Access-Capacity and Cost-Effectiveness for Future HIV Vaccines

Abstract

BACKGROUND: Even if effective HIV vaccines are developed for global use, their rapid delivery and accessibility are not ensured, since this could be affected by existing public health capacity to deliver vaccines to at-risk populations. To avoid delayed or ineffective access to future HIV vaccines, WHO and UNAIDS have been advised to facilitate global and national policy work focused on the delivery and cost-effectiveness of future HIV vaccines. Research teams from five countries, Brazil, People's Republic of China, Kenya, Peru and Thailand, joined together to design and implement an international collaborative project investigating public health perspectives on future HIV vaccine access and delivery strategies. The objectives of the study are three-fold: (i) to investigate each country's capacity to deliver future HIV vaccines and explore accessibility to various target populations, (ii) to conduct cost-effectiveness analyses of various HIV vaccine delivery strategies using a model-based approach for estimating potential HIV vaccine impacts; and (iii) to compare these to other HIV/AIDS preventive interventions for policy consideration and country-level capacity development. The first phase of this project was a policy-maker survey conducted in each country on vaccine delivery capacity and potential HIV vaccine implementation scenarios. This paper presents and compares analyses of the country-specific delivery survey findings and discusses the implications of the survey findings for the planned cost-effectiveness analyses. METHODS*: The survey involved assessment of hypothetical HIV vaccine capacity delivery and possible delivery channels achieved by collection of data using a semi-structured questionnaire of key informants (KI). KIs included high-level government health officials; other government leaders and policy-makers; practitioners who implement immunization and health promotion programmes, including HIV prevention, treatment and care strategies; health care professionals; community leaders, and NGO representatives. RESULTS: Key findings for each country include KI assessments of: 1) capacities for delivery of HIV prevention interventions and existing vaccines, 2) minimally acceptable desired vaccine characteristics (e.g. efficacies for susceptibility, infectiousness and disease progression, waning duration, doses to complete protection, vaccine costs, etc.), and 3) proposed target vaccination populations and vaccination strategies to be considered in the cost-effectiveness modeling analyses. Comparative analyses of country-specific results are reported and discussed with regard to key differences between the country's HIV epidemics. In addition to providing important information about potential vaccine supply requirements and country-specific delivery capacities, the comparison of the desired vaccine characteristics with the potential vaccine impact at population level indicates that further policy consideration should be given to potentially useful vaccines eliciting significant reductions in infectiousness and delays in AIDS progression. CONCLUSIONS: The study assesses challenges and opportunities for future country-level HIV vaccination strategies and provides data on vaccination program strategies to be considered for cost-effectiveness and modeling analysis. Costing and modeling tools are currently being developed which would assist policy-makers in making evidence-based decisions on future potential HIV vaccine immunization strategies, taking into consideration country-specific costs and HIV epidemiology in the context of other ongoing HIV/AIDS preventive, treatment and care strategies. *WHO-UNAIDS Collaborative Group on Cost-effectiveness, Delivery and Future Access to HIV Vaccines, Cost-effectiveness and delivery study for future HIV vaccines. AIDS. 2005 September 2; 19 (13): w1-w6.