EDITORIAL: Biomedical HIV Prevention Research and Development in Africa

Olukayode A. Dada

Abstract

The research and development process for new HIV prevention technologies is a global enterprise and most parts of Africa, have been actively involved in the identification and development of effective methods. The new tools for HIV prevention currently under development include vaccines, topical microbicides such as gels, creams and foams that can be applied to the vagina or rectum prior to sexual intercourse. Male medical circumcision, the use of antiretroviral drugs to prevent acquisition of HIV infection (pre-exposure prophylaxis - PrEP), and the use of antiretroviral drugs to reduce transmission of HIV infection (Treatment as prevention – TasP) have also proven to be effective1.

In November 2013, the New HIV Vaccine and Microbicide Advocacy Society (NHVMAS) of Nigeria, in collaboration with the World AIDS Campaign (WAC) and the Institute of Public Health, Obafemi Awolowo University, Ile-Ife Nigeria, convened an international gathering of community activists and advocacy groups, scientific investigators and donors to review the progress as well as the obstacles to progress, in the global endeavour to achieving biomedical HIV prevention. The 2013 Biomedical HIV Prevention Forum (BHPF), the first of a series of conferences on biomedical HIV prevention research and development in Africa, took place in Abuja, from November 18 – 20, 2013.  It provided a much valued forum for international and regional researchers, programme managers, policy makers, advocates and stakeholders to share insights on the current biomedical prevention research agenda and recent findings, policy and programme implications which it is hoped,  will inform policy formulation, policy review and programme implementation globally. 

NHVMAS is committed to advocacy for the ethical conduct of research and the roll-out of scientifically proven HIV prevention strategies and methods that are acceptable for use by different populations around the world to combat the HIV/AIDS epidemic. 

Currently available research-based prevention strategies have already contributed to the maintenance of low infection rates in a number of settings and to declining HIV epidemics in specific populations around the world. However, in resource-constrained countries, particularly in Africa, novel prevention strategies are needed for reducing new infections where there is limited access to health care and affordable antiretroviral drugs. These must be based on ethical conduct of research, clinical trials and programmatic interventions, to ensure that the most infected and affected populations are served in the most humane and equitable ways possible.

This special edition of the African Journal of Reproductive Health includes 14 publications from the presentations at the meeting. These cover a comprehensive range of issues including discussions on promising biomedical and behavioural HIV prevention interventions in clinical trials and effective ways to translate new knowledge into practice. The necessity for concerted efforts to end the HIV epidemic was echoed at the end of the meeting with a call by the Civil Society coalition made to African governments to prioritize HIV prevention and development in the post 2015 health agenda for the region.

Civil Society Call to African Governments at the 1st Biomedical HIV Prevention Forum, 18-19 November 2013. Abuja, Nigeria:   Conference Communique 

There have been exciting developments in HIV prevention research and treatment in the last 3 years. For the first time clinical trials of AIDS vaccine, microbicides and pre-exposure prophylaxes showed encouraging levels of efficacy in clinical trials. With the striking success of the HPTN 052 trial, early initiation of antiretroviral (ARV) treatment seems poised to join condoms, partner reduction, clean needles and voluntary medical male circumcision in the toolbox of comprehensive combination prevention. However, there have been challenges as well. In 2011, for example, the VOICE trial was unable to confirm the CAPRISA finding that a tenofovirbased vaginal microbicide gel could protect women from infection. The Fem-PrEP trial results were also disappointing: the study found that preexposure oral ARV prophylaxis (PrEP) that worked very well in MSM appeared ineffective for heterosexual women.

The successes and setbacks of the last three years will inevitably lead to more, and more complicated, HIV prevention research and demonstration projects taking place in Africa. It will also prompt increased national and regional dialogue about the potential benefits and risks of new prevention modalities and how they might best be deployed in country-specific settings. ‘Getting to Zero’ will depend on expanding antiretroviral treatment and proven HIV/AIDSprevention tools to all people that need them. In this regard investing in research and development of prevention tools that are appropriate for populations at high risk of HIV infection such as sex workers and men who have sex with men is of great importance.

Now more than ever, political will and commitment, illustrated through allocation of adequate resources and bold action, is needed to ‘Get to Zero’ in Africa.

Therefore, at the 1st Biomedical HIV Prevention Research Forum we call on African governments to accelerate the realization of health MDGs and the achievement of an AIDS-free generation in Africa by ensuring the following:

 We are a coalition of civil society organisations delivering programmes and advocacy in Africa on HIV, health, and broader development agenda, and we have come together around the 2013 Biomedical HIV Prevention Forum (BHPF) to demand that HIV prevention research and development be prioritized. 

  1. Allocate at least 15% of national budgets to health/step up domestic resource mobilization.
  2. Increase funding for R&D; allocate at least 2% of national health expenditure and at least 5%

of external aid for health projects to research and research capacity building (as per Algiers and Bamako declarations).

  1. Accelerate R&D of HIV prevention tools such as preventive vaccines, microbicides, drugs for treatment and for prophylaxis; improve delivery and regimens of proven tools such as condoms, medical male circumcision, PreExposure Prophylaxis and Treatment as Prevention (TasP).
  2. Proactively develop policies and agreements on intellectual property that will accelerate access to and delivery of newly found efficacious products for treatment and prevention.
  3. Create opportunities for sharing expertise and lessons learned from research conducted locally since countries in the region experience similar social challenges that drive the pandemic.

In return, African civil society organisations involved in HIV prevention research and development are committed to implementing the following strategic actions:

  1. Mobilising communities to access services and contributing to the provision of prevention, treatment, care and support services.
  2. Promoting human rights and access to essential medicines for all by advocating for rights and evidence-based policies on health and for mechanisms to strengthen health systems in Africa.
  3. Acting as a watchdog to ensure accountability, good governance and more efficient management of programmes and resources for all stakeholders, including civil society organisations; and 

Encouraging governments, citizens, development partners and the private sector to contribute significantly to funding health and research and development interventions

Full Text:

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References

Folayan MO, Gottemoeller M, Mburu R, Brown B. Getting to zero the biomedical way in Africa: outcomes of deliberation at the 2013 Biomedical HIV prevention forum in Abuja, Nigeria. BMC

Proceedings 2014; 8(Suppl 3): 51 doi: 10.1186/17536561-8-S3-S1.

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