Turning the Corner on the HIV/AIDS Pandemic—Refining the Science-Driven HIV Clinical Research Enterprise

By Carl W. Dieffenbach, Ph.D., director, Division of AIDS, National Institute of Allergy and Infectious Diseases, National Institutes of Health

February 7, 2017

Since the beginning of the HIV/AIDS pandemic, the National Institutes of Health (NIH) has advanced understanding of disease mechanisms and used basic science to create opportunities for the discovery, development, and clinical evaluation of novel prevention and treatment strategies. With this approach, the scientific community has created an array of effective tools to treat and prevent HIV infection. Over the last 30 years, these interventions have been made better and safer. We now have many of the tools to begin to draw this pandemic to a close, although significant challenges remain in delivering treatments and methods of prevention to the people who need them most.  

Despite significant progress, we still need innovations to push past these remaining obstacles. Over the next 3 years, NIH will refine its science-driven HIV research enterprise to deliver the innovations needed to turn the corner on the HIV/AIDS pandemic.

NIH funds a significant portion of HIV clinical trials through cooperative agreements. These networks have a strong track record of success. Indeed, one hallmark of HIV research is the rapid advances in scientific knowledge that help move technologies and tools from basic research into clinical practice. We have advanced the science beyond what we could have imagined in the early days of the pandemic, developing safe and effective anti-HIV treatments that require only one pill a day, discovering pre-exposure prophylaxis to prevent HIV infection, virtually eliminating perinatal and breastfeeding HIV transmission, developing long-acting technologies for HIV prevention and treatment, and investigating sex-specific methods of HIV prevention.

Every 7 years NIH competitively renews its funding of the HIV clinical research networks operating in the United States and internationally. Given the pace of discovery in the HIV field, 7 years can see significant changes in research priorities. The current agreements supporting the existing network structure are set to end in 2020. NIH is taking a proactive approach to refining the research enterprise and driving HIV discovery. By establishing a forward-looking agenda to guide this process, NIH will determine the focus and priorities of its HIV clinical trial networks through 2027. The best science has always guided the direction of our research investments, and stewardship of taxpayer dollars and safety of clinical trial participants will continue to be our highest priorities.

While the current network model historically has served only HIV research, the new structure will create a pool of interoperable sites that can address outbreaks of infectious disease. This new structure will use a fee-for-service model and will be scalable to allow for flexibility and rapid response to the threat of new and emerging infectious diseases, similar to the recent global disease outbreaks caused by Zika and Chikungunya viruses.

We begin the renewal process this month, embarking on conversations with stakeholders from all sectors. Together with the research community, NIH will define the questions that will drive the next wave of HIV innovation, and set in motion the process by which we may seek answers to those questions.

The research community has a critical role to play in this effort. We want to hear from you; stakeholder input on scientific direction, function and structure of networks and trials is vital to our shared success. To facilitate this conversation, we will make information available online, and would like to answer any questions you may have. Please share your questions and comments at NIAIDNetworkRefinement@mail.nih.gov.

We look forward to the conversation.

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