Community Engagement and HIV Prevention Research

This December, Px Pulse features a gripping, tripartite conversation between activists Morenike Giwa-Onaiwu, Stacey Hannah and Jeremiah Johnson about what their long histories fighting for community engagement in HIV prevention research have taught them, and how these lessons can be applied today, and in the future. Tune in to hear three fierce voices with fresh perspectives on how to continue designing trials, and engaging communities, in today’s landscape of expanded, but inadequate, prevention choices.

With daily oral PrEP, VMMC, partner testing and treatment that leads to virologic suppression available as potent biomedical tools, along with condoms and a range of other structural interventions, clinical trials of biomedical HIV prevention strategies to block sexual transmission are more complex, in terms of design and conduct, than ever before.

Listen to this episode of Px Pulse on iTunes or at www.avac.org/px-pulse to learn why this conversation is at a critical moment and how to manage the opportunities for an innovative and collaborative effort with the research community.

Also, in case you missed it, check out the latest issue of Px Wire, which is hot off the presses. Our year-end edition offers 10 questions for activists to galvanize their work in the year ahead. We consider the future of NIH funding for HIV prevention and its research priorities, anticipated results from the ECHO trial, what’s next for the dapivirine ring and much more! The centerspread visualizes a single time frame for trial results and critical targets for incidence reduction and scale up of primary prevention-an essential perspective for the work ahead.

Finally, please don’t forget, your support makes our work possible. Help us continue with a year-end donation at www.avac.org/donate. You can also use smile.amazon.com for your online shopping and select AVAC as your charity of choice. A portion of your purchase price is donated to AVAC—at no additional cost to you!

Happy listening and reading, and happiest of holidays!

Community Engagement and HIV Prevention

In this episode of Px Pulse, we consider how future HIV prevention trials will need to be designed as HIV prevention evolves… and how to strengthen community engagement along with it. At the heart of the matter is that clinical trials for HIV prevention are set to get bigger and more complex, in response to advances in HIV prevention, such as PrEP.

One Timeline, Two Stories, One Message: Putting trials and targets together

One problem with HIV prevention agendas is that they either live in an eternal present or in a far-off future. It’s “work with what we’ve got, which is condoms and VMMC and a little bit of PrEP”, or it’s “nothing can change without an AIDS vaccine”. The future depends on using what’s available, better and more widely, without ever losing sight of what’s in the pipeline.

As the figures below show, in the very same timeframe that the world will miss its critical target for incidence reduction and scale-up of primary prevention, several trials will release results that could change the future. 2020 will be a time of hope and reckoning. But only if the two stories start to be told as one.

The Latest Issue of Px Wire! What to Watch in 2019

As 2018 winds down, we’re struck by the many moments, and movements, in the past year that have depended on listening, without bias and also without loss of conviction. From a bold activist challenge in an elevator, to an array of young women speaking their truths about HIV prevention—the future has hinged on being willing to listen, and on demanding to be heard.

In that spirit, our year-end edition of Px Wire offers 10 questions for activists to pose, with curiosity and conviction, in 2019. What answers do you want, what do you hear, what needs to happen next? We’ll be listening!

Download the new issue here.

Our questions take on the upcoming announcement of how future NIH funding of HIV research will shape biomedical prevention, the anticipated results of the ECHO trial looking at how different contraceptive options impact women’s risk of HIV, the future of the dapivirine vaginal ring and much more.

In our centerspread, we provide a visual for uniting biomedical prevention research and implementation—a necessary fusion for our work in the coming year, and beyond.

Also necessary: your continued support. AVAC depends on your contributions of work, ideas and, yes, funds for our work! We appreciate your support in one or more of the following ways:

  • Donate: Visit www.avac.org/donate.
  • Amazon Smile: Shop at Amazon.com? Visit smile.amazon.com and select AVAC as your charity of choice and a portion of your purchase price is donated to AVAC—at no additional cost to you!
  • US Combined Federal Campaign: If you are a US government employee, support our mission through the Combined Federal Campaign, CFC #12308.

Many thanks for your continued support, partnership and inspiration.

HIV Prevention Research and Demonstration Sites in South Africa

This map demonstrates the breadth of HIV prevention research and demonstration projects in South Africa by site and type (e.g. daily oral PrEP demo projects, ARV-based rings, long-acting injectable PrEP, preventative Vaccines, antibodies, hormonal contraceptives). This map was developed by Wits RHI with support from AVAC as part of the Coalition to Accelerate and Support Prevention Research. This graphic first appeared in AVAC Report 2017: Mixed messages and how to untangle them.

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.

HIV Prevention R&D Trial Participants by Region in 2017

Participation of volunteers and the engagement of communities in which trials take place is essential to conducting HIV prevention research. In 2017, there were nearly 600,000 participants in HIV prevention research trials globally, mostly originating from sub-Saharan Africa, Europe, North America and Asia. A majority of participants were enrolled in research investigating TasP and PrEP, and while there are trials aimed specifically at men who have sex with men (MSM), transgender individuals and people who inject drugs, most of the studies do not specify the need to include members of key populations.

The full report, HIV Prevention Research & Development Investments 2017: Investing to end the epidemic, is available for download.

Investment in HIV Prevention R&D by Top Philanthropic Funders in 2017

Global philanthropic funding increased by 4.1 percent from 2016 levels and amounted to US$164 million, or 14.6 percent of overall funding. The Bill and Melinda Gates Foundation (BMGF) remained the largest funder and increased its contribution by 6.6 percent, to US$150.2 million. Wellcome Trust investment fell for the fifth consecutive year to an annual US$2 million.

The full report, HIV Prevention Research & Development Investments 2017: Investing to end the epidemic, is available for download.

Investment in Women-Focused PrEP R&D, 2017

Out of the US$63 million invested in PrEP overall, US$16 million (or 25 percent) was for research explicitly focused on women. Most of this research was preclinical, with an emphasis on discreet products with long-acting formulations, e.g., PrEP implant studies and long-acting injectables. Almost 30 percent of the implementation studies focused on the uptake of and adherence to oral PrEP in high-risk women, and 15 percent focused on PrEP for pregnant and breastfeeding women.

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.

Prevention Research Funding Report 2017: Investment slows and continues to concentrate in a few funders!

[UPDATE]: The new report was a feature story by UNAIDS, Global HIV prevention targets at risk.

Today, the Resource Tracking for HIV Prevention R&D Working Group (Working Group) launched its 14th annual report—which details 2017 investments—at the HIV Research for Prevention (HIVR4P) conference in Madrid.

Flat and/or reduced funding for HIV/AIDS and other global health issues threatens to roll back progress worldwide. There is belated and widespread acknowledgment of a prevention crisis that can only be addressed by taking today’s tools to scale while researching new ones. Given this backdrop, the report is a powerful advocacy tool. This year’s report notes troubling trends in investment flows for biomedical HIV prevention at a moment of major promise in the research landscape. The report tracks the origins, trends and direction of global funding as well as the resulting effect(s) on the prevention research funding landscape.

Key Findings
The report shows that funding for HIV prevention research funding declined for the fifth consecutive year—and by 3.5 percent in 2017 to US$1.13 billion—the lowest total observed since 2005. This reduction was unevenly distributed. Investment increased for pre-exposure prophylaxis (PrEP) and voluntary medical male circumcision (VMMC) but decreased for AIDS vaccines, microbicides, prevention of vertical transmission (PMTCT), treatment as prevention (TasP) and female condoms.

The overall decline is driven largely by a reduction in US public-sector funding, with levels dropping by 5.8 percent from 2016 to US$830 million. This is a five-year low in investment. Outside the US public sector, another major decrease came from the European Commission, with funding levels dropping by 47 percent to US$7.6 million in 2017. The impact of these cuts was cushioned by increases from Australia, Brazil, Canada, Japan and the Netherlands. While the number of philanthropic donors decreased from 12 to 10 in 2017, levels of funding grew by 4.1 percent to US$164 million or 14.6 percent of overall funding. This is largely due to the 6.6 percent increase in investment from the Bill & Melinda Gates Foundation.

The report notes that the HIV prevention R&D space is at an exciting yet precarious juncture. Ongoing late-stage efficacy trials for preventive AIDS vaccines, long-acting injectable PrEP and antibody-mediated prevention could yield new options in the coming years. Then there’s also the dapivirine vaginal ring that is currently awaiting a regulatory opinion from the European Medical Association. However, the current funding landscape is not set up for sustainability or longevity, which is essential to help ensure that new products move from research and eventually to those who need it. Out of every dollar spent on HIV prevention research, 87 cents are from the two biggest donors, the US public sector and the Gates Foundation—a literal case of having all the coins in one basket. The report advocates for diversifying the funding base and developing long-term funding strategies to support the delivery of innovative prevention tools and a durable end to the epidemic.

The Resource Tracking Working Group hopes these reports will serve as tools for advocacy and be used to inform public policy that supports and helps to accelerate 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 a funder or recipient of HIV prevention grants, or if you have further questions!

We are kicking off the launch of the report with a press conference at HIV R4P, which can be viewed live at the conference Facebook page and will be archived on the conference website.