Advancing HIV cure readiness in Zambia

For many scientists, the pursuit of an HIV cure is not only about laboratory discovery, but also about ensuring that future breakthroughs are safe, ethical, and relevant to the communities most affected. This is the focus of a new study, led by SANTHE PhD Fellow Loveness Mukuka, exploring whether Zambia is ready to host HIV cure-related clinical trials.

The research examines Zambia’s readiness for HIV cure studies, particularly those involving analytical treatment interruption, where participants temporarily stop antiretroviral therapy under close medical supervision. Mukuka, who is based in Lusaka at the Center for Family Health Research in Zambia (CFHRZ), and is supervised by Clive Michelo, is assessing whether the country is scientifically, ethically, socially, and practically prepared for such complex trials.

“Most HIV cure research has been conducted in high-income countries, even though the highest burden of HIV is in sub-Saharan Africa,” she explains. “My goal is to ensure that future cure trials in Zambia are safe, ethical, feasible, and grounded in our local realities.”

Her interest in HIV cure research stems from a desire to move beyond lifelong treatment. While antiretroviral therapy has transformed HIV into a manageable condition, she notes that challenges such as stigma, treatment burden, and adherence remain. “Africa must play an active role in shaping HIV cure science so that future strategies are relevant to the people most affected.”

A key feature of her study is its mixed-methods design, integrating biomedical, social, economic, and ethical perspectives. She emphasises that cure research cannot be understood through biology alone. “Biomedical data may tell us whether a cure strategy is possible, but it does not tell us whether people are willing to participate or whether communities trust the process.”

Her work highlights important considerations for young adults living with HIV, who are central to future cure research. Concerns around treatment interruption, viral rebound, stigma, disclosure, and relationships frequently arise in community discussions. “Young adults face unique challenges, and their perspectives on risk and hope are essential to shaping ethical research.”

Community engagement is also central to the study, including the involvement of partners of people living with HIV, whose views can strongly influence participation decisions and perceptions of risk and trust.

Zambia’s context further shapes the research approach. High HIV prevalence, limited healthcare resources, transport barriers, and unequal access to specialised care mean that cure trials must be carefully adapted. Social and economic realities such as travel costs, time away from work or school, and stigma all influence whether young people can participate in research.

Ethical considerations remain at the heart of the work. Key questions include how to ensure fully informed consent, how to balance risk and potential benefit, and how to protect confidentiality and reduce stigma. “Participants must clearly understand that research is not a guaranteed cure,” she notes.

Ultimately, the goal is to generate evidence that helps researchers, policymakers, and ethics committees design better future trials. “This means ensuring that studies are inclusive, ethical, and responsive to the lived experiences of people living with HIV, rather than based solely on assumptions from high-income settings.”

For Mukuka, the work is both professional and deeply personal. Inspired early by mathematics, science clubs, and a strong sense of purpose, her journey into HIV research began after working closely with people living with HIV in her first role after university. “It gave HIV a human face for me. It was no longer just a disease, but a lived experience.” Motivated by discipline, family values, and a strong sense of responsibility, she describes her career goal through a simple metaphor: “A single grain of rice can tip the scale. Success for me means making small but meaningful contributions that improve science and the lives of people living with HIV.”

Looking ahead, she hopes her work will help shape future HIV cure trials in Zambia and beyond, contributing to a field that is moving toward more patient-centred, globally inclusive approaches.