Globally, more than 38 million people live with HIV (2021), with 28.7 million (75%) accessing life-saving antiretroviral treatment, according to the World Health Organization.
Of the 29,460 Australians living with HIV in Australia at the end of 2021, 9% were unaware of their HIV status.
Burnet’s HIV: Reaching the Unmet program is addressing this gap.
Burnet Institute has been at the forefront of the challenges of HIV since the early days of the AIDS epidemic in the 1980s. Our discovery research has focused on new classes of HIV drugs to address drug resistance; created a low-cost, point-of-care HIV diagnostic VISITECT® CD4; explored vaccine possibilities; examined mechanisms of ageing and frailty at the cellular level of people living with HIV; and developed a device to simplify collection and transport of blood specimens in remote locations.
Our public health response has involved leading multi-country HIV strategic planning and developing national AIDS strategies; partnering on programs to support HIV prevention among highly vulnerable communities; and supporting health systems strengthening through HIV clinical training and technical oversight of HIV policy. Through Optima Consortium modelling, HIV responses have improved in over 45 countries and informed regional and global discussions on HIV resourcing.
We remain a key research and implementation partner in Australia’s HIV response. The innovative ACCESS surveillance system (The Australian Collaboration for Coordinated Enhanced Sentinel Surveillance of STIs and BBVs) is internationally unique and provides a mechanism to monitor progress towards Australia’s HIV prevention and care targets.
Through ACCESS and our analytical and modelling expertise, Burnet has led world-leading research on the impact of HIV pre-exposure prophylaxis (PrEP) scale-up through the PrEPX Trial, in partnership with Alfred Health, and broader access to PrEP through the Pharmaceutical Benefits Scheme.
In collaboration with the Kirby Institute, Burnet has also led unique innovations in the monitoring of people through the HIV care cascade and it’s impact of population-level HIV prevention.
THE WAY FORWARD: FOUR PILLARS OF ELIMINATION
Vaginal Microbiome and HIV Susceptibility
Women are the forgotten faces of HIV.
- Adolescent girls and young women (aged 15 - 24 years) - one of whom becomes infected with HIV every three minutes - are three times more likely to acquire HIV than adolescent boys and young men of the same age group in sub-Saharan Africa
- In Australia, new infections in women have not decreased and almost half of HIV infections in women are diagnosed late.
- The majority of HIV infections in PNG is among women
Women harbouring harmful vaginal bacteria have genital inflammation that increases their risk of acquiring HIV and interferes with the efficacy of topical pre-exposure prophylaxis (PrEP) in contrast to women with beneficial bacteria. Burnet Institute has discovered that beneficial bacteria produce a product that interacts with vaginal cells to block inflammation. This product also kills HIV and harmful vaginal bacteria. Burnet has been awarded a patent to enable translation of this discovery to help protect vulnerable women from HIV. Burnet is also developing live biotherapeutic approaches for HIV prevention.
HIV infects a type of immune cell called macrophages, and the virus can live on in a silent state in these cells despite effective anti-HIV therapy, which prevents HIV from being cured. Burnet researchers are studying how HIV persists within macrophages and are identifying strategies to eliminate HIV from these cells to facilitate a cure.
Test and Treat prevention strategies
Australia is on track to meet the UNAIDS 95 targets for 95 per cent of people diagnosed with HIV on treatment and 95 per cent of those on treatment achieving viral suppression. With the Australian Federation of AIDS Organisations and other research partners, the Burnet closely supported the development of Agenda 2025, a national strategic plan to end HIV in Australia by 2025, including being the technical lead for the development of HIV testing priorities. The Burnet continues to lead innovations in testing models, including work to co-design with community the development of HIV self-testing and linkages to care service models.
Burnet researchers are well-placed to address this gap and support government and community efforts to increase testing among key populations by applying models of self-testing, supporting linkages to care and treatment, and developing geo-spatial mapping techniques to inform scale-up of specific HIV responses.
The Australian Collaboration for Coordinated Enhanced Sentinel Of STIs and BBVs (ACCESS) is funded by Commonwealth and jurisdictional governments to help measure progress towards STI and BBV elimination and control targets. The internationally novel ACCESS system anonymously links episodes of care across a network of over 130 clinics and laboratories. Led by the Burnet, in collaboration with the Kirby Institute and the National Serology reference Laboratory, ACCESS has data has been published in top international journals, and provided unique insights on HIV biomedical prevention strategies that has informed policy and practice in Australia and globally. The Burnet is now piloting this system to monitor the HIV cascade of care in Myanmar, in what will be the first system of it’s type in any low income country.
Optima HIV: Efficiency analyses in HIV responses
The Optima HIV model assists governments and funding bodies to understand how to allocate funds to achieve the best health outcomes. Optima HIV was developed by the Optima Consortium for Decision Science with technical inputs and guidance from The World Bank. Since 2000, more than US$100 billion in development assistance for HIV programs have been disbursed globally. The Optima HIV model has been used in more than 45 countries to inform HIV policy and public health budget allocations. As donor funding reduces, the model can be used to guide efficient and sustainable long-term responses.
Developing new treatments and diagnostic tests for age-related diseases
People living with HIV (PLWH) on antiretroviral therapy now live longer, but they have higher levels of inflammation that increases the risk and severity of age-related diseases such as heart diseases and diabetes. Current tests cannot accurately measure inflammation or identify those at risk of developing HIV-related ageing diseases.
There are limited treatment options for PLWH who are heavily treatment experienced described as having two or less antiretroviral classes with limited active drugs within each class. To address this need, Burnet Institute is developing a new drug class against a validated and critical HIV molecule using a relatively novel strategy called fragment based drug design. Fragments are buildings blocks of drugs that have been found to bind to novel sites on the viral target and are being elaborated into more potent inhibitors.
Addressing the healthcare needs of people ageing with HIV
Burnet in collaboration with Alfred Health, Thorne Harbour Health, and Living Positive Victoria, seeks to address the psycho-social and health needs of older people living with HIV. Leveraging partners’ existing community support and health service capacity, the project aims to enhance the reach, sustainability and effectiveness of programs that address the psycho-social, health and support needs of people living with HIV aged over 50 years (PLHIV50+) across urban and rural Victoria.