Advances in both clinical research and prevention science have led to a significant reduction in HIV transmission globally. UNAIDS ambitious goal of achieving “90-90-90” targets by 2020 calls for 90% of people living with HIV to know their status, 90% of those diagnosed to receive sustained ART and 90% of those on ART to have viral suppression. One or two strategies will not be effective in reducing the HIV/AIDS pandemic to the realization of the AIDS Response in the 2030 Agenda for Sustainable Development.
Women continue to be infected with HIV at alarmingly high rates especially in sub-Saharan Africa where women constitute nearly 60% of adults living with HIV/AIDS. A range of effective, affordable and widely available prevention products are needed because no single approach will meet all women’s needs or get the epidemic under control considering that prevention should always include a combination of biomedical, behavioral and structural strategies.
WACI Health and other network partners at the Conference on Retroviruses and Opportunistic Infections Photo credit: WACI Health
The annual Conference on Retroviruses and Opportunistic Infections (CROI 2018) held between the 4th to the 7th of March 2018 at Hynes Convention Center in Boston, Massachusetts brought together top basic, translational, and clinical researchers from around the world to share the latest studies, important developments and best research methods against HIV/AIDS and related infectious diseases. The preliminary findings of HIV Open Label Extension (HOPE) and DREAM studies of the dapivirine vaginal ring were released showing 90% of women who used the ring at least some of the time had an estimated 50% reduction in the HIV acquisition.
The ring is designed to provide women with a discreet and long-acting HIV prevention option. The interim analyses of DREAM announced at CROI 2018 showed an increase in ring use over its parent Phase III study – more than 90% of women participants used the ring at least some of the time. Analyses also suggest that the overall HIV incidence rate among women in DREAM is 54% lower than would be expected without use of the dapivirine ring based on statistical modeling. This finding has important limitations due to the lack of a placebo comparison group in the open-label study (meaning that all participants know they are using the active product). Interim data from a parallel open-label study of the ring called HOPE, led by the US National Institutes of Health-funded Microbicide Trials Network (MTN), reported nearly identical results at CROI. “DREAM suggests so far that when women know that the dapivirine ring has helped lower HIV risk in clinical trials, they are more likely to use it and see higher levels of protection,” said Dr. Zeda Rosenberg, founding chief executive officer of IPM. “We are encouraged by these interim findings because more than 35 years into the epidemic, women still lack the range of practical options they need to protect themselves against HIV.”
We have made tremendous progress in the AIDS epidemic. However, this progress is not assured because of several factors among them declining funding. Governments and donors must continue to prioritize the allocation of funding for HIV programming, life-saving treatment, prevention, research and development for new health technologies which will inform an essential part of the solution to HIV.
New vaccines, microbicides, drugs, diagnostics, and other health technologies are needed in the face of many emerging threats for communities to have multiple tools that protect them especially those who are at highest risk of becoming infected with HIV for instance adolescent girls and young women. Multipurpose prevention technologies (MPTs) most of which are still experimental designed to address two or more sexual and reproductive health concerns simultaneously for example, combining protection against unintended pregnancy and sexually transmitted infections to be made available.
Ending HIV by 2030 requires collaboration across sectors, supportive policies that do not lock people out of care and support, health systems strengthening above all communities taking center stage and the commitment to not leave anyone behind – including adolescent girls and young women.