Research conducted in South Africa has shaped global health policies and revolutionized TB and HIV prevention, diagnosis, treatment, and care worldwide.
Lifesaving scientific research on prevention, testing, treatment, and care for people living with HIV and tuberculosis (TB) in South Africa is under serious threat due to funding suspensions and grant terminations from the US government, according to a recent joint analysis from Doctors Without Borders/Médecins Sans Frontières (MSF) and Treatment Action Group (TAG).
MSF and TAG’s analysis found that 39 TB and HIV clinical research sites in South Africa are under threat due to potential funding cuts by the US, placing at least 27 HIV trials and 20 TB trials at risk. This includes sites conducting research to find a cure for HIV. This analysis is the first to map specific trials and clinical research sites related to HIV and TB that are at risk due to the US funding cuts.
If the research work of tackling these two infectious diseases—including for the most vulnerable—is stalled, we risk losing hard-won progress.
Dr. Tom Ellman, director of MSF’s Southern Africa Medical Unit
“For years, South Africa has spearheaded the research and development of critical innovative medical tools for the prevention, diagnosis, treatment, and care of HIV and TB, which have saved lives not just within South Africa’s borders, but also in communities worldwide,” said Dr. Tom Ellman, director of MSF’s Southern Africa Medical Unit (SAMU). “If the research work of tackling these two infectious diseases—including for the most vulnerable—is stalled, we risk losing hard-won progress. These cuts are especially devastating since they come at a time when funding for TB and HIV programing has also been reduced.”
TAG and MSF are calling on donor agencies, governments, and philanthropic organizations to urgently intervene to ensure continuity of care and follow-up for research participants in South Africa already enrolled in impacted HIV and TB clinical research sites by providing emergency support. They must address urgent research gaps by funding vital HIV and TB trials that were planned or paused just before launch and make sustained investments to secure South Africa’s unique and internationally recognized research infrastructure. Research infrastructure includes major equipment used for research, collections of existing data, and shared research facilities.
Funding cuts imperil international research ecosystem
"Public funding from the US government to South Africa is the scaffold on which pharmaceutical companies, philanthropies, and other governments invest in transformative TB and HIV science,” said Lindsay McKenna, TB project co-director of Treatment Action Group. “These ongoing funding disruptions by the US government don't just affect US-funded research projects, they put in peril a much wider ecosystem of global research. Donors must act swiftly to preserve scientific advances, prevent the collapse of medical research infrastructure in South Africa, and ensure continuity of care for people living with HIV and TB that have volunteered to participate in research.”
TB trials that are at risk include new drugs and shorter, safer regimens for treatment and prevention, an optimized regimen for TB meningitis, and therapeutic and preventive vaccines. Cutting support to sites in South Africa that are part of international clinical trial networks—including Advancing Clinical Therapeutics Globally for HIV/AIDS and Other Infections (ACTG), HIV Vaccine Trials Network (HVTN), and International Maternal, Pediatric, Adolescent AIDS Clinical Trials Network (IMPAACT)—could derail up to 30 percent of global TB trial enrollment and between 50-90 percent for studies focused on children and pregnant people.
For HIV, trials that are at risk include research toward achieving a cure or remission for HIV, and vaccines to induce a process known as bNab production to produce antibodies capable of neutralizing HIV. Studies to promote treatment adherence for youth are also at risk.
MSF and TAG’s analysis was primarily focused on National Institutes of Health (NIH)-funded Division of AIDS (DAIDS) HIV Clinical Trials Network studies and research infrastructure, but this is just the tip of the iceberg. The US funding cuts impacting critical research being funded through other NIH mechanisms, US university grants, the US Centers for Disease Control and Prevention (CDC), and the US President’s Emergency Plan for AIDS Relief (PEPFAR) are expected to disrupt a much wider array of TB and HIV research projects.
South African teams have led global innovations for decades
Research conducted in South Africa—much of it led by South African scientists and supported with funding from the NIH, and, to a lesser extent, the CDC and the US Agency for International Development (USAID)—has helped to bring forward most of the HIV and TB innovations introduced globally in the last two decades and shaped global health policies that have revolutionized TB and HIV prevention, diagnosis, treatment, and care, benefiting both people locally and communities worldwide. Without urgent action by donors, there is a potential risk of TB and HIV research capacity in South Africa collapsing, which would hurt people living with HIV and TB in South Africa and beyond.
We call on all potential donors to step up, as without sustained investment, we will never end these deadly epidemics.
Dr. Tom Ellman, director of MSF’s Southern Africa Medical Unit (SAMU)
"Future breakthroughs in HIV and TB research, particularly in the areas of vaccine development and long-acting treatments, is likely to rely on settings with high incidence rates and vulnerable populations like those in South Africa," Dr. Ellman said. “Importantly, these advances will benefit people globally, including in high-income countries like the United States. We call on all potential donors to step up, as without sustained investment, we will never end these deadly epidemics.”