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

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Title: Targeting and vaccine durability are key for population-level impact and cost-effectiveness of a pox-protein HIV vaccine tegimen in South Africa
Authors: Christian, S
Anna, B
Dobromir, D
Blythe, A
Paul, R
Hallett, T
Andrew, P
Linda-Gail, B
Helen, R
Glenda, G
Item Type: Journal Article
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.
Issue Date: 10-Apr-2019
Date of Acceptance: 25-Feb-2019
ISSN: 0264-410X
Publisher: Elsevier
Start Page: 2258
End Page: 2267
Journal / Book Title: Vaccine
Volume: 37
Issue: 16
Copyright Statement: © 2019 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license (
Sponsor/Funder: Bill & Melinda Gates Foundation
Funder's Grant Number: OPP1084364
Keywords: Agent-based modeling
HIV vaccine
South Africa
06 Biological Sciences
07 Agricultural And Veterinary Sciences
11 Medical And Health Sciences
Publication Status: Published
Online Publication Date: 2019-03-16
Appears in Collections:Faculty of Medicine
Epidemiology, Public Health and Primary Care

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