Exploring the Potential Health Impact and Cost-Effectiveness of AIDS Vaccine within a Comprehensive HIV/AIDS Response in Low- and Middle-Income Countries.
Exploring the Potential Health Impact and Cost-Effectiveness of AIDS Vaccine within a Comprehensive HIV/AIDS Response in Low- and Middle-Income Countries.
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DOI：
10.1371/journal.pone.0146387
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发表时间：
2016
期刊：
影响因子：
3.7
通讯作者：
Näveke A
中科院分区：
文献类型：
--
作者：
Harmon TM;Fisher KA;McGlynn MG;Stover J;Warren MJ;Teng Y;Näveke A
联合国艾滋病毒/艾滋病联合规划署(艾滋病规划署)2013年提出的增强投资框架探讨了如何最大限度地利用现有干预措施并增加新的预防办法，包括疫苗，以进一步减少中低收入国家新的艾滋病毒感染和与艾滋病有关的死亡。这篇文章描述了作为联合国艾滋病规划署IFE的一部分，更密切地关注LMICs中艾滋病疫苗接种的潜在健康影响和成本效益的额外建模。一个流行病学模型被用来探索艾滋病疫苗接种与其他干预措施结合在一起到2070年在LMICs中的潜在影响。假设是基于研究、疫苗接种和公共卫生专家的观点，以及来自其他艾滋病毒/艾滋病干预措施和疫苗接种计划的观察。敏感性分析包括不同的疫苗效力、保护期限、覆盖范围和成本。如果艾滋病规划署IFE目标完全实现，低收入国家每年新感染艾滋病毒的人数将从2014年的200万人下降到2070年的55万人。2027年推出的一种70%有效的疫苗，包括三剂、强吸收和五年保护期，将在第一个十年减少44%的年度新感染人数，前25年减少65%，到2070年减少78%，达到12.2万人。如果艾滋病规划署IFE中的假设没有完全实现，疫苗的影响将会大得多。艾滋病疫苗在各种情况下都是具有成本效益的。即使是适度有效的疫苗也可以为艾滋病毒/艾滋病的可持续应对做出巨大贡献，而且即使对其他干预措施有乐观的假设，也是具有成本效益的。更高的效力将产生更大的影响和成本效益，并将支持更广泛的获取。疫苗效力和每种方案的成本对于实现成本效益至关重要，在低收入国家和较低的疗效水平上，每种方案的成本尤其关键。
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). 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. An 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. If 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. Even 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.