The Case for Adolescent HIV Vaccination in South Africa

Abstract

Despite comprising 0.7% of the world population, South Africa is home to 18% of the global human immunodeficiency virus (HIV) prevalence. Unyielding HIV subepidemics among adolescents threaten national attempts to curtail the disease burden. Should an HIV vaccine become available, establishing its point of entry into the health system becomes a priority. This study assesses the impact of school-based HIV vaccination and explores how variations in vaccine characteristics affect cost-effectiveness.The cost per quality adjusted life year (QALY) gained associated with school-based adolescent HIV vaccination services was assessed using Markov modeling that simulated annual cycles based on national costing data. The estimation was based on a life expectancy of 70 years and employs the health care provider perspective.The simultaneous implementation of HIV vaccination services with current HIV management programs would be cost-effective, even at relatively higher vaccine cost. At base vaccine cost of US$ 12, the incremental cost effectiveness ratio (ICER) was US$ 43 per QALY gained, with improved ICER values yielded at lower vaccine costs. The ICER was sensitive to duration of vaccine mediated protection and variations in vaccine efficacy. Data from this work demonstrate that vaccines offering longer duration of protection and at lower cost would result in improved ICER values.School-based HIV vaccine services of adolescents, in addition to current HIV prevention and treatment health services delivered, would be cost-effective.

Economic evaluation of safety-engineered devices and training in reducing needlestick injuries among healthcare workers in South Africa

“…Transition probabilities are summarised in Table 1. Self-reported incidence data of NSIs suffer from significant under-reporting, so Transition probabilities* Annual attrition rate 0.031 0.024 -0.038 [44] Annual probability of NSI HIV transmission 0.0023 Beta [41] Effectiveness PEP 0.81 0.43 -0.94 [42,43] HIV progression Asymptomatic to symptomatic 0.32 [48] Symptomatic to AIDS 0.20 [48] Annual mortality rate (probability*) Asymptomatic HIV 0.0148 [49] Symptomatic HIV 0.0169 [49] AIDS 0.21 [49] NSI = needlestick injury; PEP = post-exposure prophylaxis. *1 = absolute certainty an event will occur, 0 = absolute certainty an event will not occur.…”

Cost-Effectiveness of Interventions to Prevent HIV Acquisition

“…Subsequent analyses for tenofovir gel estimated a cost of less than US$300 per DALY averted (Terris-Prestholt and others 2014), assuming effectiveness. Similarly, the incremental cost-effectiveness for an HIV vaccine, also assuming effectiveness, was US$43 per DALY averted (Moodley, Gray, and Bertram 2016). A study of female condom program modeling found a low of US$107 per DALY averted in Zimbabwe and a high of US$303 per DALY averted in Mozambique, assuming that condoms would be used and would be effective (Mvundura and others 2015).…”

The future of a partially effective HIV vaccine: assessing limitations at the population level

“…Such vaccine could be seen as a first-generation product that must still be improved upon in order to fundamentally transform the HIV epidemic. Mathematical models [23,19,39,6,18,26,25,16,31,5,24] suggest that the first-generation vaccine would be useful and cost-effective to roll out, but that its overall impact will be modest. Here, we explore what factors contribute collectively to limiting the impact of such a vaccine.…”