Exploring the Potential Health Impact and Cost-Effectiveness of AIDS Vaccine Within a Comprehensive HIV/AIDS Response in Low- and Middle-Income Countries

Overview

Journal PLoS One

Specialties General Medicine
Science

Date 2016 Jan 6

PMID 26731116

Citations 22

Authors

Thomas M Harmon

Kevin A Fisher

Margaret G McGlynn

John Stover

Mitchell J Warren

Yu Teng

Arne Naveke

Affiliations

Soon will be listed here.

Abstract

Background: The Investment Framework Enhanced (IFE) proposed in 2013 by the Joint United Nations Programme on HIV/AIDS (UNAIDS) explored how maximizing existing interventions and adding emerging prevention options, including a vaccine, could further reduce new HIV infections and AIDS-related deaths in low- and middle-income countries (LMICs). This article describes additional modeling which looks more closely at the potential health impact and cost-effectiveness of AIDS vaccination in LMICs as part of UNAIDS IFE.

Methods: An epidemiological model was used to explore the potential impact of AIDS vaccination in LMICs in combination with other interventions through 2070. Assumptions were based on perspectives from research, vaccination and public health experts, as well as observations from other HIV/AIDS interventions and vaccination programs. Sensitivity analyses varied vaccine efficacy, duration of protection, coverage, and cost.

Results: If UNAIDS IFE goals were fully achieved, new annual HIV infections in LMICs would decline from 2.0 million in 2014 to 550,000 in 2070. A 70% efficacious vaccine introduced in 2027 with three doses, strong uptake and five years of protection would reduce annual new infections by 44% over the first decade, by 65% the first 25 years and by 78% to 122,000 in 2070. Vaccine impact would be much greater if the assumptions in UNAIDS IFE were not fully achieved. An AIDS vaccine would be cost-effective within a wide range of scenarios.

Interpretation: Even a modestly effective vaccine could contribute strongly to a sustainable response to HIV/AIDS and be cost-effective, even with optimistic assumptions about other interventions. Higher efficacy would provide even greater impact and cost-effectiveness, and would support broader access. Vaccine efficacy and cost per regimen are critical in achieving cost-effectiveness, with cost per regimen being particularly critical in low-income countries and at lower efficacy levels.

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References

Levin A, Wang S, Levin C, Tsu V, Hutubessy R . Costs of introducing and delivering HPV vaccines in low and lower middle income countries: inputs for GAVI policy on introduction grant support to countries. PLoS One. 2014; 9(6):e101114. PMC: 4072768. DOI: 10.1371/journal.pone.0101114. View

Raymond A, Hill A, Pozniak A . Large disparities in HIV treatment cascades between eight European and high-income countries - analysis of break points. J Int AIDS Soc. 2014; 17(4 Suppl 3):19507. PMC: 4224795. DOI: 10.7448/IAS.17.4.19507. View

Kristiansen P, Diomande F, Ky Ba A, Sanou I, Ouedraogo A, Ouedraogo R . Impact of the serogroup A meningococcal conjugate vaccine, MenAfriVac, on carriage and herd immunity. Clin Infect Dis. 2012; 56(3):354-63. DOI: 10.1093/cid/cis892. View

Lema D, Garcia A, De Sanctis J . HIV vaccines: a brief overview. Scand J Immunol. 2014; 80(1):1-11. DOI: 10.1111/sji.12184. View

Levine O, Knoll M, Jones A, Walker D, Risko N, Gilani Z . Global status of Haemophilus influenzae type b and pneumococcal conjugate vaccines: evidence, policies, and introductions. Curr Opin Infect Dis. 2010; 23(3):236-41. DOI: 10.1097/QCO.0b013e328338c135. View

Esparza J . A brief history of the global effort to develop a preventive HIV vaccine. Vaccine. 2013; 31(35):3502-18. DOI: 10.1016/j.vaccine.2013.05.018. View

Kim J, Rerks-Ngarm S, Excler J, Michael N . HIV vaccines: lessons learned and the way forward. Curr Opin HIV AIDS. 2010; 5(5):428-34. PMC: 2990218. DOI: 10.1097/COH.0b013e32833d17ac. View

Stover J, Hallett T, Wu Z, Warren M, Gopalappa C, Pretorius C . How can we get close to zero? The potential contribution of biomedical prevention and the investment framework towards an effective response to HIV. PLoS One. 2014; 9(11):e111956. PMC: 4221192. DOI: 10.1371/journal.pone.0111956. View

Pruss-Ustun A, Wolf J, Driscoll T, Degenhardt L, Neira M, Calleja J . HIV due to female sex work: regional and global estimates. PLoS One. 2013; 8(5):e63476. PMC: 3662690. DOI: 10.1371/journal.pone.0063476. View

10.

Cohen M, Chen Y, McCauley M, Gamble T, Hosseinipour M, Kumarasamy N . Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011; 365(6):493-505. PMC: 3200068. DOI: 10.1056/NEJMoa1105243. View

11.

Harmon T, Guo W, Stover J, Wu Z, Kaufman J, Schneider K . The Potential Impact of Preventive HIV Vaccines in China: Results and Benefits of a Multi-Province Modeling Collaboration. Vaccines (Basel). 2015; 3(1):1-19. PMC: 4494240. DOI: 10.3390/vaccines3010001. View

12.

Hankins C, Glasser J, Chen R . Modeling the impact of RV144-like vaccines on HIV transmission. Vaccine. 2011; 29(36):6069-71. PMC: 4580279. DOI: 10.1016/j.vaccine.2011.07.001. View

13.

Newall A, Jit M, Hutubessy R . Are current cost-effectiveness thresholds for low- and middle-income countries useful? Examples from the world of vaccines. Pharmacoeconomics. 2014; 32(6):525-31. DOI: 10.1007/s40273-014-0162-x. View

14.

Jit M, Brisson M, Laprise J, Choi Y . Comparison of two dose and three dose human papillomavirus vaccine schedules: cost effectiveness analysis based on transmission model. BMJ. 2015; 350:g7584. PMC: 4285892. DOI: 10.1136/bmj.g7584. View

15.

Schwartlander B, Stover J, Hallett T, Atun R, Avila C, Gouws E . Towards an improved investment approach for an effective response to HIV/AIDS. Lancet. 2011; 377(9782):2031-41. DOI: 10.1016/S0140-6736(11)60702-2. View

16.

Rerks-Ngarm S, Pitisuttithum P, Nitayaphan S, Kaewkungwal J, Chiu J, Paris R . Vaccination with ALVAC and AIDSVAX to prevent HIV-1 infection in Thailand. N Engl J Med. 2009; 361(23):2209-20. DOI: 10.1056/NEJMoa0908492. View

17.

Stover J, Bollinger L, Hecht R, Williams C, Roca E . The impact of an AIDS vaccine in developing countries: a new model and initial results. Health Aff (Millwood). 2007; 26(4):1147-58. DOI: 10.1377/hlthaff.26.4.1147. View