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EuropePMC; 2022.
Preprint in English | EuropePMC | ID: ppcovidwho-334185


Background: Tuberculosis is a leading infectious cause of death worldwide. Novel vaccines will be required to reach global targets and reverse setbacks from the COVID-19 pandemic. We estimated the impact of novel tuberculosis vaccines in low- and middle-income countries (LMICs), under alternative delivery scenarios. Methods: We calibrated a tuberculosis model to 105 LMICs (93% of global incidence). Vaccine scenarios were implemented as Basecase routine vaccination of 9-year-olds and a one-time vaccination campaign for ages ≥10 with country-specific introduction between 2028[ndash]2047 and 5-year scale-up to target coverage;Accelerated Scale-up as Basecase , but all countries introducing in 2025 with instant scale-up;and Routine Only as Basecase , but routine vaccination only. Vaccines protected against disease for 10-years, with 50% efficacy. Findings: The Basecase scenario reduced tuberculosis incidence (19.5% [95% uncertainty range=18.3–21.6%]) and mortality (20.6% [19.2–23.4%]) rates in 2050 and prevented 3.6 (3.3–3.9) million deaths before 2050, including 1.6 million in the WHO South-East Asian region. The Accelerated Scale-up scenario reduced tuberculosis incidence (25.2% [23.9–27.5%]), mortality (26.7% [25.2–29.9%]), and prevented 7.9 (7.3–8.5) million deaths. The Routine Only scenario reduced tuberculosis incidence (9.9% [9.0–11.6%]), mortality (9.9% [8.9–12.3%]), and prevented 1.1 (0.9–1.2) million deaths. Interpretations Novel tuberculosis vaccines could have substantial impact, which will vary depending on delivery strategy. Including a campaign will be crucial for rapid impact. Accelerated introduction similar to the pace of COVID-19 vaccines could approximately double the lives saved before 2050. Investment is required to support vaccine development, manufacturing, prompt introduction and scale-up. Funding WHO (2020/985800-0)

J Acquir Immune Defic Syndr ; 87(3): 899-911, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1169727


BACKGROUND: The COVID-19 pandemic indirectly impacts HIV epidemiology in Central/West Africa. We estimated the potential impact of COVID-19-related disruptions to HIV prevention/treatment services and sexual partnerships on HIV incidence and HIV-related deaths among key populations including female sex workers (FSW), their clients, men who have sex with men, and overall. SETTING: Yaoundé (Cameroon) and Cotonou (Benin). METHODS: We used mathematical models of HIV calibrated to city population-specific and risk population-specific demographic/behavioral/epidemic data. We estimated the relative change in 1-year HIV incidence and HIV-related deaths for various disruption scenarios of HIV prevention/treatment services and decreased casual/commercial partnerships, compared with a scenario without COVID-19. RESULTS: A 50% reduction in condom use in all partnerships over 6 months would increase 1-year HIV incidence by 39%, 42%, 31%, and 23% among men who have sex with men, FSW, clients, and overall in Yaoundé, respectively, and 69%, 49%, and 23% among FSW, clients, and overall, respectively, in Cotonou. Combining a 6-month interruption of ART initiation and 50% reduction in HIV prevention/treatment use would increase HIV incidence by 50% and HIV-related deaths by 20%. This increase in HIV infections would be halved by a simultaneous 50% reduction in casual and commercial partnerships. CONCLUSIONS: Reductions in condom use after COVID-19 would increase infections among key populations disproportionately, particularly FSW in Cotonou, who need uninterrupted condom provision. Disruptions in HIV prevention/treatment services have the biggest impacts on HIV infections and deaths overall, only partially mitigated by equal reductions in casual/commercial sexual partnerships. Maintaining ART provision must be prioritized to minimize short-term excess HIV-related deaths.

COVID-19/complications , COVID-19/epidemiology , HIV Infections/complications , HIV Infections/epidemiology , HIV-1 , SARS-CoV-2 , Benin/epidemiology , Cameroon/epidemiology , Condoms , Female , Humans , Male , Models, Biological , Risk Factors , Safe Sex , Sex Workers , Urban Population