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Meet Grace, Denise, and Sarah. At age 21, Grace is a single mother of two living in South Africa. Because her children need routine check-ups and immunizations, Grace frequently sees pediatricians and nurses, but rarely visits doctors for her own health needs. In Namibia, 19-year-old Denise is a first-time mother. She wants contraceptives but the few times she’s asked, the local pharmacist said they were available only for married women. And in Malawi, 18-year-old Sarah has started having sex, sometimes with male partners twice her age.  These three young women lead very different lives, but they all have one thing in common—they’re at high risk for HIV infection. Although Grace, Denise, and Sarah are not real people, their stories illustrate diverse challenges young women face, particularly in sub-Saharan Africa, where young women ages 15-24 are at least twice as likely to have HIV as men their age—and, in some regions, are more than eight times as likely to get infected. IPM's Sharyn Tenn with workshop participantsExisting HIV prevention strategies are not doing enough to reduce the high rate of infection among women because women still lack a range of options that address their diverse needs. While some women may feel comfortable discussing available HIV prevention options such as condoms with their partners, negotiating safe sex is not a realistic option for many others, including those at risk of sexual violence. In addition, while some women may be able to use a daily oral HIV prevention pill known as PrEP, in the three African countries where it recently become available, others may prefer a long-acting prevention method.The payoff for all of these tools spans far beyond individual women—evidence shows that when women are both empowered and healthy, they are more likely to have healthy families, educate their children, and make positive social and economic contributions to society. New discreet and long-acting HIV prevention tools have the potential to empower women to protect their own health and unlock their potential.My organization, the International Partnership for Microbicides (IPM), has developed one such tool–the monthly dapivirine ring. This flexible, silicone vaginal ring is the first long-acting, self-initiated method shown to safely help prevent new HIV infections in women.Results from two Phase III clinical trials last year—The Ring Study and ASPIRE—found that the ring safely reduced HIV risk among women in four African countries. Data from one study suggests that women who used the ring most consistently saw greater risk reduction, and that the youngest women, who saw little to no protection, appeared to be the least likely to use the product. Such adherence challenges are consistent with studies of other HIV prevention methods and underscore the urgent need to identify and overcome barriers to product-use for young women. The dapivirine ring. (Photo: Andrew Loxley) IPM is committed to doing all we can to understand how to help young women who want to use new HIV prevention technologies, like the monthly dapivirine ring, to do so consistently. Last month, we, along with AVAC, the US Agency for International Development, and Dalberg Global Development Advisors, co-hosted an event during the United Nations Commission on the Status of Women to take a holistic view of young women’s lives. Presenters shared examples of the ways HIV-prevention efforts can be informed by the very people who would benefit leveraging an approach called human-centered design, which places end-users and other key stakeholders at the center of the design and implementation process. This approach is being used to create concepts and materials to increase the adoption and sustained use of the dapivirine ring.Several insights shared at the event could inform future steps for the dapivirine ring, should it be approved for use and added to HIV prevention programs in sub-Saharan Africa. For example, the ring could be offered where women already regularly access health services, whether for themselves or for their children.Doing so would make access to the ring more convenient, and subsequently, may increase its uptake. Participants also suggested that a welcoming, environment may also help facilitate uptake as fear of judgment can be a powerful barrier to accessing and using HIV prevention products and services.We’re encouraged by these discussions, recognizing that they are one step in a long and iterative process of getting new HIV-prevention methods into the hands of women worldwide. Continuing to involve women in additional research on the ring and its possible introduction must continue if we are to realize its potential and pave the way for other technologies in the pipeline such as a three-month dapivirine-only ring and a multipurpose dapivirine-contraceptive ring. We’re currently pursuing regulatory approval for the dapivirine ring and looking to two open-label extension studies—DREAM and HOPE—currently underway, to gain insight into when, why, and how women use the ring now that its safety and efficacy are known, and to collect extended safety data.Expanding the toolkit of HIV prevention options available to young women would lower HIV infection rates, allow healthy women to pursue employment, and help sustain strong and productive workforces.The sooner we reduce the heavy HIV burden young women bear, the sooner we can empower a new generation to lead healthy and productive lives. Sharyn Tenn is the senior director for external affairs at the International Partnership for Microbicides.

On April 28,  senior leaders from government, the private sector, and the global health community came together in Berlin for a lively discuss on how the G20 can advance global health innovation to drive sustainable development and health security. Here are six key takeaways from that discussion: 1. Global health security can drive economic growth, but health crises destroy economies. While the cost of developing technologies may be significant, the cost of failing to have technologies needed on hand can be far greater. For example, US funding cuts in 2012 stalled development of a promising Ebola vaccine, leaving us without a critical tool needed to stem the 2014 outbreak. The result: Over 11,000 deaths and the collapse of health systems and economies in the three affected West African countries, as well as enormous investment by G20 countries to stem the outbreak. The US government alone spent US$2.4 billion on efforts to combat the disease at its source, in addition to investments at home. On the other hand, investment in global health research and development (R&D) can drive economic growth and job creation. Healthier people lead to healthier economies. 2. Resource mobilization is critical. If there is one message the eclectic group of conference participants can all could agree on, it is that we need additional investment from public- and private-funders to ensure global health security. What was less clear is who will pay for it. Speakers emphasized the vital role governments have to play in funding R&D for poverty-related and neglected diseases (PRNDs) given there isn’t sufficient stand-alone interest from the private industry. German Bundestag member, Stephan Albani, encouraged governments to double their investments in R&D for PRNDs and to continue funding product development partnerships (PDPs), which leverage public- and private-sector contributions to advance health technologies targeting PRDNDs. Other panelists stressed the need to draw in additional support from the private-sector, philanthropy, and other unconventional donors. Tara Hayward from Sabin Vaccine Institute emphasized the need for alternative financing models to stretch investments, while Dr. Kei Katsuno from GHIT Fund discussed his organization’s unique approach to leveraging private and public funds. Katharina Kuss, from the Spanish Foundation for International Cooperation, Health, and Social Affairs, also reminded participants of the need to focus on value-for-money to avoid donor fatigue and continue to engage the private-sector and philanthropy. 3. No one can do this alone; Partnerships are needed. Participants emphasized the need for partnerships in both funding and research. PATH’s Claire Wingfield discussed the unique role of PDPs in drawing together public and private resources and engaging local partners to develop affordable and appropriate technologies for PRNDs, as well as the need to foster an enabling environment for innovation in low- and middle-income countries as they strengthen R&D capacity to address their own health needs. Dr. Peter Jackson from the AMR Centre and Founding Member of CARB-X emphasized the length and high cost of drug development and thus the need for collaboration to bring new antibiotics to market. CEPI’s new CEO, Dr. Richard Hatchett, stressed the need for portfolio partnerships rather than companies working on developing a single vaccine. On the private industry side of our community, Dr. Denis Broun of CEPLA spoke of partnerships with generic companies working on new drug formulations, while Dr. Harald Nusser of Novartis focused on the need for co-creation through multiple partnerships which are less transactional. Professor Helen Rees, Chairperson of the South African Medicines Control Council, raised the issue of medicine affordability for countries as an example of the need for mechanisms of tiered pricing and noted the need for collaboration to ensure tech transfer. 4. We must connect R&D with the overall health system. A new global health technology will only have impact if ultimately reaches the people who need it and is designed for the communities and contexts in which it will be used. Silvia Ferazzi from Medicines for Malaria Venture emphasized that R&D must be viewed as part of broader health systems with product developers and implementers coordinating throughout the R&D process to ensure technologies can be rapidly scaled up at the community level once developed. She also stressed the need for technologies to be designed and adapted to meet the unique constraints of health systems. The need for communities to be engaged at an early stage to inform product design was echoed by both Abdullah Adlahmash of King-Saud University and Dr. Michelle Gayer of International Rescue Committee, while Julie Archer of FIND stressed the need to innovate diagnostics in parallel with drugs and vaccines to enable these tools to be deployed most effectively. 5. Governments DO care, but better coordination is required. Many of the government and multilateral officials in attendance—including German Bundestag member Kordula Schulz-Asche, United Kingdom member of parliament, Jeremy Lefory, and Emanuel Frederico Sotelo from the Embassy of Argentina—highlighted the remarkable gains in global health achieved through new technologies and the stressed their commitment to driving forward global health innovation and strengthening health systems to address longstanding and emerging challenges, including antimicrobial resistance (AMR) and pandemic threats. But attendees also pointed out the need for governments to better coordinate to support new technologies on the journey from lab to bedside. Rob Terry of the World Health Organization (WHO) R&D observatory, discussed his team’s work to create a directory of product profiles to identify priorities and gaps in R&D. Bernhard Schnittger from the European Union (EU) Commission in Germany, stressed the need for alignment between Africa and Europe—in areas of disease surveillance and response, pandemic preparedness, regulatory issues, and capacity building—which H.E. Ajay Bramdeo, AU Permanent Representative to the EU, also reiterated. Ben Alsdurf from TB Alliance focused on the need for streamlined regulatory processes and better coordinated procurement. Discussing the alignment between G20 initiatives and WHO, German B20 Sherpa Dr. Stormy-Annika Mildner noted that the G20 in health can’t divert from the WHO role, but it should set an agenda to streamline initiatives with WHO, and cited five areas where global health is a focus within the G20: Innovation in health, pandemic preparedness, NTDs, AMR, and digital health. 6. These global health challenges impact us all.   Dr. Peter Hotez, Dean of the National School of Tropical Medicine at Baylor College of Medicine, perhaps summed it up best when he shared some surprising new statistics indicating that the majority of cases of certain neglected diseases—including HIV and AIDS, malaria, and tuberculosis—currently exist within the G20 countries, so this is an area which countries of all economic levels cannot afford to ignore. On a positive note, the Millennium Development Goals helped catalyze a 50-80 percent reduction in preventable child diseases. On a more concerning note, new challenges have emerged: Dengue has returned to Southern Europe and malaria cases are on the rise in Greece. Call to action! It’s clear that neglected diseases can no longer be seen as a distant concern only affecting the global south. In this increasingly globalized world where diseases know no borders and our security and economies are intertwined, the leading countries of the world must come together with a coordinated approach to ensuring global health security. That’s why we are calling on all interested parties to sign on to our call to action for G20 leaders to commit investment in research, innovation, and development of innovative health technologies to counter threats posed by AMR, PRNDs, and pandemics. We are working to include global health innovation on the agenda for the B20 meeting, and continue to engage in dialogue with representatives from Argentina and India, the next two G20 hosts and national ministers and heads of government. Join us!

In this regular feature on Breakthroughs, we highlight some of the most interesting reads in global health research from the past week. For many years, ineffective treatment plans and archaic diagnostic tools have stood as a barrier to tackling tuberculosis (TB). More recently, new drugs and diagnostics have emerged. Yet, availability has not always translated to widespread access. For example, despite the availability of new rapid diagnostic tools like GeneXpert, it is estimated that over 40 percent of new TB cases go undiagnosed or are not reported and use of older, less accurate sputum tests still outpace use of the GeneXpert. Though new drugs like bedaquiline and delamanid are not available, more than 75 of patients who need them do not have adequate access. A number of hurdles to adoption and scale-up exist from lack of funding for TB programs to high costs to implementation failures Action is needed by global leaders and innovators to break down these barriers if the global community wants to achieve its goal of eradicating TB by 2030. Malaria is more complex than scientists previously thought. In a recent study published in the Proceedings of the National Academy of Sciences, scientists used DNA fingerprinting to track malaria on a cellular level. They found that the parasite has a heightened level of genetic recombination developed during meiosis, leading to a wide variety of malaria strains. This suggests that malaria can evade immune system response, acting as a chronic disease—and it means there is no one-cure-fits-all solution. Because of the incredible amount of genetic diversity malaria can have in the body, one vaccine solution may not work for all individuals, casting doubt on the efficay of vaccines now in development. While this discovery makes malaria harder to prevent and eradicate, scientists have also discovered that malaria isn’t as transmissible as it first seemed, with the parasite only causing five or six secondary cases from one original infection, whereas it was previously thought one case could subsequently infect dozens of individuals. The International Partnership for Microbicides (IPM) has announced a clinical trial that is hopeful to significantly reduce cases of HIV in Sub-Saharan Africa and around the world. The clinical trial will use the IPM-developed dapivirine ring, a small silicone ring inserted in the vagina, releasing a contraceptive (levonorgestrel) and an anti-HIV drug (dapivirine). The ring is easy to insert and lasts three months. Building on the previous ring that only released dapivirine, having the ring also act as a contraceptive will not only reduce the likelihood of HIV infecting women, but will also provide women with the choice to protect against unwanted pregnancy. This trial is especially important because women are most at-risk for contracting HIV, especially in countries with low rates of condom use. IPM hopes to have the ring ready for shipment globally by 2020.