HIV prevention research needs to be coordinated
HIV prevention research was responsible for the recent revelation that male circumcision can play an important role in protecting men from infection with the deadly virus. But according to a new study funded by an independent coalition of public and private sector scientists and public health leaders, research is hampered by gaps in some areas of research and duplication in others. The group recommends the establishment of a neutral body to set priorities for research and promote collaboration without undermining the flexibility needed for scientific endeavor.
"The rate of new HIV infections threatens to dwarf whatever progress has been made in improving treatment in recent years," said Veronica Miller, PhD, director of the Forum for Collaborative HIV Research, which is based at George Washington University's School of Public Health and Health Services in Washington DC. "This obligates the prevention research community to pull together, consolidate individual agendas, and prioritize according to what is most likely to succeed and can be realistically implemented."
The new report, entitled A New Era for HIV Prevention?, arrives at a pivotal time for HIV prevention research. Results from some interventions, such as male circumcision, are showing great potential to lower the risk of infection. Meanwhile, an estimated 4.3 million people become newly infected with HIV each year.
Today, there are a number of promising HIV prevention interventions actively being studied, including male circumcision, microbicides, female-initiated barrier methods, HSV-2 treatment, pre-exposure prophylaxis, and treatment of the index partner, in addition to vaccines. Forum leaders remain optimistic that many of these interventions - either on their own or in combination with something else - will turn out to be powerful tools to fight HIV infection. With multiple lines of HIV prevention intervention research approaching Phase III studies, Forum leaders say the HIV prevention research field will need to find ways to:
- Support the sustainable capacity of clinical trial sites;
- Fill gaps in scientific knowledge;
- Promote coordination among researchers and donors without stifling innovation;
- Engage host communities to take ownership of clinical trials;
- Prepare for effective global delivery of prevention interventions.
"You are going into a community where you have to find people who are not yet infected but who are willing to be tested and participate in clinical trials. Unless there is community ownership, it is not going to happen," says Miller.
The group recommends creation of a neutral planning mechanism, which could set priorities for research and promote collaboration without undermining the flexibility needed for scientific endeavor. Such a planning organization would attempt to reach out to a diverse group of stakeholders, including vaccine researchers, and would facilitate design and testing of combination products, share information, connect donors and stakeholders, fill knowledge gaps, reduce duplication in the research agenda, and make recommendations for choices regarding use of scarce resources.
"This is an exciting time for HIV prevention research - we have more promising leads for effective new prevention tools than ever before. All those involved, from researchers to community leaders, must work together to accelerate this urgently needed research," says Nicholas Hellmann, MD, interim director for HIV and TB at the Bill & Melinda Gates Foundation.
"This report answers the question of what we will need to do to enhance the next steps for research," says Ward Cates, MD, president of research at Family Health International and co-chair of the Biomedical Interventions HIV Prevention Working Group. "The field of HIV prevention is just like all other fields of research. It's a continual work in progress that needs coordinated oversight to optimize the outcomes."