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A Dynamic HIV-Transmission Model for Evaluating the Costs and Benefits of Vaccine Programs

Systems Research Department (MS-9201), Sandia National Laboratories, PO Box 969, Livermore, California 94551-0969
Department of Engineering-Economic Systems and Operations Research, Stanford University, Stanford, California 94305
VA Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, California 94304 and Department of Medicine, Stanford University, Stanford, California 94305

We developed a dynamic model of HIV transmission to evaluate the costs and benefits of HIV-vaccine programs in a population of homosexual men. We examined how changes in high-risk sexual behavior and the growth pattern of the epidemic influence the cost-effectiveness of preventive vaccines and of therapeutic vaccines. We found that the effect of reductions in condom use is more important for therapeutic vaccines than for preventive vaccines. Therapeutic vaccines may increase HIV seroprevalence in the population, unless the vaccine program is accompanied by increased condom use. Epidemic growth patterns also influence the cost-effectiveness of both vaccines, but the effects are more pronounced for preventive vaccines, which are more cost-effective in an early-stage epidemic than in a late-stage epidemic.

Key Words: health care; epidemiology; dynamic programming; models