HIV Preexposure Prophylaxis Cascades to Assess Implementation in Australia: Results From Repeated, National Behavioral Surveillance of Gay and Bisexual Men, 2014–2018

Abstract

Background: HIV prevention cascades can assist in monitoring the implementation of prevention methods like preexposure prophylaxis (PrEP). We developed 2 PrEP cascades for Australia's primary HIV-affected population, gay and bisexual men. Methods: Data were drawn from 2 national, repeated, cross-sectional surveys (the Gay Community Periodic Surveys and PrEPARE Project). One cascade had 3 steps, and the other had 7 steps. Trends over time were assessed using logistic regression. For the most recent year, we identified the biggest drop between steps in each cascade and compared the characteristics of men between the 2 steps using multivariate logistic regression. Results: Thirty-nine thousand six hundred and seventy non–HIV-positive men participated in the Periodic Surveys during 2014–2018. PrEP eligibility increased from 28.1% (1901/6762) in 2014 to 37.3% (2935/7878) in 2018 (P < 0.001), awareness increased from 29.6% (563/1901) to 87.1% (2555/2935; P < 0.001), and PrEP use increased from 3.7% (21/563) to 45.2% (1155/2555; P < 0.001). Of 1038 non–HIV-positive men in the PrEPARE Project in 2017, 54.2% (n = 563) were eligible for PrEP, 97.2% (547/563) were aware, 67.6% (370/547) were willing to use PrEP, 73.5% (272/370) had discussed PrEP with a doctor, 78.3% (213/272) were using PrEP, 97.2% (207/213) had recently tested, and 75.8% (157/207) reported reduced HIV concern and increased pleasure because of PrEP. The break point analyses indicated that PrEP coverage was affected by geographical availability, education level, employment, and willingness to use PrEP. Conclusions: PrEP eligibility, awareness, and use have rapidly increased among Australian gay and bisexual men. The cascades identify disparities in uptake by eligible men as a result of socioeconomic factors and PrEP's acceptability.

HIV pre-exposure prophylaxis: scaling up for impact now and in the future

“…Second, willingness to use PrEP is critical and can potentially explain non-use in some people at high risk who are aware of PrEP. 25 Willingness to use PrEP is a multifaceted concept that can incorporate affordability or willingness to pay, fears of side-effects, attitudes towards medicines generally, and willingness to engage in the required clinical procedures. These elements need to be disentangled and addressed for specific populations and settings.…”

Challenges of providing HIV pre-exposure prophylaxis across Australian clinics: qualitative insights of clinicians

“…Pre-exposure prophylaxis (PrEP) has been rapidly implemented in Australia, shifting from restricted provision through demonstration studies to general prescribing with public subsidy. Although the impact of PrEP on HIV notifications and behavioural trends is well documented in Australia, 1,2 less is known about the challenges that clinicians have experienced with this shift in clinical provision of PrEP.…”

“…13,42 Although important insights into clinical practices are generated through trial settings, 43 it is important to understand how these practices are then integrated into 'real world' clinical settings. 44 Given rapid rollout of PrEP, and growing levels of use, 1 Australia provides a pertinent setting in which challenges and solutions to PrEP provision can be explored. This article analyses clinicians' experiences of providing PrEP in the context of workforce and regulatory challenges, including how services manage restrictions on who can prescribe and who can receive subsidised medication, debates on who is best suited to providing PrEP, and accommodating changes to PrEP dosing regimens.…”

Adherence, Sexual Behavior and Sexually Transmitted Infections in a New Zealand Prospective PrEP Cohort: 12 Months Follow-up and Ethnic Disparities

“…Administrative data such as funded PrEP prescriptions would provide intelligence on disparities in uptake and continuation. Community behavioral surveillance should examine PrEP awareness, willingness, eligibility and uptake [80], and interest in long-acting or on-demand PrEP options for ethnic minority GBM that could minimize barriers to drug adherence and clinic engagement [81]. Findings should be triangulated to describe the "PrEP cascade" for GBM and whether this varies by ethnicity.…”