Implementation of a national HIV pre-exposure prophylaxis service is associated with changes in characteristics of people with newly diagnosed HIV: a retrospective cohort study

Abstract

ObjectivesTo review characteristics of individuals newly diagnosed with HIV following implementation of a national pre-exposure prophylaxis (PrEP) programme (comprehensive PrEP services, delivered in sexual health clinics) to inform future delivery and broader HIV prevention strategies.MethodsWe extracted data from national HIV databases (July 2015–June 2018). We compared sociodemographic characteristics of individuals diagnosed in the period before and after PrEP implementation, and determined the proportion of ‘potentially preventable’ infections with the sexual health clinic–based PrEP delivery model used.ResultsThose diagnosed with HIV before PrEP implementation were more likely to be male (342/418, 81.8% vs 142/197, 72.1%, p=0.005), be white indigenous (327/418, 78.2% vs 126/197, 64.0%, p<0.001), report transmission route as sex between men (219/418, 52.4% vs 81/197, 41.1%, p=0.014), and have acquired HIV in the country of the programme (302/418, 72.2% vs 114/197, 57.9% p<0.001) and less likely to report transmission through heterosexual sex (114/418, 27.3% vs 77/197, 39.1%, p=0.002) than after implementation.Pre-implementation, 8.6% (36/418) diagnoses were ‘potentially preventable’ with the PrEP model used. Post-implementation, this was 6.6% (13/197), but higher among those with recently acquired HIV (49/170, 28.8%). Overall, individuals with ‘potentially preventable’ infections were more likely to be male (49/49, 100% vs 435/566, 76.9%, p<0.001), aged <40 years (37/49, 75.5% vs 307/566, 54.2%, p=0.004), report transmission route as sex between men (49/49, 100% vs 251/566, 44.3%, p<0.001), have previously received post-exposure prophylaxis (12/49, 24.5% vs 7/566, 1.2%, p<0.001) and less likely to be black African (0/49, 0% vs 67/566, 11.8%, p=0.010) than those not meeting this definition.ConclusionsThe sexual health clinic–based national PrEP delivery model appeared to best suit men who have sex with men and white indigenous individuals but had limited reach into other key vulnerable groups. Enhanced models of delivery and HIV combination prevention are required to widen access to individuals not benefiting from PrEP at present.

PrEP for women in Europe: a systematic literature review

“…Finally, 44 original studies represented in 45 peer‐reviewed articles were included. See Figure 1 [10–42] [43–53].…”

“…Six studies, including 1009 women, examined awareness of and willingness to use PrEP [14, 25, 32, 43, 48, 50]. Generally, PrEP awareness was low, but once information on PrEP was provided, most participants across these studies viewed PrEP as a potential prevention option they would use.…”

“…In Russia, a sub‐sample of participants in a study looking at serodiscordant partnerships and opportunities for PrEP among partners of women and men living with HIV in St. Petersburg ( n = 56), only 25% were aware of PrEP for the prevention of sexual transmission of HIV [25]. Couples‐based interventions were suggested as one way to increase PrEP awareness and uptake.…”

How can we enhance HIV Pre Exposure Prophylaxis (PrEP) awareness and access?: Recommendation development from process evaluation of a national PrEP programme using implementation science tools

“…The program was successful in reducing HIV incidence, [24] but has primarily served gay, bisexual and other men who have sex with men (GBMSM) with less impact on other groups and has only identified a minority of individuals with 'potentially PrEP preventable' HIV infection. [25] There was no largescale awareness intervention when the programme was launched to avoid overwhelming clinic-based services due to the anticipated high early demand for PrEP. Instead, awareness-raising occurred within clinics and via community-based organisations (CBO).…”

Evaluation of an inner city HIV pre‐exposure prophylaxis service tailored to the needs of people who inject drugs

“…Provision is for individuals at risk of sexual (but not injecting‐associated) acquisition. A 20% reduction in new HIV diagnoses in gay and bisexual men followed implementation [8], but there has been limited impact on other groups [9,10]. This is perhaps unsurprising among PWID, who may find it difficult to engage with mainstream health services [11].…”