who do not fit the standard picture. For them, the problem is therefore a shortage of insulin, not a reduced response to insulin.” Projectleader Charles Agyemang at Amsterdam UMC believes “this study shows that we need to look for better treatments for this large group of lean Africans.”
A different disease process, so a different treatment too
Yet in Africa both groups are almost always given the same treatment, based on international guidelines: oral tablets such as metformin or sulfonylureas. These medicines, however, are mainly effective against insulin resistance, not against a shortage of insulin. They are therefore probably receiving the wrong treatment, and until now the consequences of this had not been investigated.
The researchers analysed data from more than 3300 African adults with type 2 diabetes from Ghana, Nigeria, Kenya and Europe. “From this we concluded that lean patients more often develop eye damage, known as retinopathy, and strokes. People who are overweight, by contrast, more often have high blood pressure and an increased risk of cardiovascular disease. Chronic kidney disease occurred equally often in both groups,” says senior author Felix Chilunga. The amount of body fat explained the greater part of these differences, which points to genuinely different disease processes. The risk factors differ as well: whereas being overweight is often linked to an unhealthy lifestyle, lean patients have more often experienced malnutrition or a low birth weight, which can disrupt the development of the pancreas.
Type 2 diabetes in lean Africans is therefore, biologically and clinically, a different type of disease from the one seen in people who are overweight. But it is still being treated as though it were the same. As a result, millions of people may not be receiving the right care. Chilunga: “We are calling for targeted clinical trials to determine which treatment works best for this large and often overlooked group of patients.”
Africans in Europe
For Africans in Europe, too, it is very likely that a different treatment is needed. Another study with analysis from data from the UK Biobank showed that people of African descent with a BMI of 26 already have the same diabetes risk as Europeans with a BMI of 30. Studies of migrants in Europe consistently show that Africans are more likely to have type 2 diabetes, develop it around ten years earlier, and have poorer blood sugar control than the native population. Agyemang: “So a considerable proportion of African patients in Europe have a lower BMI but are treated according to guidelines written for the form of the disease found in people who are overweight, and their control is demonstrably worse. There is no reason to assume that the treatment mismatch we describe stops at the border.”
This study was carried out by Amsterdam UMC, University of Ghana, the national Institutes of Health (Center for Research on Genomics and Global Health) via de cohorts AADM and RODAM. The findings were published today in Diabetologia.
After several years of living with HIV, some people are able to produce a special type of antibody known as broadly neutralising antibodies. (Photo: Pixabay)
By Catherine Tomlinson for Spotlight
HIV is known for its ability to outsmart our immune system’s normal defences. A small number of people living with the virus are however able to generate unusually effective immune responses. In this special briefing, Spotlight zooms in on broadly neutralising antibodies, the secret sauce in these immune responses, and their potential role in the future of HIV treatment and prevention.
Our immune systems are highly effective at identifying and fighting off foreign invaders, such as viruses. One way our immune systems does this is by producing antibodies. In short, antibodies recognise viruses and then latch on to them. This blocks the viruses from entering our cells and flags them for destruction by other parts of the immune system.
One of the most remarkable things about our immune system is that it is able to create an enormous variety of such antibodies tailored to each different virus and other disease-causing pathogen that we encounter over our lifetime.
The human immunodeficiency virus (HIV), however, outsmarts our bodies’ normal immune responses by constantly changing the parts of its surface that antibodies recognise. This makes HIV difficult for antibodies to attach to and neutralise.
After several years of living with HIV, some people are able to produce a special type of antibody, known as broadly neutralising antibodies, or bNAbs. These antibodies are more effective at neutralising HIV than regular antibodies because they recognise parts of the virus that change very little, known as ‘conserved regions’. By targeting parts of the virus that are less prone to change, bNAbs are more effective than regular antibodies in identifying and neutralising the constantly changing virus.
“About 20 percent of people living with HIV naturally develop bNAbs, after many years,” explains AVAC, a US-based NGO seeking to advance the development of HIV prevention tools. “By the time bNAbs have developed in these individuals, the constantly mutating HIV has outpaced these defenders, changing too fast and too significantly for bNAbs to be effective in that individual. But that same bNAb, or a combination of them, may work in someone else,” they say.
A vibrant area of research
Researchers first identified bNAbs in a person living with HIV in the 1990s. Since then, they have discovered many more bNAbs and papers and presentations on the topic have become a staple at HIV conferences. At the 2026 International AIDS Conference held in Rio de Janeiro, Brazil, in July, there were 21 abstracts related to the topic.
Since the 1990s, researchers have learned how to replicate and produce bNAbs in the lab. They have conducted early-stage trials showing that bNAbs can be safely administered to people and they have learned how to engineer bNAbs to increase their potency and make them last longer in our bodies.
Currently, researchers are studying whether bNAbs, given by infusion or injection, can prevent HIV infection in people who are HIV negative and control the virus in people who are already living with it. There is also an interesting cross-over with vaccine research, whereby researchers are trying to develop HIV vaccines that prompt the body into making bNAbs.
Before we dig into the details, it is worth stressing that all of this research is still at an early stage. Whereas bNAbs show promise, they have neither set the world alight, nor completely failed. For now, antiretroviral medicines remain the only effective form of HIV treatment, as well as being an extremely effective form of HIV prevention. It is not clear whether bNAbs will ever reach the high bar set by antiretrovirals.
bNAbs for HIV prevention
One of the big HIV stories of the last decade or so has been the use of antiretrovirals to prevent HIV infection. Antiretroviral tablets to prevent HIV infection are already widely available in the public sector, and since June this year, government has been rolling out the six-monthly lenacapavir HIV prevention injection to around 10% of clinics. Such pre-exposure prophylaxis, taking something to prevent infection, is commonly referred to as PrEP.
One of the big hopes for bNAbs is that an infusion of the cells could similarly work as a form of HIV PrEP. The thinking is that these ‘smarter’ immune responses will be more effective than our regular immune responses in recognising and neutralising the shape-shifting virus, and thus clearing it before it can get a foothold in the body.
Substantial research has already been done in this area with two landmark studies, the AMP trials, having garnered the most attention. In the two trials, researchers evaluated an infusion of a bNAb called VRC01 to prevent HIV acquisition in men and transgender people who have sex with men, as well as in cis-gender women. The trials were conducted by the HIV Vaccine Trials Network (HVTN) and the HIV Prevention Trials Network (HPTN).
The AMP trials found that VRC01 did not prevent HIV infection. While this was disappointing, the studies did make a breakthrough by showing that bNAbs could neutralise strains of the HIV virus under certain conditions. While HIV could shape-shift enough to get around VRC01 and cause HIV infection, VRC01 was able to neutralise the HIV strains that were vulnerable to this specific bNAb.
This pattern of bNAbs blocking some, but not all strains of HIV, has been seen in several other studies. It provides both reason for hope, since there is clearly some efficacy, but also frustration, since the efficacy is not nearly as good as what is achieved with antiretrovirals.
Learning from the AMP trials, scientists are now studying whether combining different bNAbs that target a broader range of HIV strains, as well as different regions of the virus’ surface, into a single infusion or injection can be used to prevent HIV.
HVTN and HPTN’s planned Combo-AMP trial will evaluate whether providing people with a combination of different bNAbs can prevent HIV, explained Fred Hutchinson Cancer Center’s Holly Janes at the recent AIDS Conference.
Beyond the AMP trials, the Durban-based research group CAPRISA has also led important studies on the use of bNAbs for HIV prevention. They recently announced the results of a trial called CAPRISA 012C that evaluated the use of a combination of two bNAbs to prevent HIV acquisition in young women in Southern Africa.
Disappointingly, the combination bNAb provided in this trial did not prevent HIV infection. However, CAPRISA reported that “a positive finding was that there was a trend towards protection when the viruses were sensitive to both or one of the two bNAbs compared to when the viruses were resistant to both bNAbs.” In other words, HIV infections occurred more frequently with strains of the virus that were resistant to the bNAbs studied than with strains that were sensitive to them.
“The CAPRISA 012C trial is a culmination of 22 years of research – while it has not led to a new HIV prevention product, it provides valuable information to guide further bNAb research,” said CAPRISA, adding that sensitivity to bNAbs in contemporary circulating viruses will need to be factored into planning future trials of bNAbs.
bNAbs for HIV treatment
bNAbs are also being evaluated as potential treatment for HIV. Researchers are trying to understand whether, under what circumstances, and for how long bNAbs can control the virus in people living with HIV, with the goal of developing products that can achieve long-lasting HIV control without antiretroviral treatment.
This is important because the emotional and psychological burden of having to adhere to a life-long daily pill regimen to treat HIV is a known cause of poor treatment adherence. For infants and young children there are also practical challenges to swallowing and keeping down daily treatment.
One of the main ways that researchers are evaluating the potential of bNAbs to treat HIV is through analytical treatment interruption (ATI) studies. In ATI studies, people living with HIV are given bNAb infusions or injections – sometimes in combinationwith long-acting injectable antiretroviral drugs – and then temporarily taken off their regular antiretroviral treatment under close medical observation.
Researchers then monitor how long HIV remains suppressed in order to learn whether and how well bNAbs can control HIV infection.
The results from ATI studies, including the RIO and FRESH trials, have been tantalizing. bNAb infusions have allowed some study participants to remain off antiretroviral treatment for more than a year without the virus rebounding in their bodies.
Yet, the studies have also raised questions about how and why bNAbs have such mixed efficacy. Researchers are still trying to understand why some people are able to maintain periods of viral control after receiving bNAbs, while others experience rapid viral rebound. The reasons for this appear to extend beyond a person’s sensitivity to the specific bNAbs being used to also include other factors related to the characteristics of one’s HIV infection and immune response.
At the 2026 AIDS Conference, Michel Nussenzweig, senior physician at the Rockefeller University, told delegates that research so far indicates that bNAb therapy is more likely to deliver periods of post-treatment control in individuals with a less diverse HIV reservoir, pre-existing autologous antibodies, and pre-existing stem cell like CD8+ T cells.
Scientists are now considering whether the factors associated with bNAb treatment success can be boosted through other interventions, said Nussenzweig.
Another important area of research is whether bNAbs can be used as a form of treatment for infants and young children living with HIV. An infusion or injectable treatment could be a gamechanger for this group, given the challenges faced by caregivers in getting infants and young children to swallow and keep down daily antiretroviral treatment.
The Tatelo and Tatelo Plus studies conducted in Botswana were set up to evaluate whether young children given bNAbs can maintain viral suppression after stopping antiretrovirals. Results from the Tatelo study reported in 2022 showed that some children (44%) who received a combination of two bNAbs were able to maintain a period of viral control (24 weeks) after stopping HIV treatment. The Tatelo Plus study, now underway, is evaluating whether and for how long a combination of three bNAbs can maintain HIV suppression in young children after antiretrovirals are stopped.
bNAbs for HIV vaccination
While bNAbs have not yet been shown to be a practical and effective form of HIV prevention or treatment, research has demonstrated that, under the right conditions, they can protect against and suppress HIV strains that are susceptible to them.
These findings have generated excitement about using bNAbs as a target for HIV vaccines. Unlike research into bNAbs for PrEP or HIV treatment, in which laboratory made bNAbs are infused or injected directly into our bodies, some HIV vaccine researchers are trying to figure out how to trigger our bodies to produce their own bNAbs.
In other words, vaccine researchers are trying to make our bodies, rather than laboratories, the factories that make bNAbs against HIV.
At this stage, scientists do not expect that a single vaccination will be able to trigger our bodies to produce mature bNAbs capable of combating HIV. Instead, they anticipate that a vaccine protocol that involves a series of vaccines will be needed to coax our immune systems to produce mature bNAbs.
While this branch of research remains at its early stages, many HIV researchers are hopeful that it may one day produce an effective vaccine protocol against HIV.
One study to watch is a Phase 1 safety and dosing trial launched by the International AIDS Vaccine Initiative (IAVI) and partners in South Africa at the end of 2025. “The hypothesis being tested is that highly specialized vaccine immunogens, delivered in a specific sequence, can target certain B cells within the immune system and coach them toward the production of broadly neutralizing antibodies against HIV,” says IAVI, adding “scientists widely believe that a vaccine inducing broadly neutralizing antibodies (bNAbs) could provide broad protection against many strains of HIV.”
Where to from here?
Since the first bNAbs against HIV were discovered in the 1990s, scientists have made important, but incremental, progress towards translating these immune responses into tools that can prevent and treat HIV.
As we’ve seen in this Spotlight special briefing, research into bNAbs for HIV treatment is arguably the furthest along, with bNAbs already demonstrating the ability to control HIV during extended periods of antiretroviral treatment interruption in some people. But why some people respond to this treatment and not others remains uncertain. This is an important area for future research.
In the HIV prevention space, bNAbs have delivered protection against HIV strains susceptible to the specific bNAbs studied, but this protection has not been broad enough to protect against HIV infection by the highly diverse, mutating virus. Hope however remains that combining different bNAbs that target different conserved regions of the HIV virus, as well as currently circulating viruses, could broaden protection enough to prevent HIV infection. Here too, as with attempts to develop vaccines that spark the production of bNAbs, it is imperative that the research continues.
Of course, even if scientists can crack the code and find a way to produce highly effective bNAbs, the road ahead might not be a smooth one. For these products to have an impact in the developing world, where they are most needed, they will have to be cost-effective compared to cheap antiretroviral therapy. They will also have to be easy to administer in often stretched and under-resourced healthcare systems.
While much remains to be done, the scientific leads are certainly there, waiting to be explored.
