SAB Opening Remarks

Scientific Advisory Board Meeting- September 14-15, 2011 

Ambassador Eric Goosby Opening Remarks

Welcome to the second meeting of the PEPFAR Scientific Advisory Board (SAB). Our meeting in January was the first time PEPFAR had ever formally convened such a large group of eminent HIV/AIDS scientists, clinicians and thought-leaders to strengthen our scientific foundation and direction.

From my perspective, it was a great step forward. The dialogue and outcomes from that meeting have been invaluable and have led to many follow-on discussions. Your advice has helped us distill our programmatic priorities, shape our implementation science program, and identify key areas where challenges require our attention.

The agenda for this meeting starts with discussing work that has been generated in response to the scientific priorities identified from last meeting, including our strong new prevention guidance. We will also consider important developments related to most at risk populations, data issues, and new issues such as PEPFAR’s response to HPTN 052.

It’s worth taking a minute to reflect on the HPTN 052 study and the group’s New England Journal of Medicine paper. It’s no overstatement to say the findings have invigorated the global AIDS community. For the first time, we have a randomized controlled trial clearly documenting not only the benefit of treatment for people living with HIV, but also its vaccine-like impact in reducing transmission to sexual partners.

One thing that distinguishes treatment from other potential antiretroviral-based modalities such as pre-exposure prophylaxis and microbicides is that we now have almost a decade of experience developing and implementing treatment programs in the field. We have developed the systems, training, monitoring and evaluation and clinical platforms to deliver antiretroviral therapy (ART), and frankly, it has worked. So we as PEPFAR, and also national programs, are particularly well-positioned to draw on experience to decide how best to use these treatment platforms not only to improve individual health, but to also drive down HIV incidence.

This study, and the supporting observational trials, have eliminated the ‘prevention versus treatment’ dichotomy. They are reenergizing global efforts to expand treatment access. Most of all, along with other high-impact prevention interventions, they allow us to begin to chart a course for truly moving toward the end of the global HIV epidemic.

For this particular meeting, our task is to take what we have learned and assess what it means in practical terms for HIV programs. We will also need to consider the role of further effectiveness data that is forthcoming, especially at higher CD4 cell counts from cohort and other studies outside of randomized controlled trials.

In all of this, PEPFAR needs input from the global HIV/AIDS scientific leadership, which is represented so well in this room. Let me highlight my expectations as we begin this meeting. I believe we will have a successful meeting if the Board can reach consensus on advising us on elements of how science should inform PEPFAR, particularly in relation to the HPTN 052 study.

But even if there is not full agreement about all key issues, the meeting will be a success for PEPFAR if the Board is able to closely examine and highlight for us some of the key opportunities, risks, and challenges of various strategies for programmatic adoption. These issues are not clear cut. We recognize that discussion not only in this forum, but also following the meeting, will be essential.

We need to hear your interpretation of the latest scientific developments and your best advice on the smartest way forward given the science. It is my job, and that of my office, to use this input as we work with our interagency colleagues to develop policies to guide our PEPFAR program.

And informed by the science, it’s also PEPFAR’s role to then take into account budgetary, programmatic, diplomatic and many other considerations as we make these decisions. Of course, we will touch on some of these broader facets over the next two days because they all have points of contact with the science. But please know that we’re really looking to you for help on the science, and that it is my responsibility to craft a way forward that makes sure our programming is based on the best science available.

There will be a chance for public comment on both days and we are eager to hear opinions and thoughts from all.

Let me end by saying that thirty years since the first case of AIDS was diagnosed in the United States, the world finds itself at a tipping point in the fight against this deadly disease. For the first time, grounded in scientific evidence, our efforts can put us within reach of an AIDS-free generation.

This Advisory Board has, and will continue to have, a vital role for PEPFAR and the world as we work together to chart a strategic course forward. Again, I would like to thank everyone here for taking the time to participate. Thank you.

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