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Population-Level PrEP Roll-Out Associated With Rapid Decline in HIV Diagnoses

Jaime Rosenberg

The first study to evaluate population-level roll-out of pre-exposure prophylaxis (PrEP) for HIV in men who have sex with men has demonstrated rapid decline of new HIV infections, researchers reported.

According to the study, rapid, targeted, and high-coverage roll-out of PrEP in New South Wales, Australia, led to a 25% reduction in HIV diagnoses in just 1 year.

“Our results support the population-level effectiveness of PrEP 1 year after rapid implementation at scale,” Andrew Grulich, professor, Kirby Institute, University of New South Wales, and lead author of the study, said in a statement. “PrEP is a highly effective preventive approach when implemented alongside high levels of HIV testing and treatment. Roll-out should be prioritized as a crucial component of HIV prevention in epidemics predominantly affecting men who have sex with men.”

The study recruited 3700 men at high risk of HIV infection who took a daily, single-dose of oral emtricitabine/tenofovir disoproxil fumarate, marketed as Truvada, between March 1, 2016, and October 21, 2016. The men, followed for a year, were tested for HIV at 1 month, 3 months, and every 3 months thereafter.

During the study period, the amount of participants who attended follow-up visits declined, dropping from 88% at 1 months and 90% at 3 months to 76% at 12 months. However, nearly all (97%) participants took the treatment more than once, and median medication possession over the 12 months was 97.8%. Less than one-third (30%) of participants had adherence below 80%, and these participants were also less likely to attend follow-up visits.

By the end of follow-up, just 2 of the men were diagnosed with HIV, both of which were nonadherent to PrEP. With a total of 4100 person-years of follow-up among 3638 patients with a record of at least 1 HIV test after baseline, the HIV incidence was 0.048 per 100 person-years. The researchers observed a 31.5% decline in recent HIV infections and an 18.5% decline in other HIV diagnoses.

“The number of HIV diagnoses in men who has sex with men in New South Wales declined from 295 in the 12 months before PrEP roll-out to 221 in in the 12 months after PrEP roll-out, the lowest annual HIV diagnosis count in men who have sex with men recorded in New South Wales since the beginning of HIV surveillance in 1985,” wrote the researchers.

Declines were seen across all ages but were greatest in men aged 45 and older.

In addition to significantly lowering the risk of acquiring HIV, PrEP has been shown to serve as a gateway to primary care. Previous research has found that PrEP usage is linked ot routine care, such as infleunza vaccination, tobaco and depression screening, and glucose testing.

Reference:
Grulich A, Guy R, Amin J, et al. Population-level effectiveness of rapid, targeted, high-coverage roll-out of HIV pre-exposure prophylaxis in men who have sex with men: the EPIC-NSW prospective cohort study. [published October 17, 2018]. Lancet HIV. doi: https://doi.org/10.1016/S2352-3018(18)30215-7.
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