Population-level effectiveness of a national HIV preexposure prophylaxis programme in MSM

Abstract

Objective: The aim of this study was to evaluate Scotland's national HIV preexposure prophylaxis (PrEP) programme in relation to PrEP uptake and associated population-level impact on HIV incidence among MSM. Design: A retrospective cohort study within real-world implementation. Methods: Comparison of HIV diagnoses from national surveillance data and HIV incidence within a retrospective cohort of HIV-negative MSM attending sexual health clinics from the National Sexual Health information system between the 2-year periods pre(July 2015–June 2017) and post(July 2017–June 2019) introduction of PrEP. Results: Of 16 723 MSM attending sexual health services in the PrEP period, 3256 (19.5%) were prescribed PrEP. Between pre-PrEP and PrEP periods, new HIV diagnoses among MSM declined from 229 to 184, respectively [relative risk reduction (RRR): 19.7%, 95% confidence interval (95% CI) 2.5–33.8]; diagnosed recently acquired infections declined from an estimated 73 to 47, respectively (35.6%, 95% CI 7.1–55.4). Among MSM attending sexual health clinics, HIV incidence per 1000 person-years declined from 5.13 (95% CI 3.90–6.64) pre-PrEP to 3.25 (95% CI 2.30–4.47) in the PrEP period (adjusted IRR 0.57, 95% CI 0.37–0.87). Compared with the pre-PrEP period, incidence of HIV was lower in the PrEP period for those prescribed PrEP (aIRR 0.25, 95% CI 0.09–0.70) and for those not prescribed PrEP (aIRR 0.68, 95% CI 0.43–1.05). Conclusion: We demonstrate national population-level impact of PrEP for the first time in a real-world setting. HIV incidence reduced in MSM who had been prescribed PrEP and, to a lesser extent, in those who had not. Promotion of the benefits of PrEP needs to extend to MSM who do not access sexual health clinics.

Elimination of HIV transmission in Japanese MSM with combination interventions

“…PrEP is highly effective to prevent HIV transmission and 10% coverage with 100% adherence will enable Japan to achieve HIV elimination by 2050. Since using antiretroviral drugs for PrEP has not been officially licensed in Japan, the coverage of PrEP in the Japanese MSM population is much lower 15 than the UK 44 and the USA. 45 With strong willingness to use PrEP among Japanese MSM, 15 the government should consider approval of PrEP at reasonable prices with enough medical support and care.…”

Adherence, Sexual Behavior and Sexually Transmitted Infections in a New Zealand Prospective PrEP Cohort: 12 Months Follow-up and Ethnic Disparities

“…Despite imperfect adherence, no participant acquired HIV during study follow-up. Participants reported fewer male sexual partners over time [median (IQR) for baseline = 10.5 (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20), visit 4 = 6 (4-12); RR 0.71, 95% CI 0.66-0.77] [for mean (SD), see Table 2]. However, the number of condomless receptive anal intercourse partners was steady [median (IQR) for baseline = 3 (2-7) vs visit 4 = 2 (1-5); RR 1.10, 95% CI 0.98-1.24] [for mean, (SD) see Table 2].…”

“…PrEP is now an essential component of combination HIV prevention for GBM including condoms, HIV testing and viral suppression of people living with HIV [3,13]. Modelling suggests that high PrEP uptake can help eliminate HIV transmission at the population level [14][15][16] and ecological data support this [17,18].…”

Maintaining access to HIV pre-exposure prophylaxis in a pandemic: A service evaluation of telephone-based pre-exposure prophylaxis provision

“…1 3354 individuals received at least one prescription for PrEP in the first 2 years and reduction in HIV transmission at population-level has been demonstrated in men who have sex with men. 2,3 Our large urban sexual healthcare service provides PrEP care for around 1300 people, almost half of all those on PrEP at any one time in Scotland. 2 Prior to the COVID-19 pandemic, around 230 patients/month accessed PrEP though 30-min face-to-face appointments.…”