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Vaccine. 2019 Apr 10;37(16):2258-2267. doi: 10.1016/j.vaccine.2019.02.073. Epub 2019 Mar 16.

Targeting and vaccine durability are key for population-level impact and cost-effectiveness of a pox-protein HIV vaccine regimen in South Africa.

Author information

1
Institute for Disease Modeling, Bellevue, WA, United States. Electronic address: christian.selinger@gmail.com.
2
Institute for Disease Modeling, Bellevue, WA, United States.
3
Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States.
4
Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, University of Washington, WA, United States; Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States.
5
University of York, York, UK.
6
Imperial College, London, UK.
7
University College, London, UK.
8
The Desmond Tutu HIV Centre, Cape Town, South Africa.
9
Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
10
Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; South African Medical Research Council, Cape Town, South Africa.

Abstract

BACKGROUND:

RV144 is to date the only HIV vaccine trial to demonstrate efficacy, albeit rapidly waning over time. The HVTN 702 trial is currently evaluating in South Africa a similar vaccine formulation to that of RV144 for subtype C HIV with additional boosters (pox-protein regimen). Using a detailed stochastic individual-based network model of disease transmission calibrated to the HIV epidemic, we investigate population-level impact and maximum cost of an HIV vaccine to remain cost-effective.

METHODS:

Consistent with the original pox-protein regimen, we model a primary series of five vaccinations meeting the goal of 50% cumulative efficacy 24 months after the first dose and include two-yearly boosters that maintain durable efficacy over 10 years. We simulate vaccination programs in South Africa starting in 2027 under various vaccine targeting and HIV treatment and prevention assumptions.

RESULTS:

Our analysis shows that this partially effective vaccine could prevent, at catch-up vaccination with 60% coverage, up to 941,000 (15.6%) new infections between 2027 and 2047 assuming current trends of antiretroviral treatment. An impact of up to 697,000 (11.5%) infections prevented could be achieved by targeting age cohorts of highest incidence. Economic evaluation indicates that, if treatment scale-up was achieved, vaccination could be cost-effective at a total cost of less than $385 and $62 per 10-year series (cost-effectiveness thresholds of $5,691 and $750).

CONCLUSIONS:

While a partially effective, rapidly waning vaccine could help to prevent HIV infections, it will not eliminate HIV as a public health priority in sub-Saharan Africa. Vaccination is expected to be most effective under targeted delivery to age groups of highest HIV incidence. Awaiting results of trial, the introduction of vaccination should go in parallel with continued innovation in HIV prevention, including studies to determine the costs of delivery and feasibility and further research into products with greater efficacy and durability.

KEYWORDS:

Agent-based modeling; Cost-effectiveness; HIV vaccine; South Africa

PMID:
30890385
PMCID:
PMC6684280
[Available on 2020-04-10]
DOI:
10.1016/j.vaccine.2019.02.073
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