Prevention Activism as PEPFAR Finalizes its Country Operational Plans

For the second year in a row, the US AIDS program PEPFAR has opened its annual planning process up to civil society engagement and input. Last week and this week, the country operational plans, or COPs, for a range of sub-Saharan African countries are being finalized at in-person meetings in Johannesburg, South Africa. Meeting participants included PEPFAR staff, government representatives, UNAIDS staff and international and in-country civil society.

The in-person COP review is the culmination of an engagement process that has included countries sharing voluminous quantities of data on the previous year’s performance and the next year’s targets, along with a narrative “Strategic Direction Summary” describing the plans for the years ahead.

AVAC and a range of partners, including strong in-country coalitions in Kenya, Malawi, Uganda, Zambia and Zimbabwe, have been working over the past year—since the last review—to access quarterly country data and to shape input into the next COP. We’re also delighted to work in strong coalition with international groups including Health GAP, MSMGF, amfAR and the International HIV/AIDS Alliance.

One COP review meeting is still underway, but the news from last week’s meeting is energizing and speaks volumes about the importance of engagement and activism in this space. As detailed in a blog from Health GAP, there was a range of ways that civil society had impact on treatment targets, service-delivery models and engagement with key populations (Click here to read a report from MSMGF on key populations advocacy). These weren’t easy victories, and they depended on sharing work, diving deep into data and standing ground on key demands.

In addition to the gains detailed by Health GAP, there were key strides in non-ART prevention. These included:

  • Increases in VMMC targets in Zambia and (as of press time—with the COP not yet signed) Zimbabwe.
  • Safeguarding of VMMC resources from PEPFAR, GFATM and World Bank in Malawi—when one possibility was reallocating a portion of GFATM away from VMMC. (GFATM, UNAIDS and other stakeholders also attend the PEPFAR reviews and contribute to broader planning conversations.)
  • Commitments to troubleshoot and accelerate Uganda’s VMMC program, which has slowed down to address cases of tetanus in young men undergoing the procedure who hadn’t previously received a tetanus vaccine.
  • Inclusion, for the first time, of PrEP targets in the COPs for Uganda and inclusion of PEPFAR commitments to PrEP preparedness and policy development in Malawi and Zambia.

All of these gains happened in a process where civil society raised the need for comprehensive HIV prevention and made specific demands as to what it would like to see in next year’s plans.

The work isn’t over when the COP is signed—in fact, it’s just beginning. Smart, strategic analysis depends on access to PEPFAR’s quarterly review of country progress. AVAC and partners will be working on evaluating these quarterly updates, influencing PrEP rollout, keeping up demand for ambitious VMMC targets—and much more. We hope you’ll join us. If you’re interested, please contact us.

The Search Continues and Science Advances on HVAD 2016

Today, the US National Institutes of Health (NIH) announced that it will fund a large-scale efficacy trial in South Africa to test the prime-boost vaccine regimen that is a modified version of the RV144 vaccine that showed modest efficacy in 2009. This will be the first large-scale HIV vaccine trial to take place in South Africa in almost a decade, and an exciting development for the country and the field. In addition to the announcement, NIH also posted questions and answers about the new study.

Still have questions or want to hear more about what this all means? Then join us on Tuesday, May 31, at 10am US Eastern/4pm South Africa time (see www.timeanddate.com for the time in your area), for a webinar with Linda-Gail Bekker from the Desmond Tutu HIV Foundation and the lead investigator on the current HVTN 100 vaccine trial.

Register for the webinar here.

The announcement of the trial, known as HVTN 702, comes on HIV Vaccine Awareness Day, the annual event that allows us all to recommit ourselves to accelerate the search for an HIV vaccine. As we wrote on Monday, today and every day, we should all say, “I’m committed to ending the AIDS epidemic, and that means finding an HIV vaccine.”

The announcement that HVTN 702 will take place comes nearly seven years after the announcement of efficacy data from RV144. In the intervening years, global scientific collaborations have probed the responses from RV144 and developed plans, in combination with industry, to optimize the regimen so that it might work better, provide more durable protection and is tailored for the HIV subtype C that is most common in Southern Africa.

Today’s decision is based on an interim analysis of HVTN 100, a current trial in South Africa led by the NIH-funded HIV Vaccine Trials Network (HVTN) that is looking for immune responses and safety in South African volunteers of the modified vaccine combination. HVTN 702 will start later this year and will measure safety and efficacy in 5,400 participants.

Under the current plan, it will be at least four years before there are data from HVTN 702. Check out our new AIDS Vaccine Research Overview that shows the HVTN 100/702 trials in context of the larger field. Other HVAD materials are here. In addition, check out some of these new HVAD articles that just came out:

As is so often and so rightly said in this field: much accomplished; much to do!

Appointment of Dr. Maureen M. Goodenow as Associate Director for AIDS Research, NIH

“I am pleased to announce the selection of Maureen M. Goodenow, PhD, as NIH Associate Director for AIDS Research and Director of the NIH Office of AIDS Research. Dr. Goodenow brings nearly 30 years of experience in HIV/AIDS research and advocacy to the position. She is expected to join NIH in July 2016 to lead OAR’s efforts, working closely with NIH institutes and centers, to pursue new tools for preventing HIV infection.” Click here for more information.

Preparing for HIV Vaccine Awareness Day 2016

It’s that time again—HIV Vaccine Awareness Day. AVAC has worked with partners to develop a range of tools and resources for this day and for year-round advocacy. We hope you’ll find them useful whether you unfurl banners, strike up a band, hold a fishing boat race, host a town hall forum, or just turn to your closest neighbor and say, on May 18, “I’m committed to ending the AIDS epidemic, and that means finding an HIV vaccine.”

This year’s HVAD tools and resources include:

Technology and Health Coverage

Out of all the different book and movie genres, my favorite is science fiction. There’s something about “futuristic” technology and how society reacts to it that fascinates me. So when I had the opportunity to attend the Global HIV Vaccine Enterprise’s “Innovative Uses of Technology in HIV Clinical Trials” meeting, I didn’t want to miss out. As technology and global health both expand—and in some places converge—I find myself more and more drawn to understanding how the global health field might benefit or be hindered by this growth in technology.

The meeting, which was part of the Enterprise’s “Timely Topics” series, concentrated on how using new technologies like biometrics, mobile phone messaging, cell phones, tablets and smart pill bottles could help clinicians, researchers and clients. Here are four key takeaways:

1. Just because we have technology doesn’t mean that researchers should use it. This idea was particularly stressed when discussing data collection. We now have the ability to collect responses through technologies like tablets or SMS. However, this doesn’t mean that we should disregard paper methods. Technology can be harder to use because it may malfunction, may not be viewed favorably by locals, get stolen or even be inaccessible when batteries run out or power goes out. We need to be sure that we are thinking about the usability of technologies and whether or not they truly add worth.

2. Policy needs to catch up with technology / Health technology companies need to ensure there are protocols in place: It’s scary to think that technology is often ahead of policy. Though it is perhaps impossible to think of every worst-case scenario, governments should start thinking of health privacy laws. In addition, health technology companies and those who utilize the technologies should put sound protocols in place should data be hacked or misused. Though biometrics (a technique using physical characteristics to identify a person), seems like a safer way to guard identity because the human body is unique to every individual, companies must proceed with caution and consider robust and secure measures.

3. Those working in the global health field and technologies need to work together to push companies to create compatible structures and platforms, at the very least within country: As the speakers stood in front to present, one of the repeated questions pertained to the compatibility of the different technologies or data systems. Unfortunately, not all of the software used seemed to be compatible. Though these new technologies are currently being tested with smaller populations, going forward, governments, clinical trial sites and companies need to decide on how to make these systems compatible. Otherwise, data sets may not be transferrable and money wasted on either starting from scratch or having someone convert data.

4. Messaging needs to be well thought out and expectations managed: I’m a big proponent of using technology to improve global health. However, I also know that transparent communication is key to growing relations and trust. That’s why I was a little bit wary as to the messaging that is potentially being conveyed when introducing something as new as biometric scanning. Are the possible cons of biometrics thoroughly listed out before participants willingly give up scans of their eyes or finger prints? Are donors and implementers aware of the responsibility and gravity of what will happen if the information were ever to get into the wrong hands? After all, things like our eyes and fingerprints cannot be reset like passwords can.

The conference was eye-opening to the different ways that technology can impact global health. The convergence of technology and health is definitely a growing field that we should be watching out for in excitement. However, we also need to pause and think before jumping into new innovations.

You can view the meeting presentations here.

Request for Information: FY 2018 Trans-NIH Plan for HIV-related Research

Feedback is invited from investigators in academia, industry, health care professionals, patient advocates and health advocacy organizations, scientific or professional organizations, federal agencies, and other interested constituents and the community [regarding] possible future directions to maximize benefits of investments in HIV/AIDS research. Click here for more information.

Funding Opportunity Revision: Applications for US-South Africa Program for Collaborative Biomedical Research

Purpose: To provide supplementary funds to current R01 [U01] awardees to add or expand activities focused on establishing or enhancing substantive research opportunities for underrepresented scientists in the biomedical research workforce in South Africa. Letters of intent are due by July 2, 2016 and applications are due by August 2, 2016. Visit here for more information.

Not If, But When: Gay men gather in Jo-burg to plot PrEP access

It’s been 12 years since I first encountered the notion of PrEP, which was at the AIDS 2004 conference in Bangkok. Before activists trashed Gilead’s booth for alleged trial misconduct, I sat in a session listening to then-Family Health International (now FHI 360) describe its trial designed to see if daily oral tenofovir could prevent HIV in sex workers in Cambodia. I was intrigued by the idea but later on, after several of the PrEP trials were shut down in a swarm of controversy, I lost both hope and track of the trajectory of PrEP. Fast forward over a decade later and PrEP is poised to become a success story. This is why last week’s meeting of mostly gay African men devising advocacy plans for PrEP access felt long overdue, but also perfectly timed.

First of all, the meeting, which was spearheaded by a coalition of out, proud, gay African men from AMSHeR, AVAC, Desmond Tutu HIV Foundation and MSMGF, among others, fell right in the wake of the musician Prince’s death. The gender-bending legend broke all rules about what black men should be and took ownership of his own path. Likewise, the PrEP meeting of over 80 participants made history as the largest gathering of gay and MSM African men to demand PrEP for HIV prevention as part and parcel to achieving social justice.

Keletso Makofane (MSMGF and Anova Health) summarized the importance of PrEP when he opened the meeting by stating, “PrEP is overdue but supposed to be delivered by the very systems that are failing us.” He went on to explain that PrEP is necessary for gay men on the continent “because of its efficacy and prevention power and because of the excitement of having sex in a way we haven’t for 30 years.” He also asserted that PrEP could be used as a catalyst to improve HIV care and health services in general. This set the tone for the remainder of the meeting which mapped out how to bring PrEP to scale for gay and MSM communities in Africa.

It’s difficult to capture all that was shared in the three-day meeting but below are some recurring themes.

One of the agreed-upon tactics was to ally with other “key populations”—those over-burdened and underserved communities—so that the push for PrEP for gay men is embedded within the demand for PrEP for all those at substantial risk. This would help avoid gay “exceptionalism” of which there are already reported rumblings.

Convincing national governments that PrEP for MSM would not be an added burden to already strapped health systems is key. To get around this, participants discussed the need for innovative service models that minimize impact on doctors, perhaps through nurse-led PrEP implementation, community-based delivery and self-testing. There’s also a need to tap existing providers such as STI clinics and reproductive health units. Activists at the meeting also discussed that another key way to convince governments of PrEP’s worth and desirability is through costing studies looking at models of test and start along with PrEP.

Jim Pickett (IRMA), the formidable gay prevention activist with folk hero status, entertained participants with snapshots of PrEP promotions from around the globe. The audience was riveted by his hometown Chicago’s prep4love campaign, with pretty yet provocative pics of queer couples. But afterwards, some delegates were disheartened, saying they could not run such gay-forward campaigns in their countries. Not yet, at any rate.

Members from each of the 14 countries represented at the meeting caucused and drafted advocacy plans to jumpstart the post-meeting national coalition work. A WHO rep in attendance promised she’d take these national priorities directly to the WHO representatives of each country to be shared with their health ministers.

The meeting closed on an inspirational note. We now have a roadmap for PrEP as an entry point to bring real change, leading human rights activist and former AVAC Fellow Gift Trapence noted. Or, as another dearly beloved leader put it, “I got a lion in my pocket and baby he’s ready to roar.”

Introducing the VARG: Focusing local lens on global advocacy for HIV vaccines

It has been said that advocates haven’t played a strong enough role in the HIV vaccine field. While this could be debated, it is true that the role of a vaccine advocate is complicated. How can advocates push to support slow-paced, expensive science, that over its history can be seen as having more low points than highs?

These questions and this conundrum simply highlight the need for focused, strategic advocacy to push forward the goal of vaccine development.

Two weeks ago, a group of HIV vaccine advocates known as the Vaccine Advocacy Resource Group (VARG) came together in Johannesburg to meet this need. They discussed the field, dialogued with researchers, and aired concerns and questions about the field’s current status and key developments. The VARG is a global team of AIDS prevention research advocates—made up of 11 individuals from countries key to vaccine research and well connected in those countries to broader HIV advocacy. Since its formation in 2012, the VARG has been convened virtually, and the chance to meet face-to-face for the first time could have been one of the reasons the room buzzed with excitement as the meeting began.

Another reason for the buzz could have been the current state of the field. With vaccine (P5 and Janssen) and antibody research (VRC01-AMP study) fields at exciting junctures, VARG members had a lot to discuss. Some of their questions included:

  • What will the results of the AMP study mean for the future of passive immunization? And for vaccine development? Will people really sit for an infusion for 30 to 60 minutes?
  • Why is there so much attention around the go/no-go decision making criteria in HVTN 100? What happens if the data indicate a no-go for HVTN 702?
  • Would the Clade C vaccine to be tested in HVTN 702 be relevant to other regions? What would the implications be for other countries if the vaccine is found efficacious in South Africa, the only country where 702 would be conducted?
  • How are vaccine research groups addressing the inclusion of PrEP in efficacy trials? How will stakeholders be involved as trials are planned and PrEP rollout evolves globally?

Vaccine efficacy trial results are a few years away, but we’re now at a time where advocacy roles are becoming clearer and clearer. VARG members left the meeting together with a new sense of priorities and actions. Watch this space!

To read more about the trials and science mentioned above, please visit www.avac.org/vaccines.

Women’s Prevention Works If Women’s Realities Are Appreciated and Prioritized

Seventy-five advocates from across Africa—friends, allies, researchers—came together for a one-day meeting in Johannesburg on April 14 to discuss the recent dapivirine ring results, what they mean in the broader context of women’s HIV prevention, what comes next and key milestones to plan for.

The recently released results of the dapivirine vaginal ring for HIV prevention demonstrated, for the first time, that an ARV-containing vaginal ring could prevent HIV acquisition. The trial data caused celebration and immediate conversation about what would happen next given that the trial showed both that the ring works and that there may be real challenges with adherence, particularly in younger women.

With new programs, funding initiatives and research specifically targeted for women and girls, this workshop convening was an important juncture to pause, take stock, consider the next few years and plan key advocacy priorities. The discussions highlighted the exciting and complicated road ahead for rings and for prevention options for women generally.

This meeting provided an opportunity to unpack and interpret the dapivirine ring results, understand and interrogate next steps, situate the next two years for women’s HIV prevention (research, implementation and funding), and identify advocacy opportunities and areas for further engagement.

Two young women living with HIV set the stage for the day with their personal stories and perspectives on where HIV prevention sits in the context of the lives of young African women. Their stories became a frame for the day—recognizing the special needs young people have for contextualized education about HIV and sexuality, but more importantly that young women are the most powerful champions and MUST be involved in designing and delivering any interventions and decision-making processes that impact their lives.

There was rich discussion on advocacy priorities for the next year or so and what is needed to ensure that women’s prevention is prioritized. Two of the issues raised underpin the way forward for women’s HIV prevention and serve as a call to action for those attending this meeting and other communities across Africa: (1) the need to roll out PrEP now as we wait for rings; and (2) the need to revive activism in the HIV prevention movement.

One of the most important takeaways was that as we consider the exciting biomedical prevention interventions to change the trajectory of the epidemic—race, gender and the unique aspects of women’s lives will continue to affect access to care and prevention. It is critical to situate the research and access in the realities of women’s, and especially young women’s lives, and that context is always important.

Please visit www.avac.org/ring-results-and-next-steps to access meeting presentations and materials.