In the Journals

PrEP roll-out in Australia led to rapid decline in new HIV infections

A rapid, targeted roll-out of pre-exposure prophylaxis, or PrEP, in New South Wales, Australia, led to a 25% decline in new HIV diagnoses in just 1 year among men who have sex with men, researchers reported.

According to the CDC, PrEP can reduce the risk for HIV infection by up to 92% when taken consistently.

“HIV pre-exposure prophylaxis is highly effective in men who have sex with other men (MSM) at the individual level, but data on population-level impact are lacking,” Andrew E. Grulich, MBBS, PhD, professor and head of the HIV Epidemiology and Prevention Program in the Kirby Institute at the University of New South Wales, and colleagues wrote. “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 statewide in Australia’s most populous state, New South Wales.”

Grulich and colleagues recruited 3,700 high-risk gay men in 21 New South Wales clinics between March 1 and Oct. 31, 2016. All participants were given PrEP for free and underwent HIV testing at 1 and 3 months after enrollment into the trial, and then every 3 months.

According to the study, adherence to PrEP was high, with a median medication possession ratio (MPR) of 98% over the first 12 months. However, roughly 30% of participants had an MPR below 80%. According to the authors, this could indicate on-demand PrEP use or stopping use after a period of high-risk behavior.

Among the 3,700 participants, 3,645 (99%) were dispensed PrEP or had an HIV test at least once during follow-up at 1 month and 3,069 (83%) participants attended a visit at 12 months or later. During the year-long study, two men became infected with HIV; however, neither of them were adherent to PrEP, according to Grulich and colleagues.

HIV diagnoses among MSM in New South Wales declined from 295 in the 12 months before PrEP roll-out to 221 in the 12 months after, study findings showed.

“Our results support the population-level effectiveness of PrEP 1 year after rapid PrEP implementation at scale," Grulich said in a news release. "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.” – by Caitlyn Stulpin

Disclosures: Grulich reports receiving a grant from the New South Wales Ministry of Health and nonfinancial support from Gilead Sciences as well as grants and personal fees from Viiv Healthcare, grants from Seqirus Australia and Gilead, and personal fees from MSD, outside of the submitted work. Please see the study for all other authors’ relevant financial disclosures.

A rapid, targeted roll-out of pre-exposure prophylaxis, or PrEP, in New South Wales, Australia, led to a 25% decline in new HIV diagnoses in just 1 year among men who have sex with men, researchers reported.

According to the CDC, PrEP can reduce the risk for HIV infection by up to 92% when taken consistently.

“HIV pre-exposure prophylaxis is highly effective in men who have sex with other men (MSM) at the individual level, but data on population-level impact are lacking,” Andrew E. Grulich, MBBS, PhD, professor and head of the HIV Epidemiology and Prevention Program in the Kirby Institute at the University of New South Wales, and colleagues wrote. “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 statewide in Australia’s most populous state, New South Wales.”

Grulich and colleagues recruited 3,700 high-risk gay men in 21 New South Wales clinics between March 1 and Oct. 31, 2016. All participants were given PrEP for free and underwent HIV testing at 1 and 3 months after enrollment into the trial, and then every 3 months.

According to the study, adherence to PrEP was high, with a median medication possession ratio (MPR) of 98% over the first 12 months. However, roughly 30% of participants had an MPR below 80%. According to the authors, this could indicate on-demand PrEP use or stopping use after a period of high-risk behavior.

Among the 3,700 participants, 3,645 (99%) were dispensed PrEP or had an HIV test at least once during follow-up at 1 month and 3,069 (83%) participants attended a visit at 12 months or later. During the year-long study, two men became infected with HIV; however, neither of them were adherent to PrEP, according to Grulich and colleagues.

HIV diagnoses among MSM in New South Wales declined from 295 in the 12 months before PrEP roll-out to 221 in the 12 months after, study findings showed.

“Our results support the population-level effectiveness of PrEP 1 year after rapid PrEP implementation at scale," Grulich said in a news release. "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.” – by Caitlyn Stulpin

Disclosures: Grulich reports receiving a grant from the New South Wales Ministry of Health and nonfinancial support from Gilead Sciences as well as grants and personal fees from Viiv Healthcare, grants from Seqirus Australia and Gilead, and personal fees from MSD, outside of the submitted work. Please see the study for all other authors’ relevant financial disclosures.