Effectiveness of UNAIDS targets and HIV vaccination across 127 countries

PNAS – Proceedings of the National Academy of Sciences of the United States
of America
http://www.pnas.org/content/early/
[Accessed 25 March 2017]

Biological Sciences – Population Biology:
Effectiveness of UNAIDS targets and HIV vaccination across 127 countries
Jan Medlock, Abhishek Pandey, Alyssa S. Parpia, Amber Tang, Laura A. Skrip, and Alison P. Galvani
PNAS 2017 ; published ahead of print March 20, 2017, doi:10.1073/pnas.1620788114
Significance
Despite extraordinary advances in the treatment of HIV, the global pandemic has yet to be reversed. We developed a mathematical model for 127 countries to evaluate Joint United Nations Program on HIV/AIDS (UNAIDS) targets for expanding diagnosis and treatment of the infected, and partially efficacious HIV vaccination. Under the current levels of diagnosis and treatment, we estimated 49 million new HIV cases globally from 2015 to 2035. Achieving the ambitious UNAIDS target is predicted to avert 25 million of these new infections, with an additional 6.3 million averted by the 2020 introduction of a 50%-efficacy vaccine. Our study provides country-specific impacts of a partially effective HIV vaccine and demonstrates its importance to the elimination of HIV transmission globally.
Abstract
The HIV pandemic continues to impose enormous morbidity, mortality, and economic burdens across the globe. Simultaneously, innovations in antiretroviral therapy, diagnostic approaches, and vaccine development are providing novel tools for treatment-as-prevention and prophylaxis. We developed a mathematical model to evaluate the added benefit of an HIV vaccine in the context of goals to increase rates of diagnosis, treatment, and viral suppression in 127 countries. Under status quo interventions, we predict a median of 49 million [first and third quartiles 44M, 58M] incident cases globally from 2015 to 2035. Achieving the Joint United Nations Program on HIV/AIDS 95–95–95 target was estimated to avert 25 million [20M, 33M] of these new infections, and an additional 6.3 million [4.8M, 8.7M] reduction was projected with the 2020 introduction of a 50%-efficacy vaccine gradually scaled up to 70% coverage. This added benefit of prevention through vaccination motivates imminent and ongoing clinical trials of viable candidates to realize the goal of HIV control.