TY - JOUR
T1 - Population-level effectiveness of rapid, targeted, high-coverage roll-out of HIV pre-exposure prophylaxis in men who have sex with men
T2 - the EPIC-NSW prospective cohort study
AU - Expanded PrEP Implementation in Communities New South Wales (EPIC-NSW) research group
AU - Grulich, Andrew E.
AU - Guy, Rebecca
AU - Amin, Janaki
AU - Jin, Fengyi
AU - Selvey, Christine
AU - Holden, Jo
AU - Schmidt, Heather Marie A.
AU - Zablotska, Iryna
AU - Price, Karen
AU - Whittaker, Bill
AU - Chant, Kerry
AU - Cooper, Craig
AU - McGill, Scott
AU - Telfer, Barbara
AU - Yeung, Barbara
AU - Levitt, Gesalit
AU - Ogilvie, Erin E.
AU - Dharan, Nila J.
AU - Hammoud, Mohamed A.
AU - Vaccher, Stefanie
AU - Watchirs-Smith, Lucy
AU - McNulty, Anna
AU - Smith, David J.
AU - Allen, Debra M.
AU - Baker, David
AU - Bloch, Mark
AU - Bopage, Rohan I.
AU - Brown, Katherine
AU - Carr, Andrew
AU - Carmody, Christopher J.
AU - Collins, Kym L.
AU - Finlayson, Robert
AU - Foster, Rosalind
AU - Jackson, Eva Y.
AU - Lewis, David A.
AU - Lusk, Josephine
AU - O'Connor, Catherine C.
AU - Ryder, Nathan
AU - Vlahakis, Emanuel
AU - Read, Phillip
AU - Cooper, David A.
AU - Smith, Don
AU - Ooi, Catriona
AU - Martin, Sarah
AU - Soo, Tuck Meng
AU - Templeton, David
AU - Townson, David
AU - Forssman, Brad
AU - Doong, Nick
AU - Han Thai, Gai
N1 - Publisher Copyright:
© 2018 Elsevier Ltd
PY - 2018/11
Y1 - 2018/11
N2 - 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 ClinicalTrials.gov, 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.
AB - 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 ClinicalTrials.gov, 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.
UR - http://www.scopus.com/inward/record.url?scp=85055338221&partnerID=8YFLogxK
U2 - 10.1016/S2352-3018(18)30215-7
DO - 10.1016/S2352-3018(18)30215-7
M3 - Article
C2 - 30343026
AN - SCOPUS:85055338221
SN - 2352-3018
VL - 5
SP - e629-e637
JO - The Lancet HIV
JF - The Lancet HIV
IS - 11
ER -
