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Showing content from http://www.ncbi.nlm.nih.gov/pubmed/30890385 below:

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

. 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

Affiliations

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.

PMID: 30890385
PMCID: PMC6684280
DOI: 10.1016/j.vaccine.2019.02.073

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

Christian Selinger et al. Vaccine. 2019.

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

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.

PMID: 30890385
PMCID: PMC6684280
DOI: 10.1016/j.vaccine.2019.02.073

Item in Clipboard

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.

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Conflict of interest statement

Conflict of interest

The authors declare no competing interests.

Figures
Fig. 1.

Averaged incidence rates projected under…

Fig. 1.

Averaged incidence rates projected under three different treatment and prevention scale-up scenarios starting…

Fig. 1.

Averaged incidence rates projected under three different treatment and prevention scale-up scenarios starting in 2016, without vaccination: ‘Status Quo without PrEP’ in blue, ‘Status Quo with PrEP’ in red, ‘Fast Track with PrEP’ in green, and the average across all three scale-up scenarios in grey. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 2.

Time-dependent vaccine efficacy (red) is…

Fig. 2.

Time-dependent vaccine efficacy (red) is modeled by a parametric impulse and exponential decay…

Fig. 2.

Time-dependent vaccine efficacy (red) is modeled by a parametric impulse and exponential decay model. Cumulative vaccine efficacy at a given endpoint (green) is interpreted as the area under the time-dependent vaccine efficacy curve (shaded red) normalized by the length of the considered time period. We first fit to RV144 point estimates at month 6 and the 3 years endpoint of cumulative efficacy (red and green cross in the small panel). Then weadjusted parameters of the time-dependent vaccine efficacy curve to the P5 regimen schedule such that the goal of 50% efficacy at the 24 month endpoint is met (green point). Dotted lines refer to time-dependent vaccine efficacy with continued booster vaccination after month 24. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)

Fig. 3.

Impact of cohort vaccination at…

Fig. 3.

Impact of cohort vaccination at 80% coverage for different treatment scale-up scenarios measured…

Fig. 3.

Impact of cohort vaccination at 80% coverage for different treatment scale-up scenarios measured by average number of new infections (first row), percent of new infections prevented (second row), and number needed to vaccinate (third row) between 2027 and 2047 at 50% vaccine efficacy and varying levels of booster attrition (0%, 20% and 50%). Average and 95% confidence intervals are relative to summary statistics across stochastic replicates.