This annual accounting of funding for biomedical HIV prevention research tracks trends and identifies gaps in investment. In 2015, reported funding for HIV prevention R&D decreased from US$ 1.25 billion in 2014 to US$1.20 billion. However, overall funding has remained essentially flat for over a decade. While investments towards research for preventive vaccines and female condoms increased from 2014 levels, investments towards microbicides, PrEP, TasP, VMMC and PMTCT declined.
HIV Prevention Research & Development Investments, 2000–2015: Investment priorities to fund innovation in a challenging global health landscape (1-pager)
Not To Be Missed: New report on funding for prevention research
The span of a decade—that interval that’s neither too long nor too short to bring innovation—is one that’s often used in the HIV prevention research space, usually to convey optimism. Back in 1997, then President Bill Clinton called for a national commitment to develop an AIDS vaccine within ten years. Just this week, Bill Gates said, “With the right leadership and investments over the next decade, we can discover and deliver a vaccine for HIV.”
The success of these forward-looking claims has always depended on sustained funding. Note, in both cases, the emphasis on commitment and leadership. No one is promising a vaccine with anything less. A look back at the last ten years provides a warning on this front. Released today, the Resource Tracking for HIV prevention R&D Working Group’s latest annual report on global investment into biomedical HIV prevention reports that overall funding for HIV prevention research and development (R&D) has remained essentially flat for over a decade.
- Click here to download the full Report and here for a one-page summary
- Click here for the press release
- Click here for an infographic from AVAC’s new issue of Px Wire
Close followers of the annual “RT” report take note—a preliminary version was released at AIDS 2016 in Durban in July. The final version contains slightly updated data and the same overall messages: with a slight fall from US$1.25 billion in 2014 to US$1.20 billion in 2015, overall funding for HIV prevention research and development (R&D) has been more or less level for the past ten years.
And what a decade it’s been! Consider the developments in PrEP, the pipeline of injectable ARVs for prevention and treatment, the continued advance of the ARV-containing vaginal dapivirine ring, and the insights and advances that have come from sustained scientific inquiry related to the search for an HIV vaccine. These are exciting times. And the fact that all of this happened in the context of flat funding for research doesn’t mean that flat funding will get us where we need to go next. As Tom Hope, PhD (Northwestern University) stressed at an opening plenary of the HIV R4P conference where the report was launched, the fact that funding is declining concurrent with new discoveries is a major challenge for the field.
The report notes that preventive vaccine research funding constituted the bulk of all investments, followed by investments in microbicides, TasP, PMTCT, PrEP, VMMC and female condoms. With the exception of vaccines and female condoms, every other 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 VMMC and TasP, research in this arena can be expected to slow down. Nevertheless, the overall trends bear close watching and strong advocacy to ensure that research continues.
The right products need to be tested in the populations who need them most. The report is also a powerful reminder that this isn’t necessarily how research works. It provides information on the demographic breakdown of almost 900,000 participants in ongoing HIV prevention trials in 2015, with the majority of these volunteers residing in sub-Saharan Africa, most notably Uganda, Kenya, and South Africa. Only one in eight trial participants in 2015 belonged to a population most affected by HIV, including MSM and transgender women, injection drug users, and cisgender women.
These sobering facts come in the context of a vigorous period in research and development. It’s a time of growing recognition from the global community that research has to be part of the long-term fight to end the HIV epidemic. Taking stock of all that’s been accomplished with ten years of flat funding, now is the time to support continued progress with additional, well-targeted resources.
The Resource Tracking Working Group hopes that this tool provides strong facts for advocacy and supports efforts to assess public policy and its role in accelerating 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
A Decade of Flat Funding Could Imperil Progress of the HIV Prevention Research Pipeline
Contacts
AVAC: Kay Marshall, [email protected], +1-347-249-6375
IAVI: Arne Naeveke, [email protected], +1-212-847-1055
A PDF version of this press release is also available.
Report released at HIV Research for Prevention Conference highlights funding trends, opportunities and challenges for HIV prevention R&D
Chicago – A new report released today at the second HIV Research for Prevention Conference in Chicago documents 2015 funding, highlighting a decade of flat funding and its potential impact on continued innovation in the HIV prevention research and development (R&D) field.
The Resource Tracking for HIV Prevention R&D Working Group’s (RTWG) 12th annual report, HIV Prevention Research & Development Investments, 2000-2015 Investment priorities to fund innovation in a challenging global health landscape, finds that funding for R&D of new and emerging prevention options decreased slightly in 2015. This was due in part to decreases from the US public sector and a downswing in global philanthropic funding.
Steady progress in R&D for AIDS vaccines, microbicides, pre-exposure prophylaxis using antiretroviral drugs (PrEP) and treatment as prevention (TasP) confirms science’s critical role in providing solutions to end the HIV/AIDS epidemic. Yet research for these badly-needed solutions is in danger of being slowed or even sidelined by inadequate funding.
“It is critical that investments into HIV prevention innovations, science and technology are scaled up to put us firmly on the Fast-Track to ending AIDS by 2030,” said Luiz Loures, Deputy Executive Director, UNAIDS.
In 2015, funders invested a total of US $1.20 billion across R&D, down from US $1.25 billion in 2014, across eight key areas: preventive AIDS vaccines, microbicides, PrEP using antiretroviral drugs, TasP, HSV-2 vaccines and operations research related to voluntary medical male circumcision, female condoms and prevention of vertical transmission.
The report also finds that investment is being made along all phases of the research pipeline but remains concentrated among a few large investors. A more diverse base of funders would increase the stability of R&D financing and cushion the impact if any of the major funders were to reduce their investments. To improve continuity, RTWG calls for a more balanced funding base, especially through support of new investment by European and low- and middle-income countries. The US public sector (primarily via the National Institutes of Health) remained the largest global contributor at US$850 million, accounting for 70 percent of total funding. Together the US government and the Bill & Melinda Gates Foundation, the largest philanthropic funder, accounted for 81 percent of all funding in 2015.
“There is now very strong momentum in research and development, and we need to expedite the development of vaccine strategies and other new, biomedical prevention options that promise to be safe, accessible and effective for use throughout the world,” said Mark Feinberg, President and CEO of IAVI. “There must be adequate and sustained investment at all stages from early laboratory research and to clinical testing if we are to truly be able to contain the HIV pandemic and approach and end to AIDS.”
This is indeed a time of great optimism for HIV prevention research. Daily oral PrEP is gaining traction as a new prevention option in an increasing number of countries; an antiretroviral-based microbicide ring that showed modest efficacy earlier in 2016 will be further evaluated to determine its viability as a prevention option for women; large-scale efficacy trials of an AIDS vaccine candidate and an injectable form of PrEP are slated to begin soon and a novel proof-of-concept trial of antibody-mediated prevention is underway in several countries. Many more promising candidates in earlier stages are progressing toward pre-clinical and clinical evaluation.
Importantly, 2015 saw increasing investment in the science of delivery – or implementation research – primarily focused on delivery of TasP interventions. Such investments will become even more important to help ensure new prevention options move quickly and efficiently into prevention programs and begin to have an impact on HIV infection rates. There is also an increasing understanding that research must understand and integrate the needs and desires of people who will eventually use new prevention options. Ensuring that the perspective of those for whom new prevention options are being developed is included from the beginning of the research process can help ensure that safe and effective products can be rolled out swiftly and be more fully accepted.
“Innovative science needs innovative funding,” said Mitchell Warren, AVAC Executive Director. “We need an expanded and more diverse global cadre of funders who will be involved in and dedicated to advancing HIV prevention R&D, including product delivery. And these investments need to ensure that new options like daily oral PrEP, and potentially the dapivirine vaginal ring, do not sit on the shelf unused because we don’t know how to effectively deliver them, and that future R&D better meets the needs and wants of those for whom products are developed.”
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 IAVI, UNAIDS, 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.
Trial Participants by Prevention Research Area, 2015
Given the higher rates of acquisition seen across so-called key populations—members of highly burdened and underserved groups—it is critical to provide access to the research process such that they can participate and reap more immediate benefit of scientific progress. Greater efforts must be made to include key populations in this crucial process for the HIV prevention response to be truly impactful.
Global HIV Prevention R&D Investments by Technology, 2000-2015
In 2015, global funding for HIV prevention R&D declined slightly, from US $1.25 billion in 2014 to US $1.20 billion in 2015. This continues a decade of roughly flat funding. The US public sector remained the largest global contributor at US $850 million, and together with the Bill & Melinda Gates Foundation, the largest philanthropic funder, constituted 81 percent of all funding.
Self-Testing is on the Map
UNAIDS’ “Fast Track” plan to end the AIDS epidemic includes a trio of targets known as “90 90 90”. Achieving the first 90 (testing) can only happen with a dramatic growth in the number of people testing their HIV status. Only about 54 percent of the approximately 37 million people with HIV around the world know their status. One way to reach this goal might be “self-testing” kits. Studies reported at the AIDS 2016 conference brought insight into how self-testing kits could work.
UNAIDS’ “Fast Track” plan to end the AIDS epidemic includes a trio of targets known as “90 90 90”—ninety percent of all people living with HIV will know their status, ninety percent of them will get effective treatment, and ninety percent of them will see the virus suppressed in their bodies… all by 2020. Achieving the first 90 (testing) can only happen with a dramatic growth in the number of people testing their HIV status. According to US Department of Health and Human services, only about 54 percent of the approximately 37 million people with HIV around the world know their status. One way to reach this goal might be “self-testing” kits, which can be used at home and yield results within twenty minutes using technology as simple as a swab and a test tube.
Studies reported at AIDS 2016 conference in Durban brought insight into how self-testing kits could work. We’ve summarized some of these abstracts and their key findings below.
Community-based distribution of HIV self-test kits: results from a pilot of door-to-door distribution of HIV self-test kits in one rural Zimbabwean community
Euphemia Lindelwe Sibanda reported on the findings of a study conducted by the Centre for Sexual Health and HIV/AIDS Research, Zimbabwe. Researchers distributed more than 8,000 HIV self-testing kits over a one-month period, door-to-door, in a rural district in Zimbabwe. People could choose to take their test with a trained community volunteer present or on their own. Participants were asked to return their used test kits to a locked drop box. Results were obtained from the used tests.
The 8,000 people who received kits represent well over half the adult population (both men and women) in the district. 85 percent declined assistance from a community volunteer and chose to take their test alone or with their partner. Sixty-eight percent of the kits were returned to the locked drop box. Researchers were able to establish HIV positive results for more than 1100 individuals (21 percent of the returned kits), and 824 of them sought follow-up services which represents 10 percent of the 8,000 who received a kit, and 15 percent of the returned kits. The study’s authors said demand for the kits exceeded supply. The authors also reported that especially high numbers of men and young people tested themselves at home.
Acceptability, feasibility and preference for HIV self-testing in Zimbabwe
Another study based in Zimbabwe also demonstrated the acceptability and desirability of self-testing. Sue Napierala Mavedzenge from RTI International presented a study of 1,000 participants, recruited from rural and urban outskirts. Of these, 70 percent opted to test themselves and 30 percent chose testing administered by a provider. At a two week follow up, 663 (95 percent) had used the home test kit, 32 individuals (5 percent) had not. Forty-seven (8 percent) had tested positive and 25 of them had sought follow up care.
Provision of oral HIV self-test Kits triples uptake of HIV testing among male partners of antenatal care clients: results of a randomized trial in Kenya
A study from Kenya suggests that self-testing could be an important tool for reaching men, who as a rule are less likely to seek testing. The Kenya study was presented by Anthony Gichangi of Jhpiego Kenya. This randomized trial followed 1,410 women who were counseled about HIV testing during ante-natal care visits. Some were provided standard care. Others were given literature about partner testing and the risk of HIV transmission from mother to child. A third group took home both literature and self-testing kits. Testing rates for the latter group (literature and a home testing kit) far surpassed the other two: 83 percent of the men in group three took the test. Only 28 percent of men from the first group, who received standard care, obtained a test. Thirty-eight percent of men responded to the literature alone. A majority of men and women who tested, including all three options, reported they took the HIV tests together.
Together these studies suggest that scaling up the availability of home test kits could spur accelerated HIV testing in countries hard hit by the epidemic. Visit here for a look at current initiatives, funded by UNITAID and implemented by Population Services International, advancing this work.
All this sounds like good news. And maybe it will be, especially if the field pays proper attention to the potential risks.
Understanding coercion in the context of semi-supervised HIV self-testing in urban Blantyre, Malawi
Wezzie Lora explored one such risk in a study conducted by the Malawi Liverpool Wellcome Trust.
In this study, fifteen heterosexual couples were interviewed on two occasions after having been provided with self-testing kits. A total of thirty men and women participated. Researchers asked if the participants experienced coercion by their partners to take the test. Some women reported feeling empowered by the option to bring a self-test home. More men than women said they felt coerced to take the test. Some of the participants rationalized coercion as sometimes acceptable or ethical, where there was history of infidelity, for example. Others characterized coercion as an “infringement of human rights,” according to the study’s authors. The study framed coercion as a culturally-informed concept and concluded that in certain contexts, under particular conditions, men and women expressed tolerance for coercion.
This raises a range of important questions about minimizing the risk of coercion in culturally appropriate ways. Details about what led women to feel empowered and how that affected their choices is important to understand. Certainly, the issue is complex—the privacy associated with testing at home may be appealing and empowering, and it may also invite coercion. What’s more, the privacy surrounding this technology might make it difficult for the field to ascertain if the net effect increases or reduces safety.
Self-testing offers the potential to quickly expand the global population who knows their status. Such a tool belongs alongside an equal imperative in the fight against HIV: an absolute commitment to protect human rights. More exploration is necessary and these studies, while leaving questions, also support that ongoing work.
Related:
Home Tests – Centers for Disease Control and Prevention
Durban 2016 Scorecard—How did it deliver?
Excerpted from Px Wire, this is a scorecard for the 2016 International AIDS Conference. Did it deliver?
Breaking the Cycle of Heterosexual Transmission
Excerpted from Px Wire, this is a novel look at how to use today’s tools to break the cycle of heterosexual transmission that was so clearly defined in a major AIDS 2016 presentation.
New Px Wire: Where did Durban leave HIV prevention?
The International AIDS Conference closed exactly a month ago today. While it lacked the pageantry of last night’s Olympics closing ceremony—which included a prime minister dressed as a video game character—the Durban wrap-up was a reminder of how important the meeting can be in framing global issues and priorities. AVAC’s new issue of Px Wire offers a look at how the Durban wrap-up catapults us into the future.
Click here to download the new issue.
And don’t miss our centerspread graphic:
- A scorecard for the conference—how did it deliver?
- A novel look at how to use today’s tools to break the cycle of heterosexual transmission that was so clearly defined in a major Durban presentation.
Prevention, Treatment and Human Rights
AVAC Executive Director Mitchell Warren and international gay rights activist Bisi Alimi dig into the tough realities of fighting HIV in 2016 in this interview, originally livestreamed from the AIDS 2016 conference in Durban.
Alimi asks Warren to make sense of scientific advances and new discoveries that are answering big questions and raising others. And Warren shows the imperative connection between prevention, treatment and human rights. Click to view.
Ighodaro spars with Bisi over some provocative questions about the role of Africa’s activists and an agenda for the future. View the video here.