New tuberculosis vaccines for people with HIV

In 2024, tuberculosis (TB) caused 160 000 deaths in people with HIV (PWH). Several new TB vaccines are in development. The best way to use new vaccines to reduce the TB burden in PWH, and how this may vary by setting, is unknown.

We used a mathematical model to simulate TB vaccination in 15 high HIV/TB burden countries with varying HIV prevalence and ART coverage. We estimated the impact of vaccination with 50% efficacy against TB disease targeted by HIV status and explored how the impact depends on assumptions about vaccine efficacy by HIV and ART status.

Vaccines that do not work or are contraindicated in PWH could avert 5-13% of cases in PWH between 2030 and 2050 through the indirect effect of vaccinating people without HIV. Vaccines that were equally effective in PWH and people without HIV could avert 19-25% of cases in PWH. The impact of strategies targeted by HIV status depended on country-specific factors. In countries with high ART coverage, vaccination of PWH may be more effective at averting cases in PWH than vaccination of HIV-uninfected individuals. Strategies targeting PWH are likely to be more efficient than those targeting HIV-uninfected individuals.

The most impactful way to use new TB vaccines to reduce the burden of TB in PWH will depend on setting-specific factors, including ART coverage and the efficacy of the vaccine in PWH. Vaccinating PWH is likely to be an efficient use of resources to reduce TB burden in PWH.