title: Potential future impact of a partially effective HIV vaccine in a southern African setting.
abstract: BACKGROUND
  It is important for public health and within the HIV vaccine development field to understand the potential population level impact of an HIV vaccine of partial efficacy--both in preventing infection and in reducing viral load in vaccinated individuals who become infected--in the context of a realistic future implementation scenario in resource limited settings.
  
  
  METHODS
  An individual level model of HIV transmission, progression and the effect of antiretroviral therapy was used to predict the outcome to 2060 of introduction in 2025 of a partially effective vaccine with various combinations of efficacy characteristics, in the context of continued ART roll-out in southern Africa.
  
  
  RESULTS
  In the context of our base case epidemic (in 2015 HIV prevalence 28% and incidence 1.7 per 100 person years), a vaccine with only 30% preventative efficacy could make a substantial difference in the rate with which HIV incidence declines; the impact on incidence in relative terms is projected to increase over time, with a projected 67% lower HIV incidence in 2060 compared with no vaccine introduction. The projected mean decline in the general adult population death rate 2040-2060 is 11%. A vaccine with no prevention efficacy but which reduces viral load by 1 log is predicted to result in a modest (14%) reduction in HIV incidence and an 8% reduction in death rate in the general adult population (mean 2040-2060). These effects were broadly similar in multivariable uncertainty analysis.
  
  
  CONCLUSIONS
  Introduction of a partially effective preventive HIV vaccine would make a substantial long-term impact on HIV epidemics in southern Africa, in addition to the effects of ART. Development of an HIV vaccine, even of relatively low apparent efficacy at the individual level, remains a critical global public health goal.
authors.affiliation: Research Department of Infection & Population Health, University College London, London, United Kingdom.
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Phillips
authors.affiliation: Research Department of Infection & Population Health, University College London, London, United Kingdom.
authors.forename: Valentina
authors.initials: V
authors.lastname: Cambiano
authors.affiliation: Research Department of Infection & Population Health, University College London, London, United Kingdom.
authors.forename: Fumiyo
authors.initials: F
authors.lastname: Nakagawa
authors.affiliation: Institute of Clinical Trials and Methodology, University College London, London, United Kingdom.
authors.forename: Deborah
authors.initials: D
authors.lastname: Ford
authors.affiliation: CHIP, Department of Infectious Diseases, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jens D
authors.initials: JD
authors.lastname: Lundgren
authors.affiliation: GlaxoSmithKline Vaccines, Wavre, Belgium.
authors.forename: Edith
authors.initials: E
authors.lastname: Roset-Bahmanyar
authors.affiliation: GlaxoSmithKline Vaccines, Wavre, Belgium.
authors.forename: François
authors.initials: F
authors.lastname: Roman
authors.affiliation: GlaxoSmithKline Vaccines, Wavre, Belgium.
authors.forename: Thierry
authors.initials: T
authors.lastname: Van Effelterre
mesh_terms: D016915:AIDS Vaccines / Q000008:administration & dosage* / Q000096:biosynthesis / Q000276:immunology; D000328:Adult; D000353:Africa, Southern / Q000453:epidemiology; D058872:Epidemics; D005260:Female; D006678:HIV / Q000276:immunology; D015658:HIV Infections / Q000453:epidemiology* / Q000276:immunology / Q000517:prevention & control* / Q000821:virology; D006801:Humans; D017589:Immunization Programs; D015994:Incidence; D008297:Male; D015233:Models, Statistical; D015995:Prevalence; D014611:Vaccination; D019562:Viral Load / Q000187:drug effects
chemical_list: D016915:AIDS Vaccines