emily bass aids vaccine advocacy coalition (avac) 2 july 2007 hiv prevention research and...
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Emily Bass
AIDS Vaccine Advocacy Coalition (AVAC)2 July 2007
HIV Prevention Research and Implementation: Challenges and Opportunities on the Horizon
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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.
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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
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Overview
• Prevention research – what does the future hold
• Prevention trials – what are we learning?
• Preparing for access: opportunities to learn today
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New strategies
• Treatment of HSV-2
• Pre-exposure prophylaxis
• Male circumcision (with unanswered questions)
• Microbicides
• Vaccines
• Behavorial interventions
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New types of information
• Success
• Failure
• Indeterminate results
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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
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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…
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Product/candidate Concept Trial Field Communications
Failure is/can be of the…
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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
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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
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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
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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?
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Media Headlines
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Media Articles
isiZulu Press informed by English speaking press
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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
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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
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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?
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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)
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I am surprised there is no action on male circumcision. Where are the male activists?
-- South African AIDS Researcher, 2007
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When there is a new biomedical prevention technology for use by women … will we be asking “Where are the women activists?”
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Innovative programming
Walking the walk of comprehensive prevention
Leadership from developing country governments, policy makers and communities
Where we must go…
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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
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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
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Thank you