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：285

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

共 30 条

[1] [Anonymous], 2017, BMJ, DOI DOI 10.1136/BMJ.J5011
[2] The preexposure prophylaxis revolution: from clinical trials to routine practice: implementation view from the USA
Elion, Richard
Coleman, Megan
[J]. CURRENT OPINION IN HIV AND AIDS, 2016, 11 (01) : 67 - 73
[3] Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: a cohort study
Grant, Robert M.
Anderson, Peter L.
McMahan, Vanessa
Liu, Albert
Amico, K. Rivet
Mehrotra, Megha
Hosek, Sybil
Mosquera, Carlos
Casapia, Martin
Montoya, Orlando
Buchbinder, Susan
Veloso, Valdilea G.
Mayer, Kenneth
Chariyalertsak, Suwat
Bekker, Linda-Gail
Kallas, Esper G.
Schechter, Mauro
Guanira, Juan
Bushman, Lane
Burns, David N.
Rooney, James F.
Glidden, David V.
[J]. LANCET INFECTIOUS DISEASES, 2014, 14 (09) : 820 - 829
[4] Preexposure Chemoprophylaxis for HIV Prevention in Men Who Have Sex with Men.
Grant, Robert M.
Lama, Javier R.
Anderson, Peter L.
McMahan, Vanessa
Liu, Albert Y.
Vargas, Lorena
Goicochea, Pedro
Casapia, Martin
Guanira-Carranza, Juan Vicente
Ramirez-Cardich, Maria E.
Montoya-Herrera, Orlando
Fernandez, Telmo
Veloso, Valdilea G.
Buchbinder, Susan P.
Chariyalertsak, Suwat
Schechter, Mauro
Bekker, Linda-Gail
Mayer, Kenneth H.
Kallas, Esper Georges
Amico, K. Rivet
Mulligan, Kathleen
Bushman, Lane R.
Hance, Robert J.
Ganoza, Carmela
Defechereux, Patricia
Postle, Brian
Wang, Furong
McConnell, J. Jeff
Zheng, Jia-Hua
Lee, Jeanny
Rooney, James F.
Jaffe, Howard S.
Martinez, Ana I.
Burns, David N.
Glidden, David V.
[J]. NEW ENGLAND JOURNAL OF MEDICINE, 2010, 363 (27) : 2587 - 2599
[5] Community-level changes in condom use and uptake of HIV pre-exposure prophylaxis by gay and bisexual men in Melbourne and Sydney, Australia: results of repeated behavioural surveillance in 2013-17
Holt, Martin
Lea, Toby
Mao, Limin
Kolstee, Johann
Zablotska, Iryna
Duck, Tim
Allan, Brent
West, Michael
Lee, Evelyn
Hull, Peter
Grulich, Andrew
De Wit, John
Prestage, Garrett
[J]. LANCET HIV, 2018, 5 (08): : E448 - E456
[6] Hull P, 2017, GAY COMMUNITY PERIOD
[7] Anal Sexually Transmitted Infections and Risk of HIV Infection in Homosexual Men
Jin, Fengyi
Prestage, Garrett P.
Imrie, John
Kippax, Susan C.
Donovan, Basil
Templeton, David J.
Cunningham, Anthony
Mindel, Adrian
Cunningham, Philip H.
Kaldor, John M.
Grulich, Andrew E.
[J]. JAIDS-JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES, 2010, 53 (01) : 144 - 149
[8] Kasaie P, 2017, JAIDS-J ACQ IMM DEF, V75, P175, DOI 10.1097/qai.0000000000001354
[9] The 2016 HIV diagnosis and care cascade in New South Wales, Australia: meeting the UNAIDS 90-90-90 targets
Keen, Phillip
Gray, Richard T.
Telfer, Barbara
Guy, Rebecca
Schmidt, Heather-Marie
Whittaker, Bill
Holden, Jo
Holt, Martin
Kelleher, Anthony
Wilson, David
Callander, Denton
Cooper, David A.
Prestage, Garrett
Selvey, Christine
Grulich, Andrew E.
[J]. JOURNAL OF THE INTERNATIONAL AIDS SOCIETY, 2018, 21 (04)
[10] Madeddu Daniel, 2006, Sex Health, V3, P37, DOI 10.1071/SH05034

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