Trends in Human Immunodeficiency Virus and Sexually Transmitted Infection Testing Among Gay, Bisexual, and Other Men Who Have Sex With Men After Rapid Scale-up of Preexposure Prophylaxis in Victoria, Australia

Abstract

Objective Scale-up of human immunodeficiency virus (HIV) preexposure prophylaxis (PrEP) has raised concerns regarding its impact on clinic capacity and access to HIV testing. We describe enrolment in PrEPX, a large PrEP implementation study in Victoria, Australia, and the impact of PrEP uptake and maintenance on existing health services. Methods We describe enrolment between July 26, 2016, and March 31, 2018, and trends in HIV testing among PrEPX participating and nonparticipating gay and bisexual and other men who have sex with men (GBM) at 5 study clinics participating in a sentinel surveillance system (ACCESS). We evaluated HIV and STI testing trends using segmented linear regression across the prestudy (January 2015 to June 2016) and PrEPX study (July 2016 to March 2018) periods. Findings There were 2,049 individuals who registered interest in study participation: 72% enrolled into the study. Study clinics enrolled participants rapidly; of 4265 people enrolled in PrEPX (98% GBM), 1000 enrolled by week 3, 88% (n = 876) of whom enrolled at ACCESS sites. Prestudy period HIV testing rates were increasing at all ACCESS sites. In the month PrEPX commenced, there was an additional 247 HIV tests among PrEPX participants (P < 0.01) and no significant change among non-PrEPX GBM (P = 0.72). Across the study period, HIV testing increased by 7.2 (P < 0.01) and 8.9 (P < 0.01) tests/month among PrEPX participants and non-PrEPX GBM, respectively. The HIV testing increased among non-PrEPX GBM at sexual health clinics (18.8 tests/month, P < 0.01) and primary care clinics (7.9 tests/month, P < 0.01). Similar trends were observed across testing for all measured STIs. Conclusions Rapid PrEP scale-up is possible without a reduction in HIV testing among GBM not using PrEP.

Participation, retention and uptake in a multicentre pre‐exposure prophylaxis cohort using online, smartphone‐compatible data collection

“…These findings may reflect the growing need for large‐scale PrEP programmes with integrated, comprehensive care. Our study findings are in line with those of two PrEP implementation studies conducted in Australia that showed widespread interest, rapid enrolment, and high retention among gay, bisexual and other MSM [ 24 , 25 ]. The high participation and retention at first follow‐up might also be related to the innovative design of the questionnaires used in the SwissPrEPared programme, which consisted of self‐reported data collected through online, self‐administered questionnaires compatible with smartphones.…”

HIV prevention for the next decade: Appropriate, person-centred, prioritised, effective, combination prevention

“…The opportunities for more effective prevention of new HIV infections have expanded over the past decade. Oral pre-exposure prophylaxis (PrEP) has been demonstrated to be highly efficacious and often effective in public health practice [8][9][10]. Two monthly injections of a long-acting formulation of cabotegravir have been demonstrated in clinical trials to be more effective than oral PrEP [11,12].…”

High Levels of Prevention-Effective Adherence to HIV PrEP: An Analysis of Substudy Data From the EPIC-NSW Trial

“…24 Internationally, discontinuation of PrEP has been associated with younger age, 25–27 minority ethnic status, 27,28 financial barriers, 29 and drug use. 25,26 However, as many people do appear to stop or pause their PrEP use in line with periods of lower risk, 30,31 more research is needed to determine ways to identify patients who are more likely to discontinue PrEP and subsequently engage in risk behavior. This issue has become especially pertinent in the context of the COVID-19 pandemic, during which many GBM ceased taking PrEP while physical distancing restrictions were in effect.…”