Follow the Money: HIV R&D Resource Tracking Reports 2018

Two new reports tracking resources for investment in HIV research and development are hot off the presses. The Resource Tracking for HIV Prevention R&D Working Group, a collaboration among AVAC, IAVI and UNAIDS, has launched its 15th annual report, HIV Prevention Research & Development Investments: Investing to end the epidemic, detailing overall 2018 investment and analysis of funding trends. And the Cure Resource Tracking Group, a collaboration between AVAC and the International AIDS Society, has also released its annual report, Global Investment in HIV Cure Research and Development in 2018.

These two reports represent powerful tools for advocacy. Both reports can be used to advance advocacy for a host of issues directly impacted by financial investments: the prevention crisis in the global HIV response is insurmountable without cutting-edge research and development and the scale-up of existing interventions, while cure research spearheads crucial innovation, and offers hope and inspiration to the millions affected by the epidemic.

Read on for links to downloads and key findings from each report:

Key Findings in Prevention R&D Funding

The report indicates an uptick after five consecutive years of declining investment. In 2018, funding for HIV prevention R&D increased by a modest 1.2 percent or US$13 million from the previous year, growing to US$1.14 billion. While the increase is encouraging, it’s the smallest net increase since 2003. This incremental growth impacted the various prevention categories differently. Investment increased for pre-exposure prophylaxis (PrEP), female condoms and prevention of vertical transmission (PMTCT) but decreased for voluntary medical male circumcision (VMMC), preventive vaccines, microbicides and treatment as prevention (TasP).

Despite the significant variation among these categories, donor trends remained more or less the same. Public sector (79 percent of overall or US$900 million) and philanthropic sector (14.4 percent of overall or US$164 million) investments remained mostly unchanged from 2017, while the private sector saw a 30 percent surge in investment, rising to at least 6.6 percent of overall funding or US$74.7 million in 2018. Actual commercial investment levels are higher as not all private companies responded to the Working Group’s request for data.

While US and European investment remained steady in 2018 compared to 2017, these figures are still the lowest in over a decade at US$829 million and EU$57.5 million, respectively. Outside the US, increases came from Australia, Canada, the European Commission, Germany and the UK, while declines were observed from Brazil, France and Japan. Global philanthropic levels also saw no change in 2018 and the Bill & Melinda Gates Foundation (BMGF) remained the preeminent funder in that category at US$149.7 million or 91 percent of all philanthropic sector investment.

In 2018, the US public sector and BMGF accounted for 86 percent of all funding. Citing the promise of the current R&D pipeline, the report cautions against this funding imbalance and the resulting impact on the longevity and sustainability of the field. Much hope can be drawn from the latest scientific strides: the ongoing efficacy trials for long-acting injectable PrEP and antibody mediated-prevention; the planned Phase III trial of a novel HIV vaccine regimen; and the dapivirine vaginal ring – another potential option for women. All of the above is contingent on sustainable financing and a diverse donor base that cushions against priority shifts from large donors.

Key Findings in Cure R&D Funding

The report estimates global investments in HIV cure research, which includes therapeutic HIV vaccines (for treatment) shows US$323.9 million in 2018, representing a 12 percent increase over the US$288.8 million invested in 2017. Compared to the US$88.1 million invested since tracking began in 2012, this is a 268 percent increase. The public sector accounted for the majority of funding, with the remaining US$19.7 million invested by philanthropies such as Aidsfonds, amfAR, the Bill & Melinda Gates Foundation, CANFAR, Institut Pasteur, Sidaction and Wellcome Trust.

We hope these reports will serve as tools for advocacy and inform public policy that accelerates scientific progress. We thank all of the individuals who contributed data to the report and who gave time and effort as trial participants.

If your organization is a funder or recipient of HIV prevention grants and we don’t know you already please contact us at [email protected]!

Global Investment in HIV Cure Research and Development in 2018

In 2014, the HIV Vaccines and Microbicides Resource Tracking Working Group and AVAC began a collaboration with the International AIDS Society’s (IAS) Towards an HIV Cure initiative. AVAC, Treatment Action Group (TAG) and the IAS brought together a group to review and allocate grants towards HIV cure research and analyze data on global funding. The working group released a report in July 2019, Global Investment in HIV Cure Research and Development in 2018.

As per findings, US$323.9 million was invested in cure research in 2018, representing a 12 percent increase over the US$288.8 million invested in 2017. Compared to the US$88.1 million invested in 2012, this is a 268 percent increase. The public sector accounted for the majority of funding, with the remaining US$19.7 million invested by philanthropies such as Aidsfonds, amfAR, the Bill and Melinda Gates Foundation, CANFAR, Institut Pasteur, Sidaction and Wellcome Trust.

Cure Research: Why it matters, how to talk so that people will listen and a few thoughts on what you might hear

Rob Newells, Executive Director of AIDS Project of the East Bay, PxROAR member, and minister and founder the HIV program at Imani Community Church in Oakland, delivered this address to the amfAR Cure Summit in November.

Thank you to Dr. Rowena Johnston and all the good folks who organized this Summit for allowing me the opportunity to share some thoughts about my vision for HIV Cure research. I won’t be before you long… and if you’ve ever been to a black church, you know that’s the lie that the preacher tells before they put you to sleep with a 2-hour sermon… but I promise, I’ll try my best not to do that this early in the program.

I’m not here to talk to you about all of the new and exciting things that are happening with cure research. There are people with degrees that will share that stuff with you later. I am a community advocate. Yeah… I’m the Executive Director for the oldest HIV services community-based organization in Alameda County… but at my core, I am a community advocate.

I am a 48 year-old, same gender loving black man born and raised across the Bay in Oakland. I’m a 70s baby, so I saw the city go from 50 percent black when I was a teenager to 25 percent black now. (Gentrification is real.) I went to middle and high school with the children of some of the country’s most legendary drug kingpins of the 70s and 80s. I’m pretty sure I grew up middle class… but sometimes I think white middle class and black middle class are totally different. I’m a United States Marine Corps veteran who didn’t figure out he was gay until halfway through college, which for me was after my military service… Which means that I became sexually active when the epidemic was still at the top of the national news.

I started doing work around HIV prevention education in 1999. (I had a cousin and some friends living with HIV, and I had lost an uncle, a couple of church choir directors, and a choir member to the disease by then.) I tested positive for HIV in 2005. Seven years later, in 2012, I became a licensed Baptist minister… as a gay man living with HIV. (My ordination is next Sunday in Oakland in case you’re interested.) 2012 is also when I formally started working with AVAC on biomedical HIV prevention research advocacy, and talking to black men in Oakland about what was coming down the prevention pipeline. I had learned a little about cure research by then, but my real intro was at the HIV Cure Community Workshop and Pre-Conference Symposium in Durban, South Africa, before the 2016 International AIDS Conference.

That’s where I met my brother Moses Supercharger from Uganda. Getting to know Moses and his work helped me to understand that there isn’t much talk among members of my community about the need for an HIV cure mostly because in this country we’ve been driving home the message that we already have the tools we need to end the HIV epidemic. PrEP has been approved for 6 years now. Treatment as Prevention works. Undetectable really does equal untransmittable. And condoms still work. So why do we need a cure?

Moses asked the question a couple of years ago, “How do you end the HIV epidemic if people are still living with AIDS?” It’s a simple question, but when government agencies and charitable foundations are deciding where to send limited research dollars, it starts to get complicated. Why do we need a cure?

Cure may not be at the top of the HIV wish list for much of my community, but for our brothers and sisters in Africa – the continent most affected by the virus – cure is essential. U.S. citizens enjoy the privilege of traveling to countries around the world without having to obtain a visa. Africans living with HIV are routinely denied travel visas. And the social stigma of living with HIV in Africa is many times greater than it is in the United States… and the pill burden is often greater. While Americans have multiple options for once daily single-tablet regimens, Moses told me that he takes seven pills each day: three in the morning, one in the afternoon, and three in the evening. He’s been living with HIV for 20 years now. He’s tired of taking pills. Hell! I’m tired of taking pills. We’re tired of taking pills. And everybody doesn’t even have the option. Everybody doesn’t have access to treatment. So the 36.9 million people living with HIV and AIDS globally need a cure.

So… even if we can all agree that we need an HIV cure, do we really know what that means? Nope. We don’t know because y’all don’t know. A cure could be total eradication of the virus from the body. Or it could be more like remission is with cancer. Or it could be a “functional” cure where the virus remains in the body at undetectable levels without the continued use of antiretroviral medications. Who knows? There are all sorts of extremely smart infectious disease specialists, oncologists, geneticists, mathematicians, social scientists, physicists, lions, tigers, and bears (Oh, my!) working to make something happen. Something that will mean I don’t have to take any more pills, and I won’t infect my partner by having condomless sex, and my HIV test will come back negative. Well… maybe not me… but maybe my little cousin’s oldest son who called me while I was at the airport on my way back from the International AIDS Conference in Amsterdam this summer to tell me that he had just tested positive for HIV. Maybe he’ll get a cure.

This is my second year working with the Community Advisory Board for the Institute, and I’m still learning. As you can tell, I am not a scientist, nor am I trying to be one. I see my role as asking the questions my community members would want answers to, and understanding enough about what the researchers are doing to be able to talk about it in plain language with the folks who live and work and play and worship in the same circles where I live and work and play and worship. So catch phrases from researchers like

Block and Lock…
Shock and Kill…
Reduce and Control…

…those all sound a lot like…

“Catch and Release” from immigration officials or
“Stop and Frisk” from law enforcement officials…

These cutesy little shorthand ways of talking about getting to some sort of cure might work for some folks, but… as for me and my house… these phrases can be triggering. As much as I would love to be cured of my HIV, the language we use has the potential to keep a lot of my cousins away.

As unbelievable as it may sound, everyone doesn’t want a cure for HIV. There are folks who are afraid of a cure for HIV. The freedom from daily pill-taking and the (maybe) reduced stigma, depending on what type of cure we end up with, are huge pluses, but are we really ready for a cure?

I was in Madrid for the HIV Research for Prevention conference last month, and there was a poster about what HIV prevention researchers should know about what HIV Cure means to what they called “HIV disparity populations” in the United States. Some researchers in Chicago talked to groups of young men who have sex with men, men of color who have sex with men, transgender women, and cisgender women of color about HIV cure research. This fear kept coming up.

For a lot of folks, having a cure for HIV would bring a kind of freedom… freedom from pill-poppin’… freedom from HIV stigma… freedom from discrimination and criminalization… But for a lot of folks, having a cure for HIV would just make it okay for people to start having lots of crazy, condomless, raw sex. (Oh, no!!) The folks implementing PrEP have heard all this stuff before.

I mean… HIV has made us afraid of our sex. That’s absolutely horrible. It’s bad enough that we are ashamed of our sex… but we have been afraid of our sex… afraid our sex would kill us… for almost 40 years now. What will it take to address that fear? How long will it take? Who’s gonna handle that? Seriously. We’ve got to have some real conversations about what sexual freedom looks like post-HIV in the years leading up to a cure if a cure for HIV is going to be widely-accepted in communities where effective treatment is already an available option.

So, I guess my vision for HIV cure research is not really about advancing the science. Y’all are gonna do that. My vision for HIV cure research is about the freedom. (I think about my freedom a lot in our current political environment.)

My vision for HIV cure research is about freeing all of us from disease and stigma and shame. It is about freeing all of us from these daily handfuls of pills for treatment of HIV and the other stuff that comes with it… but it’s also about freeing all of us up to, without fear, have as much (or as little) good, guilt-free sex as our little souls desire…

So, researchers… I need you to be having lots of good, guilt-free sex. Get out of the lab or the clinic or the office and go get some. I need you to be free, too! As Bishop Yvette Flunder says, “Free people, free people.”

And I believe in y’all. You can do it. I believe that the smart people in this room are gonna help develop a cure for HIV. And every once in a while, when you’re in your lab or your clinic or your office, you’re gonna think about me and my baby cousin and the other folks you’ll meet today who are living with HIV… and you’ll be thinking about all the good, guilt-free sex we wanna have… and you’re gonna come up with something that will work… even for folks who don’t trust you and your little research… and it’s gonna be good. I need you all to believe that… because I am believing in you.

Thank you for your time.

No Prevention, No End – AVAC launches new report and call to action

Today AVAC released No Prevention, No End, our 2018 annual report on the state of the field. Starting from the title—which humbly borrows the cadence of the call for an end to state-sanctioned violence against Black Americans, “No Justice, No Peace”—through to the closing words, “This is the worst possible moment for slowing down,” the Report is a call to action and guide for addressing the HIV prevention crisis that threatens progress in curtailing epidemics worldwide.

Click here to download the Report and individual sections and graphics; click here for a new episode of the Px Pulse podcast which covers the Report’s key themes and features lead author Emily Bass, AVAC’s Director of Strategy and Content.

UNAIDS named the prevention crisis in its July 2018 report, Miles to Go. It acknowledged that the scale-up of antiretroviral treatment, while essential, is insufficient as a prevention strategy. AVAC has been warning of an imbalance in approaches and investments across approaches, and calling for ambitious targets matched with political will, financing, timelines and more since the UNAIDS targets were first launched in 2014. (Check out AVAC Report 2014/5: Prevention on the Line for a summary of this critique of targets.)

In this year’s Report, we call out three core problems with primary prevention and the global HIV response, identifying the risks they bring and the path to a solution. Specifically, we focus on:

  • Investing in demand creation: The private-sector gloss on this term cannot obscure its essential role in making primary prevention work. Strategies that might save lives are condemned as unwanted or unfeasible when they’re delivered in programs that lack integrated demand-side thinking, which is a science and not a set of slogans.
  • Making informed choice central to HIV prevention: Programs that offer more than one option, along with a supportive environment for a provider and client to discuss risks, benefits and personal preferences aren’t a luxury but a necessity. The family planning field has metrics to measure choice; HIV should pick these up, with prevention programs leading the way.
  • Unstinting radical action: Progress in the global AIDS response is tenuous; so is the state of democratic institutions and the future of the planet. These interconnected issues require more bold action, including from countries that are aid beneficiaries, and from the citizens of those countries who unite to hold truth to power. In the HIV prevention context, this means accountability for primary prevention at every level, including research for next-generation options.

AVAC is launching this Report as many stakeholders in HIV prevention research gather in Madrid for the HIV Research for Prevention (R4P) conference. Visit our special R4P page to find us on-site and follow along from afar, to see how the themes of this year’s Report resonate in a global and wide-ranging discussion of HIV prevention research and implementation at a critical time.

Cure Research and Analytic Treatment Interruption

In this episode of Px Pulse, researchers and advocates debate the rationale, risks and ethics of interrupting treatment as part of cure research. This is known as analytic treatment interruption or ATI.

New Px Pulse is Up With Look at Cure Research

The June episode of Px Pulse is up!

In this episode, researchers and advocates debate the rationale, risks and ethics of interrupting treatment as part of cure research. This is known as analytic treatment interruption or ATI.

AVAC spoke with advocate Udom Likhitwonnawut about when and why treatment interruption might make sense. Two cure researchers—Dr. Steven Deeks and Dr. Dave Margolis—share their differing views on treatment interruption; Deeks is professor of medicine at the University of California, San Francisco, while Margolis leads the Collaboratory of AIDS Researchers for Eradication at the University of North Carolina at Chapel Hill. Finally, HIV advocates Flahvia Namwaya and Moses Supercharger Nsubuga talk about what a cure would mean for those living with HIV.

Listen to this episode to hear the hopes, scientific mysteries and doubts surrounding HIV cure research and ATI.

For the full podcast, highlights and resources, visit here. And subscribe on iTunes to catch every episode!

US HIV Research: A family tree

This graphics shows a family tree representing HIV research in the United States. It appears in AVAC Report 2017: Mixed messages and how to untangle them.

HIV Cure Research Strategy for Women: Where are we?

This blog post first appeared on Positively Aware. It represents a report taken from a session presentation summary at this year’s US Conference on AIDS (USCA), a community-based event which was held in September in Washington, DC.

The authors are Danielle Campbell, Julie Patterson, David Evans, Pedro Goicochea, Moisés Agosto, Dawn Averitt, Catalina Ramirez, and Karine Dubé Danielle Campbell, Julie Patterson, David Evans, Pedro Goicochea, Moisés Agosto, Dawn Averitt, Catalina Ramirez, and Karine Dubé.

The need for a cure is critical, but will the search for HIV cure strategies include women? Women are drastically underrepresented in HIV cure research studies. A review of 159 studies showed that only 18 percent of HIV cure study participants were women. Women have a high willingness to participate in research, although they are in general less willing than men to take risks related to HIV cure research interventions. Research is in the works to better understand the differences in willingness, but studies outside of the HIV cure arena suggest that if structural barriers to participation are diminished, and more effort is made to establish trusting relationships between investigators and participants, more women will participate.

Currently, there is no cure for HIV. Only one person has been cured, Timothy Ray Brown, after receiving two bone marrow transplants that simultaneously rid his body of HIV infected cells and gave him new cells that are resistant to HIV. Scientists are trying to replicate his cure. The transplant of stem cells is a central HIV cure strategy being investigated, particularly to eliminate nearly all traces of the virus from a person’s body (e.g., an eradicating, or sterilizing, cure). Other methods include the early administration of antiretroviral treatment, combined with a variety of strategies that make HIV more visible to infection-fighting immune cells, improving the immune system’s ability to detect and eliminate infected cells, and possibly rendering immune cells impervious to HIV infection.

Scientists suspect that there are gender-based differences that affect how these investigational interventions might work inside the body. For example, two studies have suggested that the presence of female hormones and hormone receptors on immune cells might make it more difficult to flush HIV out of hiding. In addition, cis-gender women who have female chromosomes are genetically primed for stronger immune responses to infection and to vaccines. They might, perhaps, have an advantage if vaccines or other approaches to prime the immune system’s response to HIV are used.

While studies of all diseases have traditionally lagged far behind in terms of participation by women, HIV has more recently had a better track record in terms of prevention and treatment trials, and improvements in recruitment and retention guided in part by the efforts of the Women’s Interagency HIV Study (WIHS), which is an NIH-funded cohort (or group) that studies the impact and progression of HIV infection among women in the United States. It is the largest and longest running HIV cohort focused on women. In total, 4,982 women at nine sites have participated in the cohort to date. The WIHS cohort is also uniquely diverse in that it is reflective of the US epidemic among women. The WIHS cohort is a great platform to advance HIV cure-related research in the United States. WIHS participants volunteer in studies that measure the HIV reservoir in the blood, genital tract, and other tissues, that study the role of sex hormones on HIV reservoirs and that examine the relationship with ART pharmacology.

The WIHS cohort has been creative in overcoming challenges to women’s participation in HIV cure research. For example, if women are asked to come in fasting for a lab test, the study site provides a substantive meal after the procedure. Providing mileage reimbursements, metro vouchers, and taxi rides are critically important, since transportation issues are a main deterrent to participation in research. Other strategies to improve sex equity in HIV cure-related research include addressing eligibility criteria, adapting recruitment strategies, and engaging community members as early as possible in the process. For this reason, WIHS could serve not only as a model for successful recruitment and retention of women living with HIV into research, but also as a source of participants who might be inspired to participate in HIV cure-oriented research.

Including women in HIV cure research means:

  • Thinking about what they need: different types of recruitment strategies and study coordination which may benefit from partnerships with different organizations or advocacy groups
  • Listening to what they want: information and a chance to participate, fair reimbursement and compensation, assistance with logistical barriers
  • Designing studies that reflect them: re-thinking eligibility criteria to balance participant risk with exclusions that disproportionally affect women
  • Prioritizing their involvement: a few women or a single study is not enough, we need to advocate for representation of all women, including transwomen

More Resources on Women and HIV Cure-Related Research

The Well Project/Women’s HIV/AIDS Research Initiative
The Well Project is a non-profit organization whose mission is to change the course of the HIV/AIDS pandemic through a unique and comprehensive focus on women and girls.

Treatment Action Group
A great resource for articles, reports and other information related to HIV cure research efforts.

Advocacy resources: treatmentactiongroup.org/CURE/advocacy

Media monitor which tracks cure research related news, places stories in context and addresses inaccuracies:
treatmentactiongroup.org/cure/media-monitor

A listing of clinical trials and observational studies related to the research effort to cure HIV infection:
treatmentactiongroup.org/cure/trials

AVAC
AVAC’s work includes a range of activities aimed at addressing: ethical issues, including community involvement in research; standards of prevention and care in trials; and community engagement and research literacy outside the context of a specific clinical trial or intervention.

HIV Cure Research Glossary
This glossary is designed for the media and laypersons interested in understanding the issues involved in HIV cure-related research.

CUREiculum
The CUREiculum is a suite of tools that provides simple, accessible information on HIV cure research, organizing into a systematic format for ongoing or issue-specific learning.

Social and Ethical Aspects of HIV Cure Research (searcHIV)
searcHIV is a multi-site, multi-disciplinary working group focusing on investigating the biosocial implications of HIV cure research.

Women’s Interagency HIV Study (WIHS)
The Women’s Interagency HIV Study (WIHS) is a large, comprehensive prospective cohort study designed to investigate the progression of HIV disease in women.

New Report: Investment trends for HIV prevention and cure R&D

It is said success breeds success. 2016 was a year of encouraging progress, indeed success, on a number of HIV prevention fronts. Two trials of the dapivirine vaginal ring showed efficacy, a spate of new vaccine and antibody trials began, and a trial of long-acting injectable PrEP launched.

Those developments are successes by any measure, and yet this year’s funding report from the Resource Tracking for HIV Prevention Research & Development Working Group (Working Group) shows that prevention funding continues to slowly decline overall. Over the same time, cure research got a big bump from global funders. A separate cure-focused brief from the Working Group, developed in partnership with the International AIDS Society (IAS), showed investment in cure research tripled since 2012.

Global HIV Prevention R&D Investment by Technology Category

Released today, the Working Group’s latest annual report on global investment in biomedical HIV prevention shows that overall funding for HIV prevention research and development (R&D) has fallen to its lowest level in a decade.

The prevention research report notes that funding for preventive vaccine research constituted the bulk of all investments, followed by investments in cure, microbicides, prevention of mother-to child transmission (PMTCT), PrEP, medical male circumcision (VMMC), treatment as prevention (TasP) and female condoms. Over half of the HIV prevention option tracked by the working group experienced a decline. These trends are somewhat reflective of the cyclical nature of large-scale clinical trials—when trials end, funding drops off. Likewise, as some interventions enter full-scale rollout, like PrEP, VMMC and TasP, research in this area can be expected to slow down. Nevertheless, the overall trends bear close watching and strong advocacy to ensure that research continues. The progress of this research in the context of flat funding should not be misconstrued. Flat funding will not get us where we need to go next.

Taking stock of all that’s been accomplished with a decade of flat funding, it’s important to note that two million people continue to be infected each year. To achieve control of the epidemic, the field must also take stock of what could be achieved with the right priorities.

The right products need to be tested in the populations who need them most, and research does not always connect well to the people who are most at risk. The report explores the demographic breakdown of almost 700,000 participants in ongoing HIV prevention trials in 2016, with the majority of these volunteers residing in sub-Saharan Africa, most notably in treatment as prevention trials in Botswana, Uganda, Kenya and South Africa. Only one in eight trial participants in 2016 belonged to a population most affected by HIV, including MSM and transgender women, injection drug users and cisgender women.

An intensifying trend towards a small number of large investors is concerning. Together, the US public sector and the Bill & Melinda Gates Foundation (BMGF) represented 88 percent of the total global investment in 2016, compared to 81 percent in 2015. Simply put, for every dollar spent on HIV prevention R&D in 2016, 88 cents came from just two donors.

On a hopeful note, global investment in research toward an HIV cure increased to US$268 million, a 33 percent increase over 2015 levels, with a number of new funders, and an expanded research portfolio at the US National Institutes of Health. The majority of investments (US$253.2 million) came from the public sector with US$13.8 million invested by philanthropies such as Aids Fonds, amfAR, CANFAR, the Bill and Melinda Gates Foundation, Sidaction and Wellcome Trust.

This is a vigorous period in research and development, reflecting a growing recognition from the global community that research has to be part of the long-term fight to end the HIV epidemic. Now is the time to support continued progress with additional, well-targeted resources.

The Resource Tracking Working Group hopes these reports will serve as tools for advocacy and be used to develop public policy that accelerates scientific progress. We thank all of the individuals who contributed data to the report and who gave time and effort as trial participants.

Check out the report, share it with your fellow advocates, and be sure to let us know if your organization is either a funder or recipient of HIV prevention grants or if you have further questions or information about resource tracking at all!

Press Release

Declining Funding and Shrinking Donor Base Imperils Continued Success of HIV Prevention Research; European Countries Called to Renew Support

Contacts

AVAC: Kay Marshall, [email protected], +1-347-249-6375
IAVI: Rose Catlos, [email protected], +1-212-847-1049

New York and Paris —

A new report released today ahead of the 9th IAS Conference on HIV Science documents 2016 funding and highlights a continuing trend of flat or declining funding and its potential impact on further innovation in HIV prevention research and development (R&D).

The Resource Tracking for HIV Prevention R&D Working Group’s (RTWG) 13th annual report, HIV Prevention Research & Development Investments, 2016: Investment priorities to fund innovation in a challenging global health landscape, documents the lowest annual investment in HIV prevention R&D in more than a decade. In 2016, funding for HIV prevention R&D decreased by three percent (US$35 million) from the previous year, falling to US$1.17 billion.

At a time when the field is moving towards a new slate of efficacy trials across the prevention pipeline and follow-on research for successful antiretroviral-based prevention options is underway or planned this trend is worrisome, particularly in light of uncertainties around the sustainability of public sector support from the US and other funders. Even small declines in funding can delay or sideline promising new HIV prevention options that are needed to end the HIV epidemic.

The US continued to be the major funder of HIV prevention research. In fact, 88 cents of every dollar spent on HIV prevention R&D in 2016, came from just two donors: the US public sector and the Bill & Melinda Gates Foundation. In contrast, European public sector funding fell by US$10 million from 2015, and at US$59 million, accounted for just six percent of all public sector investment. This is the lowest European funding recorded in the last decade and marks a 52 percent decrease from the peak funding (US$124 million) in 2009. In addition, the number of philanthropic donors fell sharply from a total of 27 in 2015 to just 12 in 2016.

The RTWG renewed a call for a greater range of donors to increase the stability of R&D financing and cushion potential impact if any of the major funders were to reduce their investments. Noting increases in public sector funding from the Netherlands and Sweden, the RTWG called on other European countries to increase investment in critical HIV prevention tools to help end the epidemic.

The past year has seen one new HIV vaccine efficacy trial begin and another planned to begin later in 2017; a novel proof-of-concept trial of antibody-mediated prevention underway; a monthly vaginal ring with the antiretroviral (ARV) drug dapivirine proven effective and under review by the European Medicines Agency; a multipurpose technology combining dapivirine and a contraceptive has launched early-stage trials; a long-acting ARV-based injectable PrEP formulation is beginning efficacy trials; and, finally, daily oral PrEP delivery programs are being scaled up in multiple countries. And behind these more advanced R&D activities come many other different HIV prevention modalities poised to prove themselves in early-stage research.
“The latest figures from UNAIDS show us that there has been progress toward meeting the 90 90 90 treatment goals, but there has been less progress – and less reporting – on meeting the prevention goals that are critical to epidemic control,” said Mitchell Warren, AVAC executive director. “We need to not only vastly accelerate roll out of HIV treatment and existing prevention options, we need continued and sustained investment to keep HIV prevention research on track to provide the new tools that will move the world closer to ending AIDS.”

The RTWG has tracked more than US$17 billion in investment towards biomedical HIV prevention since 2000 and warned that the greatest impact of this investment could be lost without continued and sustained support to move promising prevention options from laboratories and clinics into the lives of those who most need them.

“We are at an incredibly exciting time in the field of HIV prevention research and development with more life saving innovations, science and technology coming to the forefront than ever before,” said Luiz Loures, Deputy Executive Director of UNAIDS. “We cannot allow a lack of funding to set back progress. Invest now and we can end AIDS by 2030.”

The report documents some critical increases in funding, including the highest annual investment in preventive HIV vaccines since 2007, which includes the highest investment by the US public sector in preventive vaccine research since 2000, in part because of the start of the first vaccine efficacy trial in almost a decade. Yet European public sector investment in vaccine research was the lowest since 2001. The increase in support for vaccine research comes at a critical time in vaccine R&D and is an example of funders responding to the need for investment to keep promising research moving forward. The RTWG noted this level of investment should be occurring across the field to support the broadest possible pipeline of promising new HIV prevention options.
“A true end to AIDS will only be possible if we can develop and deploy an effective HIV vaccine and other innovative biomedical products for HIV prevention” said Mark Feinberg, President and CEO of the International AIDS Vaccine Initiative (IAVI). “With growing risk of increasing rates of HIV infection due to demographic trends and incomplete reach of HIV treatment programs, advances being made in HIV R&D needs support and acceleration. Progress can only happen with sustained public and private sector investment in HIV prevention R&D.”

The HIV field comes together in Paris next week at IAS2017 at a time when there is both much to be optimistic about in HIV science and in the accumulated knowledge of what and how we need to deliver treatment, prevention and care to the people who need it most. Yet, as the title of the report notes, this optimism faces a volatile global health landscape. Funding constraints, policy changes, shifting donor priorities and shifting demographics will all play a role in the world’s ability to respond to the continued challenges that HIV presents.

“After years of prudent and increasingly high-impact investment in HIV prevention and treatment, we have seen amazing dividends in lives saved, families kept together, communities revitalized and economies boosted,” added Warren. “We cannot lose that momentum. We have the innovative science. Now we need an expanded cadre of innovative funders who will work with us to ensure a continued return on investment in more lives saved and more infections averted.”

The report and infographics on prevention research investment are online at www.hivresourcetracking.org and on social media with #HIVPxinvestment.

###

Since 2000, the Resource Tracking for HIV Prevention R&D Working Group (formerly the HIV Vaccines & Microbicides Resource Tracking Working Group) has employed a comprehensive methodology to track trends in research and development (R&D) investments and expenditures for biomedical HIV prevention options. AVAC leads the secretariat of the Working Group, that also includes the International AIDS Vaccine Initiative (IAVI) and the Joint United Nations Programme on HIV/AIDS (UNAIDS). This year’s report is additionally made possible by the support of several donors, including the Bill & Melinda Gates Foundation and the American people through the US President’s Emergency Plan for AIDS Relief (PEPFAR) and the US Agency for International Development (USAID). The contents are the responsibility of AVAC and the Working Group and do not necessarily reflect the views of PEPFAR, USAID or the United States Government.