Dr. François Dabis, Director of the French National Agency for Research on AIDS and Viral Hepatitis (ANRS)Dr. François Dabis, Professor of Epidemiology at the Bordeaux School of Public Health (ISPED) in France, has more than 25 years of experience in the HIV and public health fields and has led ISPED’s HIV, Cancer and Global Health research team since 2001. He is the principal investigator of the West Africa regional program of the International epidemiology Databases to Evaluate AIDS (IeDEA) global cohort consortium and was recently selected to direct the ANRS, the French National Agency for Research on AIDS and Viral Hepatitis.
The ANRS is partnering with the International AIDS Society to organize the 9th International AIDS Conference on HIV Science (IAS 2017) in Paris, July 23−26. In advance of the conference, Dr. Dabis spoke with The TREAT Asia Report about some of the pressing issues concerning HIV/AIDS and the role of the ANRS in the Asia-Pacific region.
TREAT Asia Report: What are the top priorities for the ANRS?
Dr. François Dabis: The ANRS, as a governmental research agency, has two basic aims. The first is to stimulate and fund research. We create scientific thinking “upstream” and “downstream” to generate a broad scope of research, ranging from basic science to public health science. We are looking for new solutions—in terms of simplicity, acceptability, and price—that address both prevention and care.
The second aim is to do advocacy based on our findings. We discuss the implications of our research with national authorities both in France and in our partner (site) countries, and we work extensively with international bodies such as the WHO and UNAIDS.
We need to advocate and push the role of research where it is most needed, and it has to be at the level where the problem is identified.
TREAT Asia Report: Health and development programs are increasingly being encouraged to integrate activities across different disease areas and populations. What do you see as the advantages and potential pitfalls of these integrated responses?
Dr. Dabis: When the ANRS was created more than 25 years ago it was concerned only with HIV/AIDS, but almost 12 years ago we expanded to viral hepatitis. We have then focused on HIV/hepatitis coinfection, but we have also developed a research agenda on viral hepatitis alone. This integration has been successful in targeting populations that are often affected by several diseases.
It can be difficult to mobilize additional resources to target more than one disease. We did this successfully during the Ebola crisis, but, generally speaking, getting funded is a real challenge. It can be very difficult to convince decision-makers to fund a larger integrated research agenda that includes several disease areas or populations.
TREAT Asia Report: How can research—whether basic science, clinical trials, or observational cohort analyses—contribute to achieving the 90-90-90 UNAIDS treatment targets [by 2020: 90% of HIV-positive people knowing their status, 90% of diagnosed people on treatment, and 90% of people on treatment virally suppressed]?
Dr. Dabis: Basic research and clinical research—especially randomized clinical trials—do not directly address the challenges raised by the 90-90-90 targets, but this type of “upstream” research is essential to identify, for example, more effective or cheaper screening methods, or new approaches for early treatment. If these are adopted as public health recommendations they can then serve the 90-90-90 targets.
Another type of research our agency does that has direct impact on the 90-90-90 targets is called operational, implementation, or community-based research. With this, we can experiment at large scale (populations) solutions that have almost immediate implications.
For example, in Hai Phong, Vietnam, we have a research program called DRIVE that tests whether a package of interventions proposed to drug users through local NGOs can reduce new HIV infections and improve how those already infected enter into care and receive long-term follow-up.
We are trying the same approach in populations of men who have sex with men in Africa. Although they are key drivers of the epidemic in some cities, they are hard to identify in many African countries, as people tend to hide. Through implementation research in this group we can improve screening to help achieve the first “90.” We can improve linkage to care for those who are diagnosed positive, for the second “90.” We can improve the long-term treatment of those who need it, which is the third “90.”
TREAT Asia Report: A number of key indicators suggest that Asia is falling behind Africa in its response to HIV. How can we convince governments and key stakeholders about the need for intensified leadership on HIV prevention and treatment?
The aim is on one side having a preventive vaccine, and on the other a cure for those who are living with HIV and who at the moment have to take treatment every day. These two areas remain absolutely central for the long term.Dr. Dabis: From my viewpoint it is hard to say that one continent as a whole is better or worse than another. At ANRS we have a partial view of Asia in the sense that we work deeply in only two countries, Cambodia and Vietnam, which have been good responders. We see many more challenges in the African countries where we work. In my analogy, the world is a patchwork of countries with different national and local leadership, and you can find this throughout Asia and Africa. Some countries are having more difficulty than others and within countries, some regions or some target populations are having more difficulties than others. So, I think we need to advocate and push the role of research where it is most needed, and it has to be at the level where the problem is identified. Sometimes it is at the level of one big city, and sometimes it’s at the level of one region. We increasingly have to think about the right level of the response where the problem may be, not at a global, national, or continental level.
TREAT Asia Report: What plans does the ANRS have for future projects in the Asia-Pacific region?
Dr. Dabis: We do not pretend that we can, with our limited resources, necessarily fix all the problems or have a partnership with all Asian countries. But we plan to focus on the sound research that is needed in the two countries where we have worked so far.
Because the epidemic in these countries is more and more concentrated in specific at-risk populations, our intention is to continue research that directly addresses these target populations. In particular, I’d like to be doing more to identify new solutions for intravenous drug users in Vietnam, a population at the heart of the epidemic in that country.
In Cambodia a new priority area for us is second- and third-line antiretroviral treatment. Cambodia has been very successful in first-line treatment, but is now facing some difficulties with long-term follow-up. Also in Cambodia there is a demand for better management of people living with HIV with comorbidities, especially infectious comorbidities.
TREAT Asia Report: As we look forward to the 2017 IAS conference, what do you think are the priority research questions for the field today?
Dr. Dabis: One absolute priority area is developing effective women-centered preventive tools. So far there has been research into microbicides, but what has been done has had very limited impact and produced no public health recommendations. So it is essential to continue this kind of research.
The second domain that we need to make a priority is the implementation of PrEP. We have the science; but we don’t know how to do it at the scale that is needed in most countries. We particularly need to study how to deliver PrEP to commercial sex workers and men who have sex with men in various contexts.
My third broad priority is finding a new generation of antiretroviral drugs. In addition to making less toxic drugs, we need medicines that are simpler to take, such as once a week, or even once a month.
The last domain is the aim of on one side having a preventive vaccine, and on the other a cure for those who are living with HIV and who at the moment have to take treatment every day. These two areas remain absolutely central for the long term.