Estimation of "needs" and "probable uptake" for HIV/AIDS preventive vaccines based on possible policies and likely acceptance (a WHO/UNAIDS/IAVI study).

Once an effective HIV vaccine is discovered, a major challenge will be to ensure its world wide access. A preventive vaccine with low or moderate efficacy (30-50%) could be a valuable prevention tool, especially if targeted to populations at higher risk of HIV infection. High efficacy vaccines (80-90%) could be used in larger segments of the population. Estimated "needs" for future HIV vaccines were based on anticipated policies regarding target populations. Estimated "needs" were adjusted for "accessibility" and "acceptability" in the target populations, to arrive at an estimate of "probable uptake", i.e. courses of vaccine likely to be delivered. With a high efficacy vaccine, global needs are in the order of 690 million full immunization courses, targeting 22 and 69%, respectively, of the 15-49 years old, world wide and in sub-Saharan Africa, respectively. With a low/moderate efficacy vaccine targeted to populations at higher risk of HIV infection, the global needs were estimated to be 260 million full immunization courses, targeting 8 and 41%, respectively, of the world and sub-Saharan African population aged 15-49 years. The current estimate of probable uptake for hypothetical HIV vaccines, using existing health services and delivery systems, was 38% of the estimated need for a high efficacy vaccine, and 19% for a low/moderate efficacy vaccine. Bridging the gap between the estimated needs and the probable uptake for HIV vaccines will represent a major public health challenge for the future. The potential advantages and disadvantages of targeted versus universal vaccination will have to be considered.