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. Issue 11 (November 2018)

• Record Type: Journal Article
• Authors: Grulich, Andrew E; Guy, Rebecca; Amin, Janaki; Jin, Fengyi; Selvey, Christine; Holden, Jo; Schmidt, Heather-Marie A; Zablotska, Iryna; Price, Karen; Whittaker, Bill; Chant, Kerry; Cooper, Craig; McGill, Scott; Telfer, Barbara; Yeung, Barbara; Levitt, Gesalit; Ogilvie, Erin E; Dharan, Nila J; Hammoud, Mohamed A; Vaccher, Stefanie; Watchirs-Smith, Lucy; McNulty, Anna; Smith, David J; Allen, Debra M; Baker, David; Bloch, Mark; Bopage, Rohan I; Brown, Katherine; Carr, Andrew; Carmody, Christopher J; Collins, Kym L; Finlayson, Robert; Foster, Rosalind; Jackson, Eva Y; Lewis, David A; Lusk, Josephine; O'Connor, Catherine C; Ryder, Nathan; Vlahakis, Emanuel; Read, Phillip; Cooper, David A;
• Is Part Of: Lancet. Volume 5:Issue 11(2018)
• Page Start: e629
• Page End: e637
• Publication Date: 2018-11
• Subjects: HIV (Viruses) -- Periodicals; HIV infections -- Periodicals; AIDS (Disease) -- Periodicals; 616.9792
• DOI: 10.1016/S2352-3018(18)30215-7
• Languages: English
• ISSNs: 2405-4704

Abstract

Summary: Background: HIV pre-exposure prophylaxis (PrEP) is highly effective in men who have sex with men (MSM) at the individual level, but data on population-level impact are lacking. We examined whether rapid, targeted, and high-coverage roll-out of PrEP in an MSM epidemic would reduce HIV incidence in the cohort prescribed PrEP and state-wide in Australia's most populous state, New South Wales. Methods: The Expanded PrEP Implementation in Communities–New South Wales (EPIC-NSW) study is an implementation cohort study of daily co-formulated tenofovir disoproxil fumarate and emtricitabine as HIV PrEP. We recruited high-risk gay men in a New South Wales-wide network of 21 clinics. We report protocol-specified co-primary outcomes at 12 months after recruitment of the first 3700 participants: within-cohort HIV incidence; and change in population HIV diagnoses in New South Wales between the 12-month periods before and after PrEP roll-out. The study is registered withClinicalTrials.gov, numberNCT02870790 . Findings: We recruited 3700 participants in the 8 months between March 1, 2016, and Oct 31, 2016. 3676 (99%) were men, 3534 (96%) identified as gay, and 149 (4%) as bisexual. Median age was 36 years (IQR 30–45 years). Overall, 3069 (83%) participants attended a visit at 12 months or later. Over 4100 person-years, two men became infected with HIV (incidence 0·048 per 100 person-years, 95% CI 0·012–0·195). Both had been non-adherent to PrEP. HIV diagnoses in MSM in New South Wales declined from 295 in the 12 months before PrEP roll-out to 221 in the 12 months after (relative risk reduction [RRR] 25·1%, 95% CI 10·5–37·4). There was a decline both in recent HIV infections (from 149 to 102, RRR 31·5%, 95% CI 11·3 to 47·3) and in other HIV diagnoses (from 146 to 119, RRR 18·5%, 95% CI −4·5 to 36·6). Interpretation: PrEP implementation was associated with a rapid decline in HIV diagnoses in the state of New South Wales, which was greatest for recent infections. As part of a combination prevention approach, rapid, targeted, high-coverage PrEP implementation is effective to reduce new HIV infections at the population level. Funding: New South Wales Ministry of Health, Gilead Sciences.