40 years into the HIV pandemic and we are yet to have a vaccine. Despite the many effective prevention tools deployed, Sub-Saharan Africa (SSA) is heavily burdened by the disease as 63% of HIV diagnoses are found in women and young girls.

Speaking at the media roundtable, focused on HIV research in South Africa and the region, hosted by the Aurum Institute in collaboration with the International AIDS Vaccine Initiative (IAVI), Dr Omolara Baiyegunhi, Research Associate from the African Health Research Institute (AHRI), highlights some of the problems that arise with existing HIV preventative tools, especially in low-income settings and in countries like SA, where there is a high burden of other comorbidities like Tuberculosis (TB). 

“Where there are limited funds and systems of distribution of antiretroviral therapy medication (ARVs), access to ARVs is also limited. The coverage of people accessing this medication is not total. Having to continue with lifelong treatment also increases the risk of other diseases such as TB because of the chance of defaulting,” she says.

The need for a vaccine that can work for years is urgent so that individuals don’t have to take pills daily and risk defaulting, says Baiyegunhi.

Professor Thumbi Ndung’u, Director for Basic and Translational Science, from AHRI, agrees that existing tools against HIV such as condoms, ARVS, and PREP, are minimal and difficult to use for resource-limited communities. 

Developing HIV vaccines for Africa 

Ndung’u explains that the development of the HIV vaccine has taken a lot of time because HIV, unlike other viruses, is very diverse with many strains. This makes it difficult to make a single vaccine that can stop all the strains from causing infections in individuals. 

“ART therapy is effective in suppressing it for people who are already infected, but we don’t have very effective methods to stop the virus from infecting people in the first place for a long term, whether or not they are exposed to the risk of infection at the time.”

He emphasises the need to develop HIV vaccines for the African population, bringing government, scientists, pharmaceutical companies, and community members together to build a group with multiple disciplines and accelerate the development of the vaccines for the continent. 

“If we don’t develop the know-how of making HIV vaccines in Africa, we need to collaborate to manufacture vaccines because when other countries make them, we can easily experience issues with access and procurement as a continent,” says Ndung’u. 

HIV vaccine trials in the pipeline 

There are more than 20 HIV vaccine clinical trials that are taking place all over the world, evaluating the safety, efficacy, and immunogenicity of the vaccine delivered via Moderna’s mRNA platform. 

Dr William Brumskine, Clinical Research Site Leader from the Aurum Institute, IVAI G003 clinical trial is currently taking place in Kigali, Rwanda, and Tembisa, in SA, started in May 2022, and will conclude at the end of May. The eOD-GT8 60mer protein in the vaccines delivered in HIV-negative adults will induce immune responses in the African population, as was seen in the IAVI G002, which safely induced immune responses in 97% of recipients, who were healthy in the U.S. population of adults.  

The genetic compositions of the African population may influence the difference between how we take up vaccines in comparison to European and Asian population groups. The importance of trialling the vaccine in the African population is to ensure that when the vaccine comes to Africa, it works. 

The newly approved and recommended HIV prevention tools are the Dapivirine vaginal ring and the Long-acting injectable cabotegravir (CAB-LA). 

Currently in development at the stage of efficacy trials are the long-acting injectable and the combo oral PrEP, this dual PrEP pill is expected to be on the market by 2024. 

Targeted communication for communities 

Community Engagement Officer from IAVI, Zandile Ciko, say the approach to developing an HIV vaccine aims to centre community voices in order to address the lack of information that people have about vaccines, vaccine hesitancy, and resistance.

She refers to the importance of research preparedness in helping communities understand why a vaccine is necessary and how it can work to end the HIV pandemic. 

“Prioritising communities and involving community stakeholders in HIV vaccine research educates people and builds awareness about its importance. It is also an opportunity to provide a background and understanding of the administration of particular prevention tools and why there is low uptake.”

An arising gap that impacts the recruitment and retention for clinical trials, and the subsequent uptake of preventative tools is the inadequate communication about these in communities.

“There is a limited amount of resources invested and put into the communication about preventive tools and information about HIV. We need resources to encourage wider engagement tools, making information more accessible and spread through to different communities. Including developing community service initiatives and communication”

She says that this goes along with the need for ongoing engagement and communication that is targeted at making avenues which help communities understand why they need to participate in research and trials, what is embedded into them, and why there’s a need for a vaccine. – Health-e News