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

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  • Thomas M Harmon
  • Kevin A Fisher
  • Margaret G McGlynn
  • John Stover
  • Mitchell J Warren
  • Yu Teng
  • Arne Näveke

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.

Suggested Citation

  • Thomas M Harmon & Kevin A Fisher & Margaret G McGlynn & John Stover & Mitchell J Warren & Yu Teng & Arne Näveke, 2016. "Exploring the Potential Health Impact and Cost-Effectiveness of AIDS Vaccine within a Comprehensive HIV/AIDS Response in Low- and Middle-Income Countries," PLOS ONE, Public Library of Science, vol. 11(1), pages 1-18, January.
    • Handle: RePEc:plo:pone00:0146387
    DOI: 10.1371/journal.pone.0146387
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    References listed on IDEAS

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    1. A. Newall & M. Jit & R. Hutubessy, 2014. "Are Current Cost-Effectiveness Thresholds for Low- and Middle-Income Countries Useful? Examples from the World of Vaccines," PharmacoEconomics, Springer, vol. 32(6), pages 525-531, June.
    2. Ann Levin & Susan A Wang & Carol Levin & Vivien Tsu & Raymond Hutubessy, 2014. "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, Public Library of Science, vol. 9(6), pages 1-8, June.
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    Cited by:

    1. Christian Selinger & Dobromir T. Dimitrov & Philip A. Welkhoff & Anna Bershteyn, 2019. "The future of a partially effective HIV vaccine: assessing limitations at the population level," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 64(6), pages 957-964, July.
    2. Jeffy G. Mattathil & Asisa Volz & Olusegun O. Onabajo & Sean Maynard & Sandra L. Bixler & Xiaoying X. Shen & Diego Vargas-Inchaustegui & Marjorie Robert-Guroff & Celia Lebranche & Georgia Tomaras & Da, 2023. "Direct intranodal tonsil vaccination with modified vaccinia Ankara vaccine protects macaques from highly pathogenic SIVmac251," Nature Communications, Nature, vol. 14(1), pages 1-15, December.

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