Abstract
BackgroundThe 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.MethodsAn 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.ResultsIf 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.InterpretationEven 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.
Highlights
Since its discovery in the early 1980s, HIV has infected almost 80 million people across the world and 40 million have died from AIDS-related causes
A Current Trends scenario assumes that incremental linear scale-up of Antiretroviral treatment (ART) and prevention of mother-to-child transmission (PMTCT) from 2010–2013 continues linearly into the future, offsetting the natural increase in new infections associated with population growth in Low- and middle-income countries (LMICs) after 2015 and resulting in a steady annual rate of new HIV infections
Eligibility for ART remains at CD4 counts
Summary
Since its discovery in the early 1980s, HIV has infected almost 80 million people across the world and 40 million have died from AIDS-related causes. Low- and middle-income countries (LMICs) are the most severely affected, especially in Sub-Saharan Africa, where 70% of new HIV infections and AIDS-related deaths occurred in 2014 [1]. In other countries with lower rates in the overall population, prevalence among commercial sex workers, men who have sex with men, transgender people and injecting drug users can be 12– 19 times higher than that of the general global population [1, 3]. 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). Detailed assumptions for the IFE, including scale-up targets for specific interventions, can be found in Stover et al 2014 [14]
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