Study shows ‘huge effect’ of PrEP on cutting HIV rates

Jolyon Attwooll

5/07/2021 4:27:19 PM

A world-first, Australian-led study has shown the medication’s significant impact on the widest scale yet – but gaps remain.

A man taking medication while in bed.
A NSW study has shown the HIV prevention medication PrEP has dramatically reduced transmission.

The three-year EPIC-NSW research, which was led by the Kirby Institute, is the first global study to measure the impact of pre-exposure prophylaxis (PrEP) on reducing new cases of HIV in a large population.
Published this month in The Lancet HIV, the findings show HIV transmissions hit a historical low among 9709 high-risk HIV-negative gay and bisexual men in New South Wales.
The study ran across 31 sites from March 2016, when PrEP was available for a free clinical trial, until the end of March 2019, after the medication’s transition to the Pharmaceutical Benefits Scheme (PBS) in 2018.
According to the authors, no data has previously been published on the PrEP’s effectiveness over extended periods of time among men who have sex with men.
‘Studies like this one demonstrate what a huge effect it can have at the population level,’ Professor Andrew Grulich, lead author of the study, told newsGP
‘What we did see was an incidence of 1.6 in 1000 participants a year, which was 92% lower than [what] we would have expected without PrEP.
‘It’s a remarkable new breakthrough in HIV prevention.’
HIV transmission also remained low in the follow-up year after the inclusion of PrEP to the subsidised PBS scheme.
PrEP was mostly purchased rather than provided free once the PBS subsidy kicked in. The medication possession ratio (MPR) slipped from 0.93 to 0.64 from the first to the ninth quarter of the study.
The study concludes that ‘despite declining mean MPR, HIV incidence increased only minimally, and was 2.24 per 1000 person-years in the third year of follow-up. In participants who maintained a mean MPR of 1.0 over follow-up, HIV incidence was zero over almost 5000 person-years’.
However, the study did highlight groups where the decline in transmission was much slower. These included men aged under 25, those living outside of inner Sydney, men who reported more risky behaviours, and – as indicated above – those who stopped taking the PrEP medication.
Dr Vincent Cornelisse, a GP and sexual health physician who has been involved in PrEP research, said the study confirmed that there are still gaps.
‘Certainly in the outer suburbs of Sydney there is less awareness of PrEP among those who may be at risk of HIV,’ he told newsGP.
‘It is something that is very important for us as a medical community to address and it’s very important for a GP to be aware of PrEP and how to provide it.’
Dr Cornelisse said there are ‘very useful’ online resources for GPs available from the Australasian Society for HIV Medicine (ASHM).
Meanwhile, in more rural and remote communities, where GPs are more likely to know their patients personally, he says it can prove to be an additional barrier to providing the right treatment. But there are way to open up the discussion.
‘Making efforts to make [sexual health history] a routine part of medical care, that can certainly help,’ Dr Cornelisse said.
He also highlighted the option of having PrEP medication posted from city pharmacies or ordered online as another way of overcoming concerns about confidentiality.
Another notable group where the uptake of PrEP is lower, Dr Cornelisse says, are those without access to Medicare.
On that theme, Professor Grulich believes ensuring anyone at risk of HIV has access to PrEP – regardless of their Australian residency – is a key to driving HIV transmission even lower.  
That suggestion is outlined in the Agenda 2025 document, which was published last month, detailing how AIDS transmission could reach zero by 2025. The document, which was backed by HIV clinicians, the Australian Federation of AIDS Organisations (AFAO), the Kirby Institute and the Doherty Institute, among others, describes how a $53 million funding injection could help achieve that goal.
For Professor Grulich, the EPIC-NSW study has highlighted which areas need to be addressed.
‘The people we really need to focus on are these people in the outer suburbs, in the regional and remote areas,’ he said.
‘PrEP is pretty simple. It is one pill, once a day [with] very low rates of toxicity so I would really hope more and more general practitioners familiarise themselves with what is needed.
‘PrEP is absolutely key if we want to end HIV transmission. The critical thing is [if] the person keeps taking PrEP as prescribed, they are virtually 100% protected.
‘We have the technology, now it’s about getting [it] into everybody’s hands.’
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HIV HIV transmission pre-exposure prophylaxis PrEP

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