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Title: 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
Authors: Allen, Debra M ;Smith, David J ;Grulich, A.E.;Guy, R.;Amin, J.;Jin, F.;Selvey, C.;Holden, J.;Schmidt, H.A.;Zablotska, I.;Price, K.;Whittaker, B.;Chant, K.;Cooper, C.;McGill, S.;Telfer, B.;Yeung, B.;Levitt, G.;Ogilvie, E.E.;Dharan, N.J.;Hammoud, M.A.;Vaccher, S.;Watchirs-Smith, L.;McNulty, A.;Baker, D.;Bloch, M.;Bopage, R.I.;Brown, K.;Carr, A.;Carmody, C.J.;Collins, K.L.;Finlayson, R.;Foster, R.;Jackson, E.Y.;Lewis, D.A.;Lusk, J.;O'Connor, C.C.;Ryder, N.;Vlahakis, E.;Read, P.;Cooper, D.A.
Affliation: Central Coast Local Health District
Gosford Hospital
Issue Date: Nov-2018
Source: 5(11):e629-e637
Journal title: The Lancet HIV
Department: Sexual Health
Abstract: 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 with, number NCT02870790. 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.
DOI: 10.1016/s2352-3018(18)30215-7
ISSN: 2352-3018
Publicaton type: Journal Article
Keywords: Public Health
Drug Therapy
Appears in Collections:Health Service Research

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