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

作者：Grulich, Andrew E.^*; Guy, Rebecca; Amin, Janaki; Jin, Fengyi; Selvey, Christine; Holden, Jo; Schmidt, Heather-Marie A.; Zablotska, Iryna; Price, Karen; Whittaker, Bill; Chant, Kerry; Cooper, Craig; McGill, Scott; Telfer, Barbara; Yeung, Barbara; Levitt, Gesalit; Ogilvie, Erin E.; Dharan, Nila J.; Hammoud, Mohamed A.; Vaccher, Stefanie; Watchirs-Smith, Lucy; McNulty, Anna; Smith, David J.; Allen, Debra M.; Baker, David; Bloch, Mark; Bopage, Rohan I.; Brown, Katherine; Carr, Andrew

来源：Lancet HIV, 2018, 5(11): E629-E637.

DOI：10.1016/S2352-3018(18)30215-7

• HOMOSEXUAL-MEN
• INFECTION
• PREVENTION
• PREVALENCE
• AUSTRALIA
• TRIALS
• SAFETY
• SYSTEM
• RISK

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 rollout. 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.

• 出版日期2018-11