The state of New South Wales in Australia has seen a fall of one-third in diagnoses of recent HIV infection since it started its pre-exposure prophylaxis (PrEP) implementation project, EPIC-NSW (Expanded PrEP Implementation in the Community), the 25th Conference on Retroviruses and Opportunistic Infections (CROI 2018) heard last week.
Andrew Grulich of the Kirby Institute of the University of New South Wales told the conference that only two people who entered EPIC-NSW had been diagnosed with HIV (both entered the study by the end of October 2016): this represents at least a 97.6% decline in the HIV incidence that would have previously been expected in the study population.
In New South Wales as a whole, HIV diagnoses in the last year fell by a third in the year after the trial was started compared to the previous year. They fell by half in people aged over 35 and in people born in Australia.
Grulich said that participation in EPIC-NSW was concentrated among Australian-born, older, largely white gay men who live in central Sydney’s ‘gay village’. There were considerably lower rates of participation among younger, non-white and suburban gay men, especially in Sydney’s western suburbs which are very ethnically diverse.
The figures presented by Grulich supplement a report issued by the New South Wales health department in August last year, which also announced significant drops in HIV infection. This report attributes the drops not only to the PrEP study but also to a near-doubling in the number of tests taken by gay men after the start of the study.
EPIC-NSW started in March 2016 and most other Australian states (apart from Tasmania and the Northern Territory) followed suit. The original intention, based upon calculations of the number of people at high risk of HIV infection in the state, was to enrol 3700 people in the trial. This was in fact achieved in the first eight months of the trial.
“We were very clearly seeing gay men at high risk of HIV continuing to want to join the trial,” Grulich commented at the Conference. “We asked the state Health Department for a formal protocol amendment and to remove the cap on recruitment.
“It was really helpful to have a government that had an explicit target for reducing HIV transmission,” he added, referring to the New South Wales strategy for reducing HIV infections to near-zero by 2020. “The evidence for PrEP is now so strong that we could say ‘If you want this to happen, you have to include PrEP’.”
EPIC-NSW had nearly 9000 people recruited by the end of last year and there is no sign of the linear increase in enrolments slackening off.
Grulich said that it was estimated that the proportion of at-risk people on PrEP in New South Wales had increased from 3% in 2015 to 17% in 2016, and to 25% by the end of 2017.