Nicholas Tan1, Monisha Sharma2, Rachel Winer2, Denise Galloway3, Helen Rees4, Ruanne V Barnabas5. 1. Department of Global Health, University of Washington, Seattle, WA, USA. 2. Department of Global Health, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA. 3. Department of Global Health, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA; School of Medicine, University of Washington, Seattle, WA, USA; Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA. 4. Wits Reproductive Health and HIV Institute, University of Witwatersrand, Johannesburg, South Africa. 5. Department of Global Health, University of Washington, Seattle, WA, USA; Department of Epidemiology, University of Washington, Seattle, WA, USA; School of Medicine, University of Washington, Seattle, WA, USA; Vaccine and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA. Electronic address: rbarnaba@uw.edu.
Abstract
BACKGROUND: Women in sub-Saharan Africa have high dual burden of HPV and HIV infections, which can interact to increase cervical cancer (CC) risk. The 9-valent HPV (9vHPV) vaccine has high demonstrated effectiveness against HPV types causing 90% of CC. Additionally, one dose of the 9vHPV vaccine has the potential to achieve greater coverage at lower costs than a two-dose schedule. However, the potential impact of single-dose 9vHPV vaccine accounting for HPV-HIV interactions has not been estimated. METHODS: We adapted a dynamic HIV transmission model to include HPV acquisition and CC pathogenesis and projected the impact of a single dose 9vHPV preadolescent vaccination in KwaZulu-Natal, South Africa. We report health impacts of HPV vaccination separately for HIV-positive women stratified by HIV treatment and CD4 count and HIV-negative women. RESULTS: At 90% coverage of females age 9 years with 80% lifelong vaccine efficacy, single dose HPV vaccination was projected to reduce CC incidence by 74% and mortality by 71% in the general female population at 70 years after the start of the vaccination program. Age-standardized CC incidence and mortality reductions were comparable among HIV-negative women, HIV-positive women, and HIV-positive women on ART. Health benefits were reduced when assuming waning protection at 10, 15 and 20 years after vaccination. DISCUSSION: Single dose 9vHPV vaccination is projected to avert substantial CC burden in South Africa and similar high HIV prevalence settings. Health benefits were comparable across all female subpopulations stratified by HIV status, CD4 count, and ART status.
BACKGROUND:Women in sub-Saharan Africa have high dual burden of HPV and HIV infections, which can interact to increase cervical cancer (CC) risk. The 9-valent HPV (9vHPV) vaccine has high demonstrated effectiveness against HPV types causing 90% of CC. Additionally, one dose of the 9vHPV vaccine has the potential to achieve greater coverage at lower costs than a two-dose schedule. However, the potential impact of single-dose 9vHPV vaccine accounting for HPV-HIV interactions has not been estimated. METHODS: We adapted a dynamic HIV transmission model to include HPV acquisition and CC pathogenesis and projected the impact of a single dose 9vHPV preadolescent vaccination in KwaZulu-Natal, South Africa. We report health impacts of HPV vaccination separately for HIV-positive women stratified by HIV treatment and CD4 count and HIV-negative women. RESULTS: At 90% coverage of females age 9 years with 80% lifelong vaccine efficacy, single dose HPV vaccination was projected to reduce CC incidence by 74% and mortality by 71% in the general female population at 70 years after the start of the vaccination program. Age-standardized CC incidence and mortality reductions were comparable among HIV-negative women, HIV-positive women, and HIV-positive women on ART. Health benefits were reduced when assuming waning protection at 10, 15 and 20 years after vaccination. DISCUSSION: Single dose 9vHPV vaccination is projected to avert substantial CC burden in South Africa and similar high HIV prevalence settings. Health benefits were comparable across all female subpopulations stratified by HIV status, CD4 count, and ART status.
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Authors: Ruanne V Barnabas; Elizabeth R Brown; Maricianah Onono; Elizabeth A Bukusi; Betty Njoroge; Rachel L Winer; Deborah Donnell; Denise Galloway; Stephen Cherne; Kate Heller; Hannah Leingang; Susan Morrison; Elena Rechkina; R Scott McClelland; Jared M Baeten; Connie Celum; Nelly Mugo Journal: Trials Date: 2021-09-27 Impact factor: 2.279
Authors: Gui Liu; Nelly R Mugo; Cara Bayer; Darcy White Rao; Maricianah Onono; Nyaradzo M Mgodi; Zvavahera M Chirenje; Betty W Njoroge; Nicholas Tan; Elizabeth A Bukusi; Ruanne V Barnabas Journal: EClinicalMedicine Date: 2022-02-19
Authors: Darcy White Rao; Cara J Bayer; Gui Liu; Admire Chikandiwa; Monisha Sharma; Christine L Hathaway; Nicholas Tan; Nelly Mugo; Ruanne V Barnabas Journal: J Int AIDS Soc Date: 2022-10 Impact factor: 6.707