Episode 7 - IAS initiatives and Conferences on HIV Pathogenesis and Treatment
The Industry Liaison Forum
(ILF) was established in 2001, and retains a strong profile at the IAS today. The goal of the ILF is to accelerate scientifically promising, ethical HIV research in resource-limited countries with a particular focus on the role and responsibilities of industry as sponsors and supporters of research. Led by an advisory group of senior clinicians and public health experts from both industry and academia, it published one of the first post-trial care guidelines in 2003; more recently, it addressed ethical, operational and scientific issues related to PrEP clinical research.
The burgeoning area of biomedical prevention research involving the use of approved antiretrovirals has been dogged by controversy, and several Phase III trials in Cameroon, Cambodia, Malawi and Nigeria were suspended due either to ethical concerns or to the lack of a research infrastructure capable of managing the large cohorts required to establish efficacy in HIV prevention trials. The ILF held several meetings and hosted satellites at both AIDS 2006 and IAS 2007, examining the issue from a variety of perspectives, including civil society, trial sponsors, investigators and industry. The ILF work dovetailed with other work that the IAS undertook on behalf of the Bill & Melinda Gates Foundation to convene a series of multi-stakeholder meetings in an effort to come to consensus on some of the issues and move forward on both a policy and operational level to ensure this research goes forward in a way that meets the highest ethical standards.
The IAS has also delivered a number of education programmes outside of the conferences. The first of these was Share – an Education Programme in HIV Clinical Care, which started in 2001. Share was an important initiative at a time when antiretroviral treatment access was extremely limited in developing countries, and experience with antiretroviral drugs almost non-existent. Working with a number of international collaborators, IAS used a “train the trainer” approach, training senior clinicians on HIV clinical care using the new ARVs. They in turn trained clinicians through national and regional training programmes, developing a cadre of knowledgeable health care professionals that helped prepare countries for the scale-up of treatment programmes in 2003 and beyond. The programme ended once training programmes began to expand regionally and nationally to support developing country clinicians to provide ARV therapy.
Conferences on HIV Pathogenesis and Treatment
The 1988 IAS by-laws included a commitment to organize small specialty conferences and workshops in addition to the large International AIDS Conferences; the opportunity to begin organizing these conferences emerged once the larger conferences were shifted to a biennial schedule. The IAS Conferences on HIV Pathogenesis and Treatment focus on basic science and biomedical issues, including novel therapeutics, side-effect profiles, simplified drug regimens, drug resistance and strategies for increasing patient adherence. The conferences also deliver continuing medical education and address emerging clinical trial issues, including trial design and ethical issues.
Pedro Cahn chaired the first IAS Conference on HIV Pathogenesis and Treatment in Buenos Aires in 2001. The conference attracted about 3,300 participants, including more than 600 participants who were supported by the conference’s scholarship programme. The success of the conference provided the foundation for the 2003 conference in Paris, which attracted more than 5,000 participants, and for the 2005 conference in Rio de Janeiro, where biomedical prevention science was added to the programme, in recognition of a research field growing rapidly in size and importance.
By the time the IAS was organizing the 4th IAS Conference, now referred to as the IAS Conference on HIV Pathogenesis, Treatment and Prevention (IAS 2007), in Sydney, billions of dollars in new financing for AIDS were being allocated to low- and middle-income countries through multilateral, bilateral and private foundation programmes; treatment coverage alone had risen from 400,000 in 2003 to more than 2 million by the end of 2006, or 28% of those in need. With scale-up came new challenges and questions about how to best implement the public health approach to delivering a range of HIV treatment, care and prevention interventions using the standardized population-based approach recommended by WHO for maximizing treatment coverage.