The Adolescent Medicine Trials Network for HIV Interventions as a Driver of NIH’s Mission to End the HIV Epidemic

For more than 2 decades, the Adolescent Medicine Trials Network (ATN) for HIV Interventions has stood at the forefront of advancing HIV science with its unique focus on adolescents and young adults ages 13–24 years, a population disproportionately affected by new infections in the United States [1]. Because adolescents and young adults account for a disproportionate share of new HIV infections, their inclusion is not optional but central to achieving epidemic control. The ATN has been a beacon of scientific innovation and a vital engine for public health interventions, improved youth health awareness, and national scientific infrastructure.

The ATN has played a central role in ensuring that biomedical breakthroughs are rigorously evaluated for adolescents in order to obtain regulatory approval successfully. Network studies led the evidence base supporting the use of oral pre-exposure prophylaxis (a medication to prevent HIV infection) in younger populations and continue to contribute to evaluating long-acting injectable pre-exposure prophylaxis and antiretroviral therapy (the medicines that treat HIV infection) among adolescents [2,3]. These efforts have been pivotal in demonstrating the safety, feasibility, and acceptability of prevention and treatment tools for youth, a group with unique developmental and health-care engagement challenges [4,5]. By directly informing regulatory approvals and clinical guidelines, the ATN has ensured that HIV prevention and treatment options developed in adult populations are effectively extended to adolescents and young adults.

While potent and simplified antiretroviral therapy medication regimens for people living with HIV, along with long-acting injectable prevention options for those without HIV, provide the technological tools necessary to end the HIV epidemic, their ultimate impact depends on real-world implementation. Biomedical innovation alone is insufficient without the integration of behavioral strategies and preemptive consideration of implementation barriers and facilitators. Adolescents and young adults face disproportionately high burdens of mental health conditions, substance use, and stigma, each of which can undermine HIV prevention and treatment [4–6]. The ATN has long recognized this intersection, embedding evidence-based interventions alongside biomedical innovations, including digital health platforms, peer navigation, group and individual counseling, social support for family and caregivers, and youth engagement strategies. [7,8]. These strategies extend beyond the initial uptake of the biomedical tool to address sustained medication adherence and viral suppression. By layering biomedical and behavioral techniques, the ATN reflects NIH’s vision of a multidimensional response that addresses the HIV epidemic’s biological and behavioral drivers.

Despite this history of success, the ATN, along with thousands of other funded projects, was terminated in March 2025. A strong appeal and coordinated advocacy brought the reinstatement of the ATN Scientific Leadership Center in May 2025, with the Operations Center and research sites being reinstated in September 2025. We are deeply grateful that the ATN was ultimately refunded, a decision that reflects NIH’s recognition of the network’s critical role in advancing adolescent and young adult health and its irreplaceable contributions to ending the HIV epidemic. The rapid mobilization of advocates, researchers, clinicians, and community partners demonstrated the depth of commitment to the ATN and underscored how widely HIV research is valued. At the same time, the period of rapid termination followed by a prolonged reinstatement process underscores how fragile even long-standing research networks can be, and how much is lost when continuity is interrupted. The abrupt halt in funding created immediate disruption to ongoing studies, threatened the continuity of clinical trials, and placed the retention of highly trained research staff at risk. Beyond the operational setbacks, these interruptions carried steep scientific costs: data collection delays, participant trust erosion, and the loss of hard-to-reach youth cohorts that are not easily re-engaged once cut off. The financial burden to individuals and institutions of winding down and restarting studies is considerable, but the larger cost is measured in lost momentum at a time when NIH has explicitly called for accelerated progress toward ending the HIV epidemic. Ultimately, this experience highlights the importance of stable, predictable funding for national research networks like the ATN because even temporary gaps in operations can jeopardize infrastructure that has taken decades to build, with implications not only for HIV prevention and treatment science but for adolescent health research more broadly. Our most profound hope is that this chaotic period of disruption is behind us.

As we move forward again, the scientific agenda of the ATN has implications that extend well beyond HIV. Lessons from the ATN’s portfolio can inform digital health, behavioral health, and implementation strategies for other adolescent health priorities, including sexual and reproductive health, substance use, and mental health [9,10]. In this way, the ATN functions not only as an engine for HIV research but also as a model for youth-centered science that addresses the complex needs of vulnerable populations. The ATN operationalizes this vision of transforming scientific advances into practical, scalable, and sustainable interventions by demonstrating how implementation science can close the gap between innovation and impact. By placing adolescents and young adults, the very population most critical to achieving epidemic control, at the center of its work, the ATN exemplifies NIH’s mission and accelerates progress toward a future where HIV is no longer a public health threat.

Sustained research infrastructure is not a luxury; rather, it is the backbone of scientific progress and public health impact. The ATN demonstrates that infrastructure delivers science that secures regulatory approvals, informs clinical guidelines, trains the workforce, and builds trust with communities that are too often left behind. When sustained, such infrastructure transforms biomedical innovation into population-level impact. When interrupted, the costs are measured not only in dollars, but in lost momentum and missed opportunities. At a time when we possess the tools to end the HIV epidemic, maintaining a stable, well-resourced network like the ATN is essential, not only to achieve epidemic control but to preserve the nation’s capacity to respond nimbly, equitably, and effectively to the health challenges of tomorrow.