The potential effect of an HIV/AIDS vaccine in South Africa

Johnson, Leigh; Dorrington, Robert

doi:10.4314/saaj.v7i1.24509

Cited by 4 publications

(3 citation statements)

References 21 publications

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“…This is difficult to know a priori and was not included in the analysis, and therefore remains an area important to explore in close collaboration with implementers of HIV prevention programs. We did not model risk compensation [ 15 , 51 ] i.e. increases in risky behavior by vaccine recipients, bearing in mind that a partially effective vaccine might necessitate additional counseling to prevent the false impression of full protection.…”

Section: Discussionmentioning

confidence: 99%

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

Selinger

Bershteyn

Dimitrov

et al. 2019

Vaccine

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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.

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Section: Discussionmentioning

confidence: 99%

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

Selinger

Bershteyn

Dimitrov

et al. 2019

Vaccine

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“…We studied adults (aged ≥15 years) with both HIV and SARS-CoV-2 infections who utilized public sector healthcare in the WC. The WC has about 5.5 million people aged ≥15 years with an estimated HIV prevalence of 14.2% among women and 7.7% among men [15,16]. Approximately 75% of the population are dependent on public sector health services, but a greater proportion among PWH [17].…”

Section: E T H O D S 21 Study Population and Data Sourcesmentioning

confidence: 99%

COVID‐19 among adults living with HIV: correlates of mortality among public sector healthcare users in Western Cape, South Africa

et al. 2023

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Introduction While a large proportion of people with HIV (PWH) have experienced SARS‐CoV‐2 infections, there is uncertainty about the role of HIV disease severity on COVID‐19 outcomes, especially in lower‐income settings. We studied the association of mortality with characteristics of HIV severity and management, and vaccination, among adult PWH. Methods We analysed observational cohort data on all PWH aged ≥15 years experiencing a diagnosed SARS‐CoV‐2 infection (until March 2022), who accessed public sector healthcare in the Western Cape province of South Africa. Logistic regression was used to study the association of mortality with evidence of antiretroviral therapy (ART) collection, time since first HIV evidence, CD4 cell count, viral load (among those with evidence of ART collection) and COVID‐19 vaccination, adjusting for demographic characteristics, comorbidities, admission pressure, location and time period. Results Mortality occurred in 5.7% (95% CI: 5.3,6.0) of 17,831 first‐diagnosed infections. Higher mortality was associated with lower recent CD4, no evidence of ART collection, high or unknown recent viral load and recent first HIV evidence, differentially by age. Vaccination was protective. The burden of comorbidities was high, and tuberculosis (especially more recent episodes of tuberculosis), chronic kidney disease, diabetes and hypertension were associated with higher mortality, more strongly in younger adults. Conclusions Mortality was strongly associated with suboptimal HIV control, and the prevalence of these risk factors increased in later COVID‐19 waves. It remains a public health priority to ensure PWH are on suppressive ART and vaccinated, and manage any disruptions in care that occurred during the pandemic. The diagnosis and management of comorbidities, including for tuberculosis, should be optimized.

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“…Orphan numbers for South Africa are predicted to reach 2.3 million in 2020 (2) and it is estimated that by 2015 approximately 15% of all children under the age of 15 will be orphaned (3). The global number of children orphaned by AIDS (accounted for mostly by developing countries) is estimated to be 25 million by the year 2020 (4).…”

Section: Introductionmentioning

confidence: 99%

First Evaluation of a Population-Based Screen to Detect Emotional-Behavior Disorders in Orphaned Children in Sub-Saharan Africa

et al. 2014

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Due to the HIV/AIDS pandemic which has left 12 million children orphaned in Sub-Saharan Africa, children are at increased risk for mental health problems. Currently, no validity data exist for any screening measure of emotional-behavior disorders in pre-adolescent children in Sub-Saharan Africa. The aims of the current study were to evaluate the construct validity of the caregiver-, teacher-, and self-report versions of the one-page Strengths and Difficulties Questionnaire (SDQ) in 466 orphans in South Africa between the ages of 7 and 11 (Mage = 9.23 years, SD = 1.33, 51.93% female) and to provide, for the first time, clinical cut-offs for this population. Findings demonstrated support for the caregiver SDQ, but not the teacher and selfreport versions. We provide clinical cut-offs, but caution their use before further research is conducted. There remains a critical need for further psychometric studies of the SDQ in the developing world.

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The potential effect of an HIV/AIDS vaccine in South Africa

Cited by 4 publications

References 21 publications

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

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

COVID‐19 among adults living with HIV: correlates of mortality among public sector healthcare users in Western Cape, South Africa

First Evaluation of a Population-Based Screen to Detect Emotional-Behavior Disorders in Orphaned Children in Sub-Saharan Africa

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