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

被引：292

作者：

Grulich, Andrew E. ^{[1
]}

Guy, Rebecca ^{[1
]}

Amin, Janaki ^{[2
]}

Jin, Fengyi ^{[1
]}

Selvey, Christine ^{[3
]}

Holden, Jo ^{[3
]}

Schmidt, Heather-Marie A. ^{[3
]}

Zablotska, Iryna ^{[4
,5
]}

Price, Karen ^{[7
]}

Whittaker, Bill ^{[3
]}

Chant, Kerry ^{[3
]}

Cooper, Craig ^{[8
]}

McGill, Scott ^{[9
]}

Telfer, Barbara ^{[3
]}

Yeung, Barbara ^{[1
]}

Levitt, Gesalit ^{[1
]}

Ogilvie, Erin E. ^{[1
]}

Dharan, Nila J. ^{[1
]}

Hammoud, Mohamed A. ^{[1
]}

Vaccher, Stefanie ^{[1
]}

Watchirs-Smith, Lucy ^{[1
]}

McNulty, Anna ^{[10
]}

Smith, David J. ^{[11
]}

Allen, Debra M. ^{[12
]}

Baker, David ^{[13
]}

Bloch, Mark ^{[1
,14
]}

Bopage, Rohan I. ^{[15
]}

Brown, Katherine ^{[16
]}

Carr, Andrew ^{[17
]}

Carmody, Christopher J. ^{[18
]}

Collins, Kym L. ^{[19
,20
]}

Finlayson, Robert ^{[21
]}

Foster, Rosalind ^{[22
]}

Jackson, Eva Y. ^{[23
]}

Lewis, David A. ^{[4
,5
,6
]}

Lusk, Josephine ^{[24
]}

O'Connor, Catherine C. ^{[25
]}

Ryder, Nathan ^{[1
,26
,27
]}

Vlahakis, Emanuel ^{[28
]}

Read, Phillip ^{[29
]}

Cooper, David A. ^{[1
]}

机构：

[1] Univ New South Wales, Kirby Inst, Sydney, NSW, Australia

[2] Macquarie Univ, Fac Med & Hlth Sci, Dept Hlth Syst & Populat, Sydney, NSW, Australia

[3] New South Wales Minist Hlth, Sydney, NSW, Australia

[4] Western Sydney Sexual Hlth Ctr, Westmead, NSW, Australia

[5] Sydney Med School, Westmead, NSW, Australia

[6] Univ Sydney, Marie Bashir Inst Biosecur & Infect Dis, Sydney, NSW, Australia

[7] ACON, Sydney, NSW, Australia

[8] Posit Life NSW, Sydney, NSW, Australia

[9] Australasian Soc HIV Viral Hepatitis & Sexual Hlt, Sydney, NSW, Australia

[10] Sydney Sexual Hlth Ctr, Sydney, NSW, Australia

[11] North Coast HIV Sexual Hlth Serv, Lismore, NSW, Australia

[12] Holden St Clin, Gosford, NSW, Australia

[13] East Sydney Doctors, Darlinghurst, NSW, Australia

[14] Holdsworth House Med Practice, Darlinghurst, NSW, Australia

[15] Albion Ctr, Surry Hills, NSW, Australia

[16] Illawarra Sexual Hlth Serv, Wollongong, NSW, Australia

[17] St Vincents Hosp, Darlinghurst, NSW, Australia

[18] Liverpool Sexual Hlth Clin, Liverpool, NSW, Australia

[19] Albury Sexual Hlth Serv, Albury, NSW, Australia

[20] Brookong Sexual Hlth Ctr, Wagga Wagga, NSW, Australia

[21] Taylor Sq Private Clin, Surry Hills, NSW, Australia

[22] Clin 16, Northern Sydney Sexual Hlth, St Leonards, NSW, Australia

[23] Nepean Blue Mt Local Hlth Dist, Dept Sexual Hlth, Penrith, NSW, Australia

[24] St George Hosp, Short St Clin, Kogorah, NSW, Australia

[25] RPA Sexual Hlth, Camperdown, NSW, Australia

[26] Hunter New England Sexual Hlth, Newcastle, NSW, Australia

[27] Univ Newcastle, Sch Med & Publ Hlth, Callaghan, NSW, Australia

[28] Coffs Harbour Sexual Hlth, Coffs Harbour, NSW, Australia

[29] Kirketon Rd Ctr, Kings Cross, NSW, Australia

来源：

LANCET HIV | 2018年 / 5卷 / 11期

关键词：

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

D O I：

10.1016/S2352-3018(18)30215-7

中图分类号：

R392 [医学免疫学]; Q939.91 [免疫学];

学科分类号：

100102 ;

摘要：

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. Copright (C) 2018 Elsevier Ltd. All rights reserved.

引用

页码：E629 / E637

页数：9

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