International AIDS Society launches HIV research agenda for women and children

A consensus statement designed to address key gaps in clinical and programme knowledge that hinder access to effective HIV prevention, treatment and care for women and children was issued today by the International AIDS Society together with 15 other leading public and private sector organisations.

Asking the Right Questions: Advancing an HIV Research Agenda for Women and Children was released to coincide with International Women’s Day with the theme of: “Equal Rights, Equal Opportunities: Progress for All” the Agenda comprises 20 specific recommendations to expand and improve responses to the HIV-related challenges facing women and children worldwide.

Women and children, according to UNAIDS, represented a majority of the estimated 33.4 million people living with HIV in 2008.

“HIV is the leading cause of death among women of reproductive age, and the leading cause of child death in many African countries, yet women and children are often either overlooked completely or folded into general responses to HIV,” said Robin Gorna, Executive Director of IAS.

“This agenda defines priority research needed to greatly improve our knowledge about and capacity to prevent and treat HIV in women and children. Implementation of this research agenda is key to closing these knowledge and service gaps, and to saving women’s and children’s lives.”

Planning to create a research agenda, ‘based on the most current scientific evidence and expert advice, which would answer outstanding priority knowledge and gaps in clinical and programme management relevant to the unique needs of women and children IAS’s Industry Liaison Forum (IAS-ILF) began an extensive consultative process in February 2009.

It involved an expert-led mapping exercise and literature review followed by a multi-stakeholder consultation with investigators, clinicians and civil society and UN agencies held in conjunction with the 5th IAS Conference on Pathogenesis, Treatment and Prevention in Cape Town in July 2009. Complete details on the process as well as the full research agenda can be found at: www.iasociety.org/ilf.aspx.

The Agenda identifies high priority research questions that cover four broad categories:

• Clinical research on prevention of mother-to-child transmission (PMTCT) and paediatric treatment.
• Clinical research on treatment issues for women.
• Operations research for women.
• Operations and implementation research related to PMTCT, including paediatric care, treatment and support.

Recommendations in this fourth category were developed by a parallel consultative process led by UNICEF and included the Interagency Task Team for PMTCT including the World Health Organization, UNAIDS and U.S. agencies in collaboration with George Washington University (GWU) and the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF). Details of this process will be available online at www.unicef.org and www.pedaids.org.

Three guiding principles are suggested for the first three categories: increased investment in research to address the challenges, extensive and better sharing of data from existing studies related to HIV in women and children, and increased efforts to disaggregate clinical data by sex to ensure opportunities for gender-based analysis.

Strategies outlined in the Agenda address issues that include:

• Barriers to developing paediatric formulations of HIV treatments
• The impact of interventions for TB, malaria and malnutrition on antiretroviral dosage
• The impact of exposure during pregnancy to antiretrovirals on uninfected children
• Optimal weight-adapted parameters for starting and stopping antiretroviral therapy in children
• The impact of female hormone changes on treatment outcomes for women and adolescent girls
• The impact of periodic antiretroviral exposure through vertical transmission prophylaxis on future maternal treatment choices
• Barriers to antiretroviral treatment access for women and girls.

The endorsing organisations commit to working together to put the Agenda into practice.

In addition to the IAS the consensus statement is endorsed by multilateral institutions, international civil society organisations and pharmaceutical industry leaders including: amFAR, The Foundation for AIDS Research; AVAC, Global Advocacy for HIV Prevention; Boehringer Ingelheim; Clinton Health Initiative (CHAI); Coalition on Children Affected by AIDS (CCABA); Elizabeth Glaser Pediatric AIDS Foundation; European AIDS Treatment Group (EATG); International Community of Women Living with HIV/AIDS (ICW); International Treatment Preparedness Coalition (ITPC); Merck; Treatment Action Group (TAG); UNAIDS; UNICEF; ViiV Healthcare and WHO.