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.

Autor:	Grulich AE; The Kirby Institute, University of New South Wales, Sydney, NSW, Australia. Electronic address: agrulich@kirby.unsw.edu.au., Guy R; The Kirby Institute, University of New South Wales, Sydney, NSW, Australia., Amin J; Department of Health Systems and Populations, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, NSW, Australia., Jin F; The Kirby Institute, University of New South Wales, Sydney, NSW, Australia., Selvey C; New South Wales Ministry of Health, Sydney, NSW, Australia., Holden J; New South Wales Ministry of Health, Sydney, NSW, Australia., Schmidt HA; New South Wales Ministry of Health, Sydney, NSW, Australia., Zablotska I; Western Sydney Sexual Health Centre and Sydney Medical School-Westmead, University of Sydney, Sydney, NSW, Australia., Price K; ACON, Sydney, NSW, Australia., Whittaker B; New South Wales Ministry of Health, Sydney, NSW, Australia., Chant K; New South Wales Ministry of Health, Sydney, NSW, Australia., Cooper C; Positive Life NSW, Sydney, NSW, Australia., McGill S; Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine, Sydney, NSW, Australia., Telfer B; New South Wales Ministry of Health, Sydney, NSW, Australia., Yeung B; The Kirby Institute, University of New South Wales, Sydney, NSW, Australia., Levitt G; The Kirby Institute, University of New South Wales, Sydney, NSW, Australia., Ogilvie EE; The Kirby Institute, University of New South Wales, Sydney, NSW, Australia., Dharan NJ; The Kirby Institute, University of New South Wales, Sydney, NSW, Australia., Hammoud MA; The Kirby Institute, University of New South Wales, Sydney, NSW, Australia., Vaccher S; The Kirby Institute, University of New South Wales, Sydney, NSW, Australia., Watchirs-Smith L; The Kirby Institute, University of New South Wales, Sydney, NSW, Australia., McNulty A; Sydney Sexual Health Centre, Sydney, NSW, Australia., Smith DJ; North Coast HIV/Sexual Health Services, Lismore, NSW, Australia., Allen DM; Holden Street Clinic, Gosford, NSW, Australia., Baker D; East Sydney Doctors, Darlinghurst, NSW, Australia., Bloch M; The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Holdsworth House Medical Practice, Darlinghurst, NSW, Australia., Bopage RI; The Albion Centre, Surry Hills, NSW, Australia., Brown K; Illawarra Sexual Health Service, Wollongong, NSW, Australia., Carr A; St Vincent's Hospital, Darlinghurst, NSW, Australia., Carmody CJ; Liverpool Sexual Health Clinic, Liverpool, NSW, Australia., Collins KL; Albury Sexual Health Service, Albury, NSW, Australia; Brookong Sexual Health Centre, Wagga Wagga, NSW, Australia., Finlayson R; Taylor Square Private Clinic, Surry Hills, NSW, Australia., Foster R; Clinic 16, Northern Sydney Sexual Health, St Leonards, NSW, Australia., Jackson EY; Nepean Blue Mountains Local Health District, Department of Sexual Health, Penrith, NSW, Australia., Lewis DA; Western Sydney Sexual Health Centre and Sydney Medical School-Westmead, University of Sydney, Sydney, NSW, Australia; Marie Bashir Institute for Biosecurity and Infectious Diseases, University of Sydney, Sydney, NSW, Australia., Lusk J; Short Street Clinic, Kogorah, St George Hospital, NSW, Australia., O'Connor CC; RPA Sexual Health, Camperdown, NSW, Australia., Ryder N; The Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Hunter-New England Sexual Health, Newcastle, NSW, Australia; School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia., Vlahakis E; Coffs Harbour Sexual Health, Coffs Harbour, NSW, Australia., Read P; Kirketon Road Centre, Kings Cross, NSW, Australia., Cooper DA; The Kirby Institute, University of New South Wales, Sydney, NSW, Australia.
Jazyk:	angličtina
Zdroj:	The lancet. HIV [Lancet HIV] 2018 Nov; Vol. 5 (11), pp. e629-e637. Date of Electronic Publication: 2018 Oct 17.
DOI:	10.1016/S2352-3018(18)30215-7
Abstrakt:	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 roll-out. 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. Funding: New South Wales Ministry of Health, Gilead Sciences. (Copyright © 2018 Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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