Lancet study shows success in targeted intervention in Australia among men who have sex with men
Preventive medication in gay men can reduce HIV incidence significantly, a new study has found.
The study from Australia is the first to evaluate a population-level roll-out of pre-exposure prophylaxis (PrEP) in men who have sex with men. It analysed the results of rapid, targeted, and high-coverage roll-out of PrEP. The results showed that the intervention was associated with a reduction in HIV diagnoses by 25% in one year across New South Wales (Australia). The study published in The Lancet HIV journal.
Diagnoses in men who have sex with men across New South Wales reduced from 295 cases in the year before PrEP roll-out to 221 cases in the year after – the lowest levels recorded since the beginning of HIV surveillance in 1985.
India has an estimated 21.40 lakh people living with HIV-AIDS (PLHIV), according to the latest estimations from the National AIDS Control Organisation. The prevalence among gay men is about 4.3%.
India has an estimated 21.40 lakh people living with HIV-AIDS (PLHIV). The prevalence among gay men is about 4.3%
The study, led by the Kirby Institute at UNSW Sydney, followed 3,700 men who had been dispensed PrEP as part of the roll-out. In this group, the incidence of HIV infection was less than 1 in 2,000 per year, compared with an expected incidence of 2 per 100 per year or higher in the absence of PrEP.
Randomised controlled trials have previously demonstrated the efficacy of PrEP. In addition, mathematical models have predicted that PrEP can have a large and fast impact if rolled out rapidly and at high coverage for people at risk. However, empirical studies to confirm PrEP’s population-level effectiveness have not tested these findings until now.
The study in New South Wales was possible due to the existing surveillance system for recent HIV infection in the area, which allowed researchers to quickly document the population-level effect of PrEP. It illustrates the successes possible with effective roll-out of PrEP.
Although a number of countries, including the USA, France, and England, have approved HIV PrEP, uptake has until recently been slow and geographically patchy.
“Our results support the population-level effectiveness of PrEP one year after rapid PrEP implementation at scale,” says Professor Andrew Grulich, from the Kirby Institute at UNSW Sydney. “PrEP is a highly effective preventative approach when implemented alongside high levels of HIV testing and treatment. Roll-out should be prioritised as a crucial component of HIV prevention in epidemics predominantly affecting men who have sex with men.”
In the USA, PrEP was approved in 2012 and it was estimated that 492,000 men would benefit from the drug. However, uptake was sluggish before accelerating more recently, and by late 2016 it was estimated that 83,672 men in the US had commenced PrEP.
In England, the NHS announced it would provide PrEP to 10,000 patients through an implementation study in selected clinics from September 2017. Reductions in HIV diagnoses in 2017 in London have been attributed to a combination of increased testing and treatment, as well as PrEP sourced through trials or privately.
