Vaccine Briefs

Investigators Tap Social Networking to Pique Interest in Vaccine Trial

With the pace of enrollment slower than investigators would like, a number of sites recruiting volunteers for HVTN 505, a Phase II AIDS vaccine trial conducted by the HIV Vaccine Trials Network (HVTN), have turned to social media and even online classified sites such as craigslist to try and draw volunteers to the study.

Along with traditional outlets like billboards, newspaper and radio advertisements, printed handouts, and social events, clinics are now tapping social media sites with relish to generate interest in a trial that, since its launch last summer, has recruited only 200 of the 1,350 volunteers needed to meet protocol. About 3,000 individuals have inquired about the trial and about 600 were eventually screened, but two-thirds failed to meet the eligibility criteria or decided against joining. The US-based trial is seeking to enroll HIV-uninfected men who have sex with men (MSM) or transgendered women who have sex with men at 15 sites in 12 cities. The trial is testing the safety and efficacy of a DNA/Ad5 prime-boost regimen developed at the Vaccine Research Center (VRC) at the National Institute of Allergy and Infectious Diseases (NIAID; see Vaccine Briefs, IAVI Report, July-Aug. 2009).

Investigators described the pace of enrollment as slower than usual and blame this on a number of factors. Cheryl Stumbo, a communications specialist at HVTN’s headquarters in Seattle, says that some trial sites are still confronting a skeptical public that is unsure whether the vaccine will actually work after another Ad5-based candidate developed by Merck—known as MRKAd5—failed to prevent transmission of HIV or slow disease progression in vaccinated volunteers enrolled in the Phase IIb test-of-concept STEP trial.

Participation in HVTN 505 is also limited to circumcised MSM, or transgendered women who have sex with men, with no pre-existing Ad5 immunity because the results of the STEP trial suggested that male volunteers who received the vaccine had a higher risk of acquiring HIV if they were uncircumcised and had pre-existing antibodies against the Ad5 vector as compared to placebo recipients with the same characteristics.

Stumbo also says the recession has “put some people in bad moods,” which may be delaying them from doing something altruistic, like joining a vaccine trial.

It’s not clear how much of an impact the use of social media will ultimately have on helping HVTN 505 reach its enrollment goal. Peggy Johnston, director of the Vaccine Research Program in NIAID’s Division of AIDS, says while no “immutable deadline” has been set for HVTN 505, the goal is to complete the trial within four and a half years after the first volunteer was enrolled. Johnston says vaccine shelf life is not usually a factor in influencing pre-determined trial futility. “Unless trial length is predicted to be so long that the total cost becomes fiscally indefensible, or if results from other trials become available and make HVTN 505 irrelevant, NIAID remains committed to the completion of HVTN 505,” says Johnston.

Using the Internet to draw attention to AIDS vaccine trials is not new, of course. HVTN established a separate website for the STEP trial, which was launched in 2004, and a companion study launched in South Africa in 2007 known as Phambili. What is relatively new is the ways in which trial sites are utilizing newer forms of social media, such as Facebook.

Although it does not recruit volunteers for the individual trial sites, HVTN’s headquarters has been posting information about HVTN 505 on its Facebook page and posting advertisements on the Facebook pages of men who live in the same geographic region as a trial site and whose demographics seem to fit the eligibility guidelines for enrollment.

Trial sites are also using social media to reach men in their regions. For instance, the San Francisco site recently aired a video of nine volunteers who had participated in previous vaccine trials. The volunteers talked about what it was like to participate in the trial and addressed some of the misconceptions regarding AIDS vaccine candidates.

Jennifer Sarche, director of community programs for the HIV Research Section of the San Francisco Department of Public Health, says viewers can easily share the video with friends on Facebook or MySpace. So far, the website (www.SFisReady.org) with the video and information about AIDS vaccine trials happening in San Francisco, has had about 2,000 visits since its January 20 launch. San Francisco has about 35 volunteers enrolled in HVTN 505, says Sarche.

Sarche views the use of social media strategies as part of a larger goal of community education. “We believe the Internet is a place for people to learn more about vaccines at their own pace,” she says. “Then, if a person has seen that their friend is one of our sites’ fans, and has watched our videos, and read more about it, they’ll be a person who is more likely to stop and talk when they see one of our recruiters on the street. And, fully half of our enrolled participants have come from that active street outreach.”

The Fenway Institute (formerly Fenway Community Health) in Boston has started using craigslist to recruit volunteers. After obtaining approval from the trial’s Institutional Review Board, Fenway posted a listing seeking volunteers for HVTN 505 on two separate craigslist pages, including one that seeks volunteers for clinical trials.

In addition, a Fenway recruiter combs craigslist’s personal ads looking for men who appear to fit the profile that the trial is seeking. Then they contact the individuals and ask if they would consider participating in the study. Coco Alinsug, Fenway Institute’s recruitment coordinator, says the site has screened about 90 MSM for the HVTN 505 trial, and enrolled about 17 of them, most of whom were found through their online efforts. —Regina McEnery

CDC Creates New Center for Global Health

A new center created by the US Centers for Disease Control and Prevention (CDC) is aiming to consolidate and extend the agency’s work in global health, including HIV/AIDS, with two of its major goals centered on health security and extending people’s lives.

The Center for Global Health will include about 1,000 workers, largely drawn from departments and programs that already exist within the CDC, and will be led by Kevin DeCock, the former director of the World Health Organization’s Department of HIV/AIDS. DeCock most recently served as the director of CDC Kenya.

While the CDC largely focuses on and funds domestic health programs, its international scope is substantial.“There is no way all of the CDC’s international work can fall under this new center,” says DeCock. “In fact, an important function of the new center will be to do everything it can to facilitate and support the global work that lies outside the center.”

The new center fits into US President Barack Obama’s plan to invest US$63 billion over six years in a new Global Health Initiative that has been included in the proposed 2011 spending package now undergoing legislative review. The largest slice of the initiative—about $50 billion—includes the President’s Emergency Program for AIDS Relief (PEPFAR), established during the Bush Administration and reauthorized in 2008.

DeCock says a more global approach was inevitable. “The global discourse has moved away from these large disease interventions to highlight neglected areas such as lags in maternal/child health or broader themes of strengthening health systems.” He added that for a Global Health Initiative to work there will need to be measurable outcomes. “That was one of the strengths of PEPFAR, particularly with regard to treatment.”

DeCock said it is also important not to lose sight of the “unfinished business” of HIV/AIDS. “Collectively, we should be proud of what we have achieved, but treatment coverage is still less than 50% of those who need it. For the other 50%, nothing has changed. The emergency is not over. We must not lose sight of that.”

He says long-term funding for global HIV/AIDS programs will need to include innovative financing mechanisms, a broader array of government donors, and greater involvement among countries who now receive support from PEPFAR or the Global Fund to Fight AIDS, Tuberculosis and Malaria. —Regina McEnery