Population-level effectiveness of a national HIV preexposure prophylaxis programme in MSM

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
JournalAIDS
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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