Population-level effectiveness of a national HIV pre-exposure prophylaxis programme in men who have sex with men

Claudia Estcourt*, Alan Yeung, Rak Nandwani, David Goldberg, Beth Cullen, Nicola Steedman, Lesley Wallace, Sharon Hutchinson

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objective:
The aim of this study was to evaluate Scotland's national HIV preexposure prophylaxis (PrEP) programme in relation to PrEP uptake and associated population-level impact on HIV incidence among MSM.

Design:
A retrospective cohort study within real-world implementation.

Methods:
Comparison of HIV diagnoses from national surveillance data and HIV incidence within a retrospective cohort of HIV-negative MSM attending sexual health clinics from the National Sexual Health information system between the 2-year periods pre(July 2015–June 2017) and post(July 2017–June 2019) introduction of PrEP.

Results:
Of 16 723 MSM attending sexual health services in the PrEP period, 3256 (19.5%) were prescribed PrEP. Between pre-PrEP and PrEP periods, new HIV diagnoses among MSM declined from 229 to 184, respectively [RRR: 19.7%, 95% confidence interval (95% CI) 2.5–33.8]; diagnosed recently acquired infections declined from an estimated 73 to 47, respectively (35.6%, 95% CI 7.1–55.4). Among MSM attending sexual health clinics, HIV incidence per 1000 person-years declined from 5.13 (95% CI 3.90–6.64) pre-PrEP to 3.25 (95% CI 2.30–4.47) in the PrEP period (adjusted IRR 0.57, 95% CI 0.37–0.87). Compared with the pre-PrEP period, incidence of HIV was lower in the PrEP period for those prescribed PrEP (aIRR 0.25, 95% CI 0.09–0.70) and for those not prescribed PrEP (aIRR 0.68, 95% CI 0.43–1.05).

Conclusion:
We demonstrate national population-level impact of PrEP for the first time in a real-world setting. HIV incidence reduced in MSM who had been prescribed PrEP and, to a lesser extent, in those who had not. Promotion of the benefits of PrEP needs to extend to MSM who do not access sexual health clinics.
Original languageEnglish
Pages (from-to)N/A
JournalAIDS
VolumeN/A
Early online date7 Dec 2020
DOIs
Publication statusE-pub ahead of print - 7 Dec 2020

Keywords

  • epidemiology
  • HIV pre exposure prophylaxis
  • incidence
  • MSM
  • prevention
  • public health

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