Treatment as Prevention

There is increasing evidence of the value of ART in prevention of HIV. Beginning in 2010, the prospective cohort analysis of serodiscordant couples in the Partners PrEP study showed a 92 percent reduction in infection. Then, in 2011, results of the randomized clinical trial, HPTN 052, showed that immediate treatment and sustained adherence for healthy HIV-positive sexual partners with high CD4 counts reduced risk of transmission to their HIV-negative sexual partner by 96 percent and lowered TB infection rates in the HIV positive partner. These results, and the important WHO, Swiss and Canadian consultations on treatment as prevention that preceded them, have laid the groundwork for an increase in treatment as prevention R&D.

Total global investment in treatment as prevention R&D in 2011 was US$79.4 million. Public-sector agencies from the US provided a significant portion of the funding with US$43.7 million coming from the NIH and an estimated US$11.3 million for combination prevention coming from PEPFAR. Canada provided a significant amount of funding, with CIHR investing US$2.0 million and the government of British Columbia investing an estimated $12.0 million. European funding came from France’s ANRS, the UK’s NIHR and MRC, SIDA, the Dream Fund of the Dutch Postcode Lottery and the Swiss-based Médecins Sans Frontières (MSF).

The majority of philanthropic funding comes from the BMGF, the Dream Fund of the Dutch Postcode Lottery, the Wellcome Trust and MSF. Clinical trials, sponsored by STOP AIDS/Clinton HIV AIDS Initiative (CHAI) in Swaziland, are being funded by the Dream Fund of the Dutch Postcode Lottery.

While there is no direct commercial investment in treatment as prevention R&D, a substantial amount of ARV drugs have been donated for clinical trials. In HPTN 052, for example, study drugs were donated by Abbott Laboratories, Boehringer Ingelheim, Bristol-Myers Squibb, Gilead Sciences, GSK and Merck & Co.