Proactive planning: the potential benefits of an HIV vaccination campaign – a modeling study

AMSTERDAM — July 24, 2018

Researchers used a dynamic economic mathematical model to show that five-dose series HIV vaccine campaigns rolled out every two years, in the country with the highest number of daily new HIV infections (South Africa), would  provide great health benefits and be potentially cost-effective.  In combination with existing HIV prevention tools, even a partially effective HIV vaccine would greatly reduce the number of new HIV infections and deaths. The model predicts that delivery in vaccine campaigns would offer the greatest benefits.  The modeling findings were published in the Nature journal Scientific Reports, on April 17, 2018.    

Researchers with the HIV Vaccine Trials Network, which is headquartered at Fred Hutchinson Cancer Research Center, conducted the study and the findings were shared during a July 24 press briefing held during the 22nd International AIDS Conference in Amsterdam. 

Results revealed that 480 000 – 650 000 HIV infections (13.8 – 15.3% of all infections) could be prevented over ten years if a 70% efficacious HIV vaccine reached 20% of the sexually active population (15 – 49 year olds) in South Africa.  This scenario is based on the assumption that the HIV vaccine is protective for 72% of the recipients who responded to it, while it had no effect for the 28% of vaccine recipients without an adequate immune response.  The five-dose vaccination series, administered every two years at an introductory cost of $15 (*ZAR 199) per dose, would likely be cost-effective1. Some cost of treating HIV in the future would be avoided because of infections prevented and the healthcare system would have to incur an average of $105 (*ZAR 1 394) per person vaccinated over 20 years for the implementation.

Projected estimations demonstrate that if a mass HIV vaccine campaign is implemented, South Africa could avoid over 44 000 deaths from HIV in the next ten years.  Authors estimate that the absence of a partially effective HIV vaccine could translate into a projected 3.9 million new HIV infections documented between 2017 and 2027 in the country.

“The message, at the heart of the modeling exercise, is that our thinking must be targeted towards making an effective HIV vaccine accessible and cost-effective,” says Senior Author of the study Dobromir Dimitrov, Ph.D, Senior Staff Scientist at the Vaccine and Infectious Disease Division at Fred Hutchinson Cancer Research Center. “The need and urgency for this prevention option is great and thinking ahead, of what may be possible if an effective HIV vaccine is discovered, is a step in the right direction,” Dimitrov concluded.

The authors clarify that the introduction and scaling-up of an HIV vaccination campaign will have a range of different costs per immunized individual attributed to the differences in scope and scale. Strategy, national income, as well as considerations of health systems and policies will further impact forward planning for cost projections.  For South Africa, the authors factored in the cost of HIV immunization, testing, and treatment.

Vaccination costs also include supply chain, service delivery, and rapid HIV testing at each dose. Further, the model does not account for HIV-unrelated health care costs making the results presented not easily transferable to other settings.

“These modeling studies validate our pursuit to find an effective HIV vaccine,” says Larry Corey, M.D., Principal Investigator of the HVTN, virologist and faculty member at Fred Hutchinson Cancer Research Center.

The authors found that implementing an HIV vaccination campaign would have greater health benefits at lower costs compared to clinic-based HIV vaccinations.  Furthermore, the model suggests that an HIV vaccination campaign must be implemented in combination with other prevention options such as PrEP.   

 


1Cost-effectiveness analyses are used in many fields as economic decision-aid tools to compare the impact of alternative policies and inform decisions on how to maximize returns from limited resources. The incremental cost-effectiveness ratio (ICER) is one such measure.  It is calculated as the difference in costs of two alternatives, divided by the difference in their effectiveness.


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*Note: estimated currency rates are indicated in effect at period of release.

Access to manuscript:

Funding:
This work was supported by the Bill and Melinda Gates Foundation Award Number OPP1110049, the National Institute of Allergy and Infectious Diseases Award Number UM1AI068635, and the Agency for Healthcare Research and Quality Award Number T32HS013853.

Authors:
Simon de Montigny, Blythe J. S. Adamson, Benoît R. Mâsse, Louis P. Garrison Jr, James G. Kublin, Peter B. Gilbert, Dobromir T. Dimitrov

About Fred Hutchinson Cancer Research Center
At Fred Hutchinson Cancer Research Center, home to three Nobel laureates, interdisciplinary teams of world-renowned scientists seek new and innovative ways to prevent, diagnose and treat cancer, HIV/AIDS and other life-threatening diseases. Fred Hutch’s pioneering work in bone marrow transplantation led to the development of immunotherapy, which harnesses the power of the immune system to treat cancer. An independent, nonprofit research institute based in Seattle, Fred Hutch houses the nation’s first National Cancer Institute-funded cancer prevention research program, as well as the clinical coordinating center of the Women’s Health Initiative and the international headquarters of the HIV Vaccine Trials Network.
 

CONTACT
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