The targeted implementation of the HIV pre-exposure prophylaxis (PrEP) regimen using tenofovir disoproxil fumarate plus emtricitabine greatly reduced HIV incidence at the population level, according to a study published in The Lancet HIV.
Researchers of the Expanded PrEP Implementation in Communities–New South Wales study targeted high-risk gay men (N=3700) to roll out a widespread use of tenofovir disoproxil fumarate (300 mg) plus emtricitabine (200 mg) to analyze the impact the daily, oral HIV PrEP had on new diagnosis of HIV.
After the initiation of the prophylaxis, follow-ups to evaluate sexually transmitted infections, renal function, and medication adherence were completed at 1 month and 3 months, and then every 3 months after.
Of the 3700 participants recruited, 99% were male, 96% were gay, and the average age was 36 years old. Follow-up at 12 months occurred for 76% of the entire study population and 87% of those had a high ratio of medication adherence. There were 2 new cases of HIV, both in males who were not taking PrEP as directed.
In the entire population of New South Wales, HIV diagnoses in men who have sex with men decreased from 295 before the rollout to 221 after the rollout (95% CI, 10.5-37.4), which is a decrease of 25.1% and the lowest number of new diagnoses ever recorded.
There was a 51.8% reduction in new HIV diagnoses in the predominantly gay suburbs of Sydney and a 48.4% reduction in males 45 years of age and over. It was estimated that 20% of HIV-negative gay men were taking PrEP.
Limitations of this study are that behavioral changes could be potential cofounders on the decreased diagnosis and missing HIV data on participants could alter actual outcomes. However, reports from other HIV PrEP rollouts occurring in other geographic locations show similar outcomes to this study in New South Wales.
The researchers concluded that “[r]apid, targeted, high-coverage roll-out to scale was accompanied by rapid reductions in HIV incidence at the population level” and that HIV PrEP is an essential piece of prevention in the HIV epidemic.
The study medication was provided by Gilead and Mylan. Please refer to reference for full list of disclosures.
Grulich AE, Guy R, Amin J, et al. Population-level effectiveness of rapid, targeted, high-coverage roll-out of HIV pre-exposure prophylaxis in men who have sex with men: the EPIC-NSW prospective cohort study [published online October 17, 2018]. Lancet HIV. doi: 10.1016/S2352-3018(18)30215-7