World AIDS Day 2012: Sharing responsibility to keep the promise
The world has promised to stop AIDS by 2015. There is remarkable progress in the reduction of rate of new HIV infections across many countries including in Africa, the region most affected by the disease. Nonetheless the total number of new HIV infections remains high. In 2011 alone 2.5 million new cases were reported. The World AIDS Day theme for 2012 is Zero AIDS-related deaths. It falls under the broader campaign of Getting to zero: zero new HIV infections. Zero discrimination. Zero AIDS-related deaths that runs from 2011 until 2015. This year’s World AIDS day theme appropriately emphasises sharing responsibility in spending on health and HIV. It calls for all governments to join forces and act now. It calls for governments to honour their promises.
In the Abuja Declaration (2001), African Heads of States committed to lead from the front of the battle against HIV/AIDS, tuberculosis and other related infectious diseases, and to step up the improvement of their health care systems to assure greater access to HIV/AIDS treatment and prevention. They also pledged to support the development of HIV vaccines that were suitable and affordable for Africa. Progress is seen in the domestic investments in HIV/AIDS. The recently published UNAIDS World AIDS Day Report: Recent results shows that many countries have assumed a greater role in funding their own response. The report also shows significant gains that have been achieved. For example, since 2009, the number of new HIV infections in children dropped by 24% as a result of increased availability of antiretroviral and infant feeding–based prevention services to those who need them. In 2011, 59% of HIV-positive pregnant women received antiretroviral therapy.
The European & Developing Counties Clinical Trials Partnership (EDCTP) has contributed to the fight against HIV/AIDS through partnerships between European institutions and researchers and their African counterparts in collaboration with the pharmaceutical companies and like-minded organisations. Since 2003, EDCTP has invested € 70.35 million to fund 50 clinical research projects on HIV/AIDS, including substantial capacity upgrade at clinical sites, in 23 sub-Saharan Africa countries.
EDCTP funded nine grants on HIV/AIDS treatment, totalling € 23.3 million. The CHAPAS-1 trial in Zambia is a successful example. The trial contributed to the FDA approval and WHO prequalification of Triomune Baby/Junior, a fixed-drug combination formulation for the treatment of HIV in children. This has made it possible for the drug, which is now widely used in Zambia, Uganda and Zimbabwe, to be made available under programmes such as the US President’s Emergency for HIV/AIDS Relief (PEPFAR) and the Clinton HIV/AIDS Initiative (CHAI). The study findings also contributed to the WHO recommendations on the optimal drug ratios in fixed-drug combinations and on weight band dosage for antiretroviral in children worldwide.
In the area of prevention of mother-to-child transmission of HIV/AIDS EDCTP spent € 5.7 million to fund four projects. Distinguished among these was the study cofunded by EDCTP on the impact of Highly Active Anti-Retroviral Therapy (HAART) during pregnancy and breastfeeding on mother-to-child transmission (MTCT) of HIV – the Kesho Bora study. The study strongly influenced the revised WHO guidelines on prevention of MTCT of HIV and infant feeding.
In 2006, the Bill & Melinda Gates Foundation and EDCTP launched a joint call for proposals to support projects for developing capacity to conduct large phase IIb and III clinical trials of preventive vaccines in Africa. Six projects with a total grant value of € 17.2 million were funded via this call. Among these HIV vaccine capacity building projects are safety and immunogenicity studies to optimise responses to HIV vaccines using an innovative DNA priming and MVA boosting strategy (HIVI and TaMoVac) conducted in Tanzania and Mozambique. These studies are evaluating one of the most promising HIV vaccine candidates arising from the Europe-Africa collaboration.
Other projects in the EDCTP HIV/AIDS portfolio include clinical trials investigating the safety of combined antiretroviral and anti-tuberculosis treatment in individuals with HIV-TB co-infection; projects to build capacity for conducting phase I/II and phase III clinical trials of microbicides for the prevention of HIV; and 20 Senior Fellowships.
The first phase of EDCTP funding ends in June 2015 and EDCTP is preparing for the launch of its second phase that will run from 2014 to 2024. The second programme will continue to support research to fight HIV/AIDS in sub-Saharan Africa. It will also continue to support the strengthening of research capacity, ethics review and the regulatory environment in Africa, essential to carrying out clinical trials. Nevertheless, for these activities to bear fruit commitment at all levels is still needed. Political leaders, scientists, members of the civil society and all those in a position to influence or make decisions and policies must share responsibility to keep the promise in achieving zero AIDS. The goal is to win the battle against the disease. It can be realised through strong partnerships. A world with zero AIDS-related deaths will be possible when we all work together to ensure this promise will be fulfilled.
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