Implementation of a national HIV pre-exposure prophylaxis service is associated with changes in characteristics of people with newly diagnosed HIV: a retrospective cohort study

Ceilidh Grimshaw*, Claudia S. Estcourt, Rak Nandwani, Alan Yeung, David Henderson, John Michael Saunders

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)
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Abstract

Objectives: To review characteristics of individuals newly diagnosed with HIV following implementation of a national pre-exposure prophylaxis (PrEP) programme (comprehensive PrEP services, delivered in sexual health clinics) to inform future delivery and broader HIV prevention strategies. 

Methods: We extracted data from national HIV databases (July 2015-June 2018). We compared sociodemographic characteristics of individuals diagnosed in the period before and after PrEP implementation, and determined the proportion of € potentially preventable' infections with the sexual health clinic-based PrEP delivery model used. 

Results: Those diagnosed with HIV before PrEP implementation were more likely to be male (342/418, 81.8% vs 142/197, 72.1%, p=0.005), be white indigenous (327/418, 78.2% vs 126/197, 64.0%, p<0.001), report transmission route as sex between men (219/418, 52.4% vs 81/197, 41.1%, p=0.014), and have acquired HIV in the country of the programme (302/418,72.2% vs 114/197, 57.9% p<0.001) and less likely to report transmission through heterosexual sex(114/418, 27.3% vs 77/197, 39.1%, p=0.002) than after implementation. Pre-implementation, 8.6% (36/418) diagnoses were € potentially preventable' with the PrEP model used. Post-implementation, this was 6.6% (13/197), but higher among those with recently acquired HIV (49/170, 28.8%). Overall, individuals with € potentially preventable' infections were more likely to be male (49/49, 100% vs 435/566, 76.9%, p<0.001), aged <40 years (37/49, 75.5% vs 307/566, 54.2%, p=0.004), report transmission route as sex between men (49/49, 100% vs 251/566, 44.3%, p<0.001), have previously received post-exposure prophylaxis (12/49, 24.5% vs 7/566, 1.2%, p<0.001) and less likely to be black African (0/49, 0% vs 67/566, 11.8%, p=0.010) than those not meeting this definition. 

Conclusions: The sexual health clinic-based national PrEP delivery model appeared to best suit men who have sex with men and white indigenous individuals but had limited reach into other key vulnerable groups. Enhanced models of delivery and HIV combination prevention are required to widen access to individuals not benefiting from PrEP at present.

Original languageEnglish
Pages (from-to)53-57
JournalSexually Transmitted Infections
Volume98
Issue number1
Early online date13 Jan 2021
DOIs
Publication statusPublished - 17 Jan 2021

Keywords

  • HIV
  • HIV pre-exposure prophylaxis
  • PrEP
  • service delivery

ASJC Scopus subject areas

  • Dermatology
  • Infectious Diseases

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