Emily Bass

AIDS Vaccine Advocacy Coalition (AVAC)2 July 2007

HIV Prevention Research and Implementation: Challenges and Opportunities on the Horizon

The Next Frontiers: 2007 and beyond

AVAC is a non-profit advocacy group based in New York and working internationally, dedicated to advancing ethical research on and implementation of new prevention technologies

The future is now! The next several years will bring a variety of scenarios that we must not encounter unprepared.

May you live in interesting times

More funding—in some settings—for existing prevention

Low coverage and uptake of these proven strategies

More new prevention technologies moving through large-scale clinical trials than ever before

More answers about potential tools to add to the tool kit of existing prevention

More challenges about how to communicate those answers and how to act on them

Overview

• Prevention research – what does the future hold

• Prevention trials – what are we learning?• Preparing for access: opportunities to

learn today

New strategies • Treatment of HSV-2 • Pre-exposure prophylaxis • Male circumcision (with unanswered

questions) • Microbicides• Vaccines• Behavorial interventions

New types of information

• Success • Failure • Indeterminate results

I read the news today, oh boy…

Vaccine for AIDS appears to work; Blacks, Asians receive the most protection• USA Today, February 24, 2003

Large Trial Finds AIDS Vaccine Fails To Stop Infection• New York Times, February 24, 2003

Firm vows to push for OK on AIDS vaccine; inoculation may help some minority groups • San Francisco Chronicle, February 25, 2003

AIDS Vaccine Trial Produces Disappointment and Confusion• Science, February 28, 2003

A clinical trial that produces a scientifically precise result. It may not be the result we had hoped for, but it answers

questions that help the field move forward. These trials need to be designed so that whether or not

any particular trial finds efficacy, it at least produces clear results.

At the very least we will know what doesn't work, and perhaps be able to analyze results to understand why.

Success is…

Product/candidate Concept Trial Field Communications

Failure is/can be of the…

2006 2008 2009

Female Barrier - Diaphragm

Male Circumcision - Susceptibility

20102007

Microbicides - Carraguard

Male Circumcision - Infectiousness

Microbicides• BG/Pro2000

• CS – 1• CS – 2

• Pro2000• TDF

Oral PrEP - IDU

HSV-2 Treatment - Infectiousness

HSV-2 Treatment – Susceptibility

Oral PrEP• MSM

• Heterosexual

2012

IndexPartner

Treatment

Vaccines -Adenovirus1Adenovirus 2

Vaccines -Prime/Boost

Community VCT and HIV

Support

Oral PrEP -West Africa

Research that Could Re-define Prevention, 9/06

See also http://www.avac.org/timeline-website/index.htm

2006 2008 2009

Female Barrier - Diaphragm

Male Circumcision - Susceptibility

20102007

Microbicides - Carraguard

Male Circumcision - Infectiousness

Microbicides• BG/Pro2000

• CS – 1• CS – 2

• Pro2000• TDF

Oral PrEP - IDU

HSV-2 Treatment - Infectiousness

HSV-2 Treatment –

Susceptibility

Oral PrEP• MSM

• Heterosexual

2012

IndexPartner

Treatment

Vaccines -Adenovirus1Adenovirus 2

Vaccines -Prime/Boost

Community VCT and HIV

Support

Oral PrEP -West Africa

Research that Could Re-define Prevention, 12/06

See also http://www.avac.org/timeline-website/index.htm

See also http://www.avac.org/timeline-website/index.htm

Research that Could Re-define Prevention, 7/07

2006 2008 2009

Female Barrier- Diaphragm

Male Circumcision - Susceptibility

20102007

Microbicides – Carraguard

Male Circumcision - Infectiousness

Microbicides• BG/Pro2000

•Pro2000• TDF

Oral PrEP - IDU

HSV-2 Treatment - Infectiousness

HSV-2 Treatment –

Susceptibility

Oral PrEP• MSM

• Heterosexual

2012

IndexPartner

Treatment

Vaccines -Adenovirus-1Adenovirus-2

Vaccines -Prime/Boost

Community VCT and HIV

Support

Oral PrEP -West Africa

Microbicides – CS-1

CS-21

Community is key • Advising – trial sites and staff through

community advisory mechanisms • Advocating – for proven prevention and

existing strategies • Translating – what do research results

mean; what are implications of findings in one arena on activity in another

• Assessing – what are priorities in your community?

Media Headlines

Media Articles

isiZulu Press informed by English speaking press

The Marathon: What do we still need to learn? Maintaining momentum and support for next generation studies and operational research

The Triathlon: What else is happening? Ongoing analysis of the broader context of prevention research and implementation

The Relay: What needs to happen next? Swiftly and effectively translating results into action when there is a positive finding

Acting on research results

How good is good enough?

Who will get new prevention tools – and when?

Who will pay for them?

What will the new standard of prevention & care be generally and in the context of other clinical trials?

Will we still be able to develop other new technologies?

Blurring lines

New promises, new challenges

Passing the baton: Opportunities to learn today

• HPV vaccine – Delays in clarity around access: One year after

licensure, no clear statement on cost in developing countries

– Pharma companies identify need for clearer ‘demand’ – Is this a priority for communities? – Can we make make ties between different fields? – How do we build platforms that reach our adolescent

girls?

Passing the baton: Opportunities to learn today

Male circumcision Do communities and key leaders “believe” the results? Do activists, advocates, policy makers and others feel

the new intervention is a priority that “fits” within their agendas?

Is the new strategy seen as a threat: to human and financial resources for other proven prevention; to specific groups’ needs (women versus men, eg); to paradigms (biomedical, structural, behavioral)

I am surprised there is no action on male circumcision. Where are the male activists?

-- South African AIDS Researcher, 2007

When there is a new biomedical prevention technology for use by women … will we be asking “Where are the women activists?”

Innovative programming

Walking the walk of comprehensive prevention

Leadership from developing country governments, policy makers and communities

Where we must go…

Leadership can mean

• Advocating for proven prevention • Sharing information about experimental options • Volunteering for a trial • Serving on a community advisory board • Talking to your neighbor or your health provider

or your MP or your daughter, son, mother, aunt • Advocacy to research entities, local and national

government, NGOs, and other key decision makers

Managing expectations – Under promise– Over deliver

Delivering what we have today Striving for more and better options for

tomorrow It’s not the result – it is what we do with it!

Challenges Beyond the Horizon

Thank you