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World AIDS day 2016: EDCTP’s strategy for funding research on HIV

1 December 2016

According to the AIDS by numbers 2016 report from UNAIDS, huge progress has been made in the fight against HIV since 2000, and millions of lives have been saved. But much still needs to be done. Now in its second programme, the European & Developing Countries Clinical Trials Partnership has set out its funding priorities to help end the HIV epidemic as a public health threat.

EDCTP focuses on some of the greatest areas of unmet medical needs in sub-Saharan Africa that includes HIV, as well as tuberculosis, malaria, the neglected infectious diseases, diarrhoeal diseases, lower respiratory tract infections, and emerging and re-emerging diseases.

EDCTP’s priorities for HIV

Although effective antiretroviral therapy (ART) is now available, optimised treatment regimens and formulations are required for key groups, such as children, pregnant women, and adults with co-infections and co-morbidities.

Multiple challenges in HIV management need to be addressed, from timely diagnosis and initiation of ART to retention in care. Given the availability of therapeutic options, product-focused implementation research to enhance access to evidence-based interventions is a high priority.

The number of new HIV cases remains stubbornly high, emphasising the urgent need to assess innovative methods of prevention, including microbicidal products, ARV-based interventions and, ultimately, HIV vaccines.

EDCTP second programme: funded research on HIV

Since the start of the second programme in December 2014, EDCTP has supported 4 grants on HIV, which amounts to over € 4 million in funding. The portfolio includes projects that focus on the treatment and diagnosis of HIV with other co-infections.

Findings of the REMSTART study, funded under the first EDCTP programme, presented a new approach to caring for patients with advanced HIV. Following from the positive results, the TRIP study received funding under the second EDCTP programme to assess the approach used in the REMSTART study on a larger scale trial in urban and rural settings in Tanzania. The TRIP study led by Dr Sayoki Godfrey Mfinanga (National Institute for Medical Research, Tanzania) aims to determine the feasibility of scaling up the TRIP intervention in routine health care and to inform and refine guidelines on HIV services for patients with advanced HIV. It will also determine the cost effectiveness of the TRIP intervention in reducing death in patients with advanced HIV in real health care settings when implemented on a large scale. Moreover, the study will compare differences in effectiveness of the REMSTART and TRIP interventions.

The DREAMM project, led by Dr Angela Loyse (St. George’s University of London, UK), is a multi-centre study that aims to evaluate a semi-quantitative cryptococcal antigen lateral flow assay (CrAG LFA) developed by the Pasteur Institute, France. This test will identify at diagnosis HIV patients with cryptococcal meningitis with high CrAg titres. These patients may benefit from a more aggressive or prolonged antifungal therapy. CrAg LFA testing is embedded within an algorithm that strengthens health systems for patients with HIV-associated central nervous system (CNS) infection. It aims to reduce time to diagnostic tests such as lumbar puncture, as well as the time to the patient starting effective treatments.

The Stop TB/HIV at One, led by Professor Luis Cuevas (Liverpool School of Tropical Medicine, United Kingdom) proposes to develop rapid diagnostic approaches for tuberculosis (TB) that facilitate the initiation of appropriate treatment the same day of consultation.

The project will evaluate simple, rapid diagnostic tools for TB that are emerging. It will also evaluate combinations of diagnostics that maximise the sensitivity and specificity to accurately diagnose TB within a health systems context. The goal is not only evaluate the diagnostic performance of the test, but also the impact on patient outcomes, and within real-life government settings with diagnostics employed in field conditions.

Professor Janneke van de Wijgert (University of Liverpool, United Kingdom) leads the WISH project that will take advantage of the HIV prevention and sexual and reproductive health (SRH) capacity that the non-governmental organisation Rinda Ubuzima (RU) has built during the first 10 years of its existence to formalise its role as an HIV prevention/SRH research and training centre in Rwanda; to demonstrate to and with stakeholders (including policymakers of the Ministry of Health, teaching staff of the College of Medicine and Health Services of the University of Rwanda, and representatives of other HIV/SRH care organisations in Rwanda) that it is feasible and affordable to improve SRH services in high-risk women using results from previous RU studies; and to engage the stakeholders in discussions about potential adaptations of the Rwanda STI treatment guidelines, opportunities for better integration of vertical HIV and SRH programs, and potential roll-out of novel vaginal microbicides and multipurpose prevention technologies for HIV and pregnancy prevention as soon as efficacious products become available.