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HIV diagnoses fall by a quarter after PrEP roll-out in Australia

BMJ 2018; 363 doi: (Published 18 October 2018) Cite this as: BMJ 2018;363:k4382
  1. Ingrid Torjesen
  1. London

Giving pre-exposure prophylaxis (PrEP) to a proportion of men who have sex with men was effective at reducing the number of HIV diagnoses in the community, a study has found.

HIV diagnoses in gay men fell by 25% in the first year after the roll-out of PrEP in new South Wales, Australia, by which time about 20% of HIV negative gay men were receiving PrEP, the authors said in the Lancet HIV journal.1

The number of new HIV diagnoses in men in New South Wales who have sex with men dropped from 295 in the 12 months before PrEP roll-out (1 March 2015 to 28 February 2016) to 221 in the year after (relative risk reduction 25.1% (95% confidence interval 10.5% to 37.4%)), the lowest level recorded since HIV surveillance began in 1985.

A decline was seen in recently acquired HIV infections and in other HIV diagnoses. The number of recent HIV infections fell by almost a third, from 149 in the year before PrEP roll-out to 102 the year after (31.5% (11.3% to 47.3%)), while other HIV diagnoses dropped from 146 to 119 a year (18.5% (–4.5% to +36.6%)).

The authors followed 3700 men who had free PrEP dispensed at 21 clinics in New South Wales during the first eight months of PrEP roll-out (1 March to 31 October 2016) and found high adherence to the co-formulated tenofovir disoproxil fumarate and emtricitabine daily regimen (median medication possession ratio 96.7%).

However, about three in 10 men had a medication possession ratio of under 80%. The authors suggested that this could reflect poor adherence but may also indicate intermittent use of PrEP to coincide with a period of high risk behaviour.

Only two new HIV infections were documented among 3700 men given PrEP during follow-up of at least a year to 31 October 2017, and both men had been non-adherent to PrEP at the time of infection.

The authors reported that, one year after being offered PrEP, the incidence of HIV infection was less than one in 2000 a year in the cohort, compared with an expected incidence of at least two per 100 a year. However, they noted that some infections may have been missed, if men did not attend the final HIV test at 12 months.

The NHS began providing PrEP to 10 000 men through an implementation study in selected clinics from September 2017,2 and reductions in HIV diagnoses in London have been attributed to PrEP provided through that study, PrEP sourced through trials and privately, and increased testing and treatment.1


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