World AIDS Day 2024: Supporting innovative research to end inequality
On this World AIDS Day, EDCTP joins partners in raising awareness of the remaining challenges in identifying and treating cases and preventing new HIV infections. One of these challenges is ensuring that HIV/AIDS prevention and care reach those who need them most, especially priority populations, such as infants, children, pregnant and lactating women, and all those who face stigma, discrimination, marginalisation, criminalisation, and other barriers to access to care.
EDCTP2 has invested €132 million to support 73 projects on HIV research, ranging from large-scale international collaborative clinical research projects implemented by African-European research consortia to grants that provide opportunities for African scientists to establish and develop their research programmes, and to lead the HIV research agenda in Africa.
Building on the work of previous EDCTP programmes, Global Health EDCTP3 continues to fund collaborative research and innovation projects tackling infectious diseases as well as supporting activities for research and capacity building in Africa. Since its launch in 2021, Global Health EDCTP3 has invested €23.8 million to support six collaborative research projects on HIV.
EDCTP-supported research on HIV/AIDS focuses on trials of innovative biomedical HIV prevention tools, strategies to reduce antiretroviral drug resistance, and research to ensure that products will reach and be used by populations with the greatest need. Other priorities include treatment optimisation for adults, children, adolescents, and pregnant women; improved diagnostics; and strategies to address the sexual and reproductive health needs of women living with and at risk of HIV.
Detecting and treating genital inflammation in women
Large numbers of women experience asymptomatic sexually transmitted infections or bacterial vaginosis (harmful alterations to the bacterial populations present in the vagina). These are not detected or treated through syndromic management but can have serious implications for reproductive health. Genital inflammation linked to these conditions also reduces the mucosal barrier, putting women at increased risk of HIV infections.
The GIFT project has developed a simple and affordable point-of-care diagnostic device that tests genital inflammation caused by sexually transmitted infections or bacterial vaginosis even if women are experiencing no symptoms. As well as ensuring that women get the immediate treatment they need, the test will also reduce the risk that women will acquire HIV infection because of undiagnosed sexually transmitted infections or bacterial vaginosis.
The GIFT team is evaluating the performance of the device across three countries in Africa – Madagascar, South Africa and Zimbabwe. Ultimately, the GIFT project aims to develop clear guidelines for implementation of the device in Africa, in consultation with national and international stakeholders, paving the way to improve the health of women in the region.
Preventing mother to child transmission of HIV
For more than a decade, the PROMISE consortium, set up with EDCTP funding, has developed a portfolio of studies addressing mother-to-child transmission of HIV in Africa. The PROMISE-ZERO, funded by Global Health EDCTP3, is carrying out implementation research in Zambia that aims to demonstrate the (cost)-effectiveness of point-of-care tests and lamivudine administration for preventing infant HIV infection as well as identifying and addressing barriers to uptake. The ultimate goal is to reach zero postnatal HIV transmission. The project builds on the success of previous studies, PROMISE-PEP and PROMISE-EPI, which were funded by earlier EDCTP programmes.
Broadly neutralising antibodies: a new approach to HIV prevention
Despite some progress, 1.5 million new HIV infections occur each year. In southern Africa, women are at particular risk of infection. In the absence of an effective vaccine, there is hope that broadly neutralising antibodies – rare antibodies that neutralise a wide range of HIV types – could offer an alternative approach to prevent infection. While the pre-emptive use of antiretroviral drugs is associated with adherence challenges linked to stigma and the need to take tablets regularly, this new approach would present individuals, especially women, with additional options to protect themselves. The goal is to manufacture large quantities of these antibodies, which could be injected and provide protection for several months.
The CAPRISA 012 study is evaluating the safety and persistence of several broadly neutralising antibodies (bNAbs). In work published in 2021, it found that two such antibodies, known as VRC07-523LS and PGT121, were safe and well-tolerated, when given individually or in combination. Both retained virus-neutralising ability after injection and showed good persistence over time, particularly VRC07-523LS. The CAPRISA 012 team is now evaluating VRC07-523LS alongside another bNAb CAP256V2LS, in a phase II study in South Africa and Zambia.
Broadly neutralising antibodies could also offer hope in preventing the transmission of HIV from mothers to infants, but they have not been studied in children or infants. To ensure that infants potentially benefit from this innovative new therapy, the PedMab project is carrying out a phase I study to assess the safety of broadly neutralising antibodies in newborn babies and to identify an appropriate therapeutic dose and combination of bNAbs in terms of potency and breadth, and timing of subcutaneous administration to prevent breast milk transmission of HIV. It will then run a phase II study on HIV-exposed but uninfected neonates.
The studies are carried out at a large site in South Africa serving a population where almost half of mothers are living with HIV. The PedMab project has been gathering essential data paving the way to large-scale efficacy trials to help accelerate the use of this promising new HIV intervention in infants.
Building African scientific leadership against HIV
Capacity building to strengthen the science base in sub-Saharan Africa is a core element of all EDCTP programmes, which have included a substantial investment in scientific leadership in Africa.
Funded by Global Health EDCTP3, the SUPPORT project is empowering the next generation of African researchers and healthcare professionals to address infectious diseases, including HIV, in children.
Building on two previous EDCTP-funded projects, EMPIRICAL and UNIVERSAL, SUPPORT is training eight early-career and five mid-career researchers from Mozambique, Uganda, Zambia, Zimbabwe, and Senegal.
EDCTP is proud that many of its fellows have gone on to assume leadership positions in African science and continue to generate high-quality research outputs on poverty-related infectious diseases, including HIV research. An overview of fellows supported by EDCTP is available on the EDCTP Alumni Platform.
Fellow profile: Dr Joseph Fokam
EDCTP Career Development Fellow Dr Joseph Fokam has generated important data on the evolution of HIV infections and the emergence of drug resistance in adolescents living with HIV. In March 2024, Dr Fokam was appointed as the Lead-Person (Permanent Secretary) of the National AIDS Control program in Cameroon. In this interview, Dr Fokam tell us how his fellowship helped him to become a leader in his field, coordinate large collaborative research studies and grow in his professional career.
Fellow profile: Dr Moleen Dzikiti
In her Career Development Fellowship, Dr Moleen Dzikiti (South Africa) conducted a study to evaluate the effects of text messaging combined with motivational interviewing versus the standard-of-care on sustaining continued breastfeeding, as well as the contribution of the combined intervention on child health and survival outcomes, among women living with HIV and their infants. We asked Dr Dzikiti how her EDCTP Fellowhsip helped her to establish herself as a research leader in maternal and child health and HIV.