New Resource! Advocates’ Guide to Multipurpose Prevention Technologies

AVAC has a new resource to support advocacy for multipurpose prevention technologies (MPTs), Advocates’ Guide to Multipurpose Prevention Technologies. The Guide calls out four areas ripe for advocate involvement. It also provides a snapshot on the status of MPT research and development and data on investments—critical information that can support evidence-based advocacy.

MPTs are products designed to simultaneously address more than one sexual and reproductive health (SRH) concern. Male and female condoms—which protect against pregnancy as well as HIV and other STIs—are the only MPTs available today. MPTs offer great promise for meeting people’s diverse and changing SRH needs. But advocacy for these emerging technologies is crucial to mobilize resources and broaden support through all stages of MPT R&D to ensure equitable access to products as they become available.

This new resource complements AVAC’s ongoing work to advance the integration of services for sexual and reproductive health (SRH) with HIV treatment and prevention. For the latest on the Dual Prevention Pill (DPP)—the next MPT that is likely to go to market soonest—visit its dedicated page on PrEPWatch.

AVAC is also supporting a pioneering initiative led by the Ministry of Health in Kenya, jointly run by NASCOP and the Department of Family Health, to work with implementing partners, county-level officials, advocates and other stakeholders, to integrate HIV prevention and SRH policies and services. Check out the assessment that preceded this important work in Kenya and a similar assessment with partners in Zimbabwe. Watch this space for progress as it develops, and bookmark www.srhintegration.org and www.avac.org/advance-hiv-srh-integration for an overview of the issues and key resources.

Advocates’ Guide to Multipurpose Prevention Technologies

A resource to support advocacy for multipurpose prevention technologies (MPTs). The Guide calls out four areas ripe for advocate involvement. It also provides a snapshot on the status of MPT research and development and data on investments—critical information that can support evidence-based advocacy.

New Resources on AVAC.org!

Read on for a roundup of new resources on AVAC.org and PrEPWatch.org!

It’s one year into the COVID-19 pandemic, and the pace of advocacy for many people has only accelerated. In this time, when vast quantities of information—good and bad—must be sorted and priorities set, AVAC has been generating resources to help you keep up-to-date and to inform your advocacy.

HIVR4P in 3D

Okay, maybe it’s not really three dimensions; it’s more! Catch up on many angles of R4P starting with AVAC’s coverage:

Recordings from the Advocates’ Corner went deep into the content and include insightful, lively exchanges:

Funding for HIV Prevention R&D

The 16th annual analysis of funding trends in HIV Prevention R&D is out with 2019 data, and it can all be found on a newly launched website: www.hivresourcetracking.org. The annual report is a collaboration among AVAC, IAVI and UNAIDS, and the website includes 20 years of funding trends.

1 Million PrEP Initiations…almost

These two resources will help you understand the trends in PrEP uptake, and keep you up-to-date on PrEP initiations around the world, which is fast approaching 1 million but still well below global targets.

Ending TB

AVAC, Partners in Health, Friends of the Global Fight, Results, Treatment Action Group (TAG) and the Zero TB Initiative collaborated on a report and a new website that includes case studies from around the world. Find out what successful programs in Cambodia, Ethiopia, Pakistan, Russia, South Africa and the United States have in common and learn more about the critical components needed to achieve the eradication of TB.

Protecting Global Gains

Two new vignettes on Protecting Global Gains explore how communities are adapting to maintain critical healthcare as COVID-19 threatens hard-won gains in global health. This project is a collaboration including AVAC, Partners in Health, Friends of the Global Fight, Results, Treatment Action Group (TAG) and the Zero TB Initiative.

AVAC’s “3D” View of the World: 2019 and beyond

This infographic lays out AVAC’s top-line recommendations from AVAC Report 2019: Now What? The recommendations fall into three categories: deliver — prevention programs whose impact is well-measured and -defined; demonstrate — next-generation engagement for next-generation trials; develop — new targets for the post-2020 world.

AVAC Report 2019: With 2020 targets sure to be missed, we ask Now What?

Report cover

Today, AVAC released Now What?, our 2019 annual report on the state of the HIV prevention field. Each year, the AVAC Report frames the most pressing advocacy issues facing the HIV response. At the threshold of 2020, it’s clear that global goals for HIV prevention will miss the mark by a long shot.

Though important progress has been made, the crisis UNAIDS called out in 2016 persists today with new infections around 1.7 million annually, a far cry from the 2020 target of fewer than 500,000.

So, we asked ourselves, Now What?, and answered with cross-cutting analysis and an advocacy agenda to match.

FIRST, we call for leadership that is bold, visible and activist, from the new head of UNAIDS, to houses of parliament to civil society coalitions: take uncompromising stances, demand accountability, speak out for intersectional issues of race, gender, class and climate. This work needs to be funded, full-throttle and fearless.

SECOND, we call for the use of today’s most recent evidence to guide new prevention targets that will pave the way for epidemic control. Clear milestones for the prevention research pipeline must be set. Investments over the past decades have provided us with the prevention options we have today, and much-needed new strategies are under now investigation. The field needs targets for prevention research that people can understand and influence.

THIRD, we call for multilayered prevention approaches that are centered around the person, not the virus. Since last World AIDS Day, we’ve learned again, perhaps most strikingly from the ECHO trial, about the dynamic needs of women for HIV and pregnancy prevention. The complexity of translating results into policy, bring renewed urgency to the need for comprehensive HIV prevention and reproductive health approaches. Multilayered prevention incorporates multipurpose strategies (i.e., products that prevent both pregnancy and HIV) within programs designed to address structural barriers (i.e., policy reform, transforming community norms, facilitating educational empowerment).

2020 will be a pivotal year—join us in calling on leaders, from the grassroots to global capitals, to make 2020 a turning point, when siloes come down, crises are transformed by innovation, and prevention is center stage in the fight against HIV.

Happy reading, and we’d love to hear how you answer Now What?

What’s New on AVAC.org and PrEPWatch.org

We don’t want you to miss a host of resources posted in recent weeks on AVAC.org and PrEPWatch. In case you missed them, these tools and resources will sharpen your take on the field.

Reporting on Global HIV Prevention

Check out these reports—recently published by AVAC and partners—for updates on funding trends in prevention and cure R&D, as well as a fresh look at places that have beaten back HIV with existing interventions:

Smarter Rollout

These articles and tools support advocates, implementers and decision-makers working on PrEP rollout today with an eye on future interventions tomorrow:

  • Reaching and Targeting More Effectivley: The application of market segmentation to improve HIV prevention programmes, by AVAC’s Anabel Gomez and others, and published in the Journal of the International AIDS Society, explores how to leverage the power of market segmentation for the promotion and uptake of primary prevention.
  • Just updated in July, AVAC’s Global PrEP Tracker on PrEPWatch.org provides the latest data on programs, number of enrollments by country, regulatory status and more.
  • A User’s Guide to PrEP Tools offers a handy table to navigate the many tools produced by different organizations to support policy makers, implementers, providers and others on PrEP access, uptake and continuation. Use this table to learn more about these tools, who they’re designed for, and when to use them.
  • The PrEP4Youth video series of public service announcements encourages adolescent girls and young women in South Africa to consider PrEP as an HIV prevention method. Created by the OPTIONS Consortium in collaboration with the South African National Department of Health, these videos feature popular actresses and put young women at the center with short empowering messages.

Apply to be an AVAC Fellow in 2020

AVAC would like to remind you that our call for applications for the 2020 class of AVAC Fellows is open until September 20. We encourage you to learn more about the program and share this information with your network!

Global HIV Prevention R&D Investment by Technology Category, 2000-2017

In 2017, reported funding for HIV prevention R&D decreased by 3.5 percent (US$40 million) from the previous year, falling to US$1.13 billion. The full report, HIV Prevention Research & Development Investments 2017: Investing to end the epidemic, is available for download. And all the graphics are available as well.

Press Release

Continued declines in HIV research funding put global prevention targets at great risk

Contacts

AVAC: Kay Marshall, [email protected], +1-347-249-6375
IAVI: Anita Kawatra, [email protected], +1 212-847-1055

Madrid – HIV prevention research funding continued to decline in 2017 for the fifth consecutive year, driven largely by a five-year low in US public sector funding, according to a report released today at the HIV Research for Prevention (HIVR4P 2018) conference in Madrid, Spain.

The Resource Tracking for HIV Prevention R&D Working Group’s 14th annual report, Investing to End the Epidemic, documents funding that fell to the lowest level in more than a decade: In 2017, funding for HIV prevention research and development (R&D) decreased by 3.5 percent (US$40 million) from the previous year, falling to US$1.13 billion.

This declining funding comes at a time of great optimism for research, with a slate of efficacy trials across the prevention pipeline – including major HIV vaccine, passive antibody and next generation PrEP efficacy trials – and critical follow-on research for proven antiretroviral-based prevention options, notably the dapivirine vaginal ring. But it also comes a time when the broader HIV field is grappling with a prevention crisis that is exacerbated by decreased funding for the overall HIV response and a lack of political will to adequately fund a response that will ensure the world meets the ambitious prevention targets to end the epidemic.

The Working Group warns that getting to zero new infections will not only require the expansion of existing options like voluntary medical male circumcision (VMMC) and oral pre-exposure prophylaxis (PrEP), but also the development of innovative new products, including long-acting, antiretroviral-based prevention options and a vaccine. Sustained funding is critical to keep the full gamut of HIV prevention research moving forward in a timely manner. Even small declines in funding can delay or sideline promising, new HIV prevention options that are needed to end the HIV epidemic.

“Make no mistake. We are in a prevention crisis and we cannot afford a further funding crisis,” said Mitchell Warren, AVAC executive director. “It is unacceptable that donor funding for HIV prevention research continues to fall year after year even as research is moving new options closer to reality. We need continued and sustained investment to keep HIV prevention research on track to provide the additional tools that are required for sustainable, durable control of the HIV epidemic.”

The US government continued to be the major funder of HIV prevention research, contributing almost three-fourths of overall funding. A decrease of almost six percent, though, brought funding to a five-year low of US$830 million. The Working Group noted that sharp declines in US government funding have a major impact on the biomedical HIV prevention R&D field. With uncertainty around continued political will to fund the HIV response, this trend is extremely worrying.

Together, the US public sector and the Bill & Melinda Gates Foundation (BMGF) represented 87 percent of the total global investment in 2017, an imbalance that has continued for several years. The Working Group in this year’s report cautioned against the disproportionate impact of shifting donor priorities by these two donors on cutting-edge research, noting that a US$50 million decrease in vaccine R&D in 2017 was largely attributed to cuts from the US government, while a 67 percent increase in VMMC funding in 2017 is due largely to enhanced investment from BMGF. The Working Group renewed a call to diversify the funding base to ensure both the sustainability of the field and that decades of gains made in scientific innovation are not lost to fluctuating investment.

The Working Group noted with concern that funding by the European Commission (EC) dropped by almost half from 2016 to 2017 (US$14.4 million in 2016 to US$7.6 million). Noting increases in public sector funding from Canada, Brazil and the Netherlands, the Working Group called on other European countries to increase investment in critical HIV prevention tools to help end the epidemic and to offset the drop in EC funding.

“A true end to AIDS will only be possible if we can develop and deploy an effective, accessible HIV vaccine and other biomedical innovations to prevent HIV infection,” said Mark Feinberg, M.D., Ph.D., President and CEO of the International AIDS Vaccine Initiative. “Decades of research are paying off with the most exciting advances we’ve seen to date. But progress can only continue with sustained public and private sector investment in HIV prevention R&D.”

As researchers, implementers, advocates and funders gather this week in Madrid to review progress in HIV prevention research, there is much to be optimistic about in HIV science and in the accumulated knowledge of how to end the epidemic. At the same time, sobering changes in the funding and policy environment could imperil future progress and wipe out the progress made. 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.

“With 5000 people becoming infected with HIV every day it is critical that we both scale up the effective HIV prevention programmes we currently have and invest in new technologies and solutions so that they can become a reality for the populations most affected by HIV,” said Tim Martineau, Deputy Executive Director, Programme a.i. UNAIDS. “Doing both will avert new infections, save lives and reduce the rising costs of life-long antiretroviral treatment.”

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

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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. AVAC does not accept funding from the pharmaceutical industry.

Putting Women at the Center: Informed choice in 2018 and beyond

We need to give women the choice to use DTG or not and to use contraception if indicated and desired. We need to support choices across options, with risk reduction—not use of a specific product—as the primary outcome. We need to give women the choice to use DMPA-IM or –SC or not, and to use HIV prevention as desired.

MPT Field Investments & Collaborations are Assets for Global Sexual Health

This post first appeared on the Initiative for MPTs’ blog.

Recently, on World Sexual Health Day, we at the IMPT reflect on how to work with partners to improve sexual health across the globe. There are many things that could be done, many different approaches, and many people we can work with towards this goal. Here, at the IMPT, we see multipurpose prevention technologies (MPTs) to be one such promising strategy with the potential to improve the sexual health – and lives – of women and their families across the globe.

Sexual and reproductive health risks, such as unintended pregnancy and sexually transmitted infections, including HIV, are intrinsically interlinked. Yet, the current mix of prevention options has fallen short in protecting the sexual health of millions of women. The innovative work being done to advance prevention science, including the development of MPTs, is essential to better meet sexual health needs and improve countless lives. The price of innovation is steep and the time horizon is long, but the end result has the potential to be game changing.

Sustained investment in prevention science is crucial for both the roll-out of existing prevention methods, as well as the development of new and effective technologies, like MPTs. The IMPT, led by the IMPT Secretariat, has partnered with the Resource Tracking for HIV Prevention R&D Working Group to monitor investments that support MPTs and the wider field of HIV prevention on an annual basis.

Since its inception in 2004, the Resource Tracking for HIV Prevention R&D Working Group, hereby referred to as the Working Group, has tracked US$17 billion of investments in biomedical HIV prevention research and analyzed funding trends across various prevention technologies, research stages, and sectors. This multi-tiered analysis of global investment flows is crucial for evaluating public policies, improving transparency, and furnishing facts for advocacy. As the HIV prevention toolbox has expanded, so has the mandate of the Working Group and the scope of our resource tracking efforts.

Substantial growth of the MPT pipeline coupled with an ever-present concern about the risk of STIs and unintended pregnancy in women, heralded the beginning of a partnership between the IMPT and the Working Group. From 2013 onwards, in a unique collaboration defined by a shared commitment to prevention science, knowledge and data-sharing, the IMPT and the Working Group have collated and analyzed close to US$142 million in funding for the advancement of MPT products. Expanding the scope of the Working Group’s original mandate, grants relevant to MPT R&D are also collected during the annual outreach to funders and implementers of HIV prevention science. This engenders a more efficient and streamlined method for data collection and the monitoring of field-wide investment trends.

Funding trends for MPT R&D reflect the rapid pace with which the field has grown – to cover two dozen new products and a 52 percent increase from 2013 levels when the resource tracking partnership began. While annual investments have averaged at US$37 million, overall funding dropped for the first time in 2016 by 14 percent to US$40 million. The US public sector remains the predominant funder of MPT research, primarily through the NIH and USAID, and accounting for 63 percent, 74 percent, and 67 percent of all overall investments in 2014, 2015, and 2016 respectively. Philanthropic investment in MPT research totaled US$4 million in 2016. Compared to the preceding year, private sector investment fell in 2016 and represented 10 percent of overall investment in MPT research.

The MPT field has seen a remarkable increase in investment in the last five years. However, the recent decrease in investment in prevention science, including MPTs, is concerning and should not be ignored. Advocates need to reinvigorate support for this important work and push for the investment needed to drive cutting edge and life changing science that will improve the sexual health of millions worldwide. The IMPT and the Working Group will continue to work together to monitor the progress of the fields and hope to see the needed resources committed to advancing prevention science and saving lives.

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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).

More information about the growth and investment in the MPT field can be accessed in the 2017 IMPT Annual Report.

About the Authors
Fatima Riaz is the Program Coordinator for Research and Data Analytics at AVAC and has an MPH from Columbia University and a certification in Global Health Delivery from Harvard University. Her career started as a student health advocate in Pakistan where she founded and led a national polio advocacy campaign, and has since worked with the World Bank, the International Rescue Committee and UNICEF on diverse issues like WASH, violence prevention and maternal child health.

Kathryn Stewart is Deputy Director for CAMI/IMPT and has a Master’s in Public Policy from UC Berkeley with a special focus on maternal and child health. She also holds a BA in Politics and International Relations from Scripps College. Kathryn applies her 20-year experience in sexual and reproductive health prevention, policy, and research to coordinate a spectrum of projects aimed to advance the development and introduction of multipurpose prevention technologies (MPTs).