Population-level effectiveness of rapid, targeted, high-coverage roll-out of HIV pre-exposure prophylaxis in men who have sex with men: the EPIC-NSW prospective cohort study

Andrew E. Grulich*, Rebecca Guy, Janaki Amin, Fengyi Jin, Christine Selvey, Jo Holden, Heather Marie A. Schmidt, Iryna Zablotska, Karen Price, Bill Whittaker, Kerry Chant, Craig Cooper, Scott McGill, Barbara Telfer, Barbara Yeung, Gesalit Levitt, Erin E. Ogilvie, Nila J. Dharan, Mohamed A. Hammoud, Stefanie VaccherLucy Watchirs-Smith, Anna McNulty, David J. Smith, Debra M. Allen, David Baker, Mark Bloch, Rohan I. Bopage, Katherine Brown, Andrew Carr, Christopher J. Carmody, Kym L. Collins, Robert Finlayson, Rosalind Foster, Eva Y. Jackson, David A. Lewis, Josephine Lusk, Catherine C. O'Connor, Nathan Ryder, Emanuel Vlahakis, Phillip Read, David A. Cooper, Expanded PrEP Implementation in Communities New South Wales (EPIC-NSW) research group

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    177 Citations (Scopus)


    Background: HIV pre-exposure prophylaxis (PrEP) is highly effective in men who have sex with men (MSM) at the individual level, but data on population-level impact are lacking. We examined whether rapid, targeted, and high-coverage roll-out of PrEP in an MSM epidemic would reduce HIV incidence in the cohort prescribed PrEP and state-wide in Australia's most populous state, New South Wales. Methods: The Expanded PrEP Implementation in Communities–New South Wales (EPIC-NSW) study is an implementation cohort study of daily co-formulated tenofovir disoproxil fumarate and emtricitabine as HIV PrEP. We recruited high-risk gay men in a New South Wales-wide network of 21 clinics. We report protocol-specified co-primary outcomes at 12 months after recruitment of the first 3700 participants: within-cohort HIV incidence; and change in population HIV diagnoses in New South Wales between the 12-month periods before and after PrEP roll-out. The study is registered with ClinicalTrials.gov, number NCT02870790. Findings: We recruited 3700 participants in the 8 months between March 1, 2016, and Oct 31, 2016. 3676 (99%) were men, 3534 (96%) identified as gay, and 149 (4%) as bisexual. Median age was 36 years (IQR 30–45 years). Overall, 3069 (83%) participants attended a visit at 12 months or later. Over 4100 person-years, two men became infected with HIV (incidence 0·048 per 100 person-years, 95% CI 0·012–0·195). Both had been non-adherent to PrEP. HIV diagnoses in MSM in New South Wales declined from 295 in the 12 months before PrEP roll-out to 221 in the 12 months after (relative risk reduction [RRR] 25·1%, 95% CI 10·5–37·4). There was a decline both in recent HIV infections (from 149 to 102, RRR 31·5%, 95% CI 11·3 to 47·3) and in other HIV diagnoses (from 146 to 119, RRR 18·5%, 95% CI −4·5 to 36·6). Interpretation: PrEP implementation was associated with a rapid decline in HIV diagnoses in the state of New South Wales, which was greatest for recent infections. As part of a combination prevention approach, rapid, targeted, high-coverage PrEP implementation is effective to reduce new HIV infections at the population level. Funding: New South Wales Ministry of Health, Gilead Sciences.

    Original languageEnglish
    Pages (from-to)e629-e637
    Number of pages9
    JournalThe Lancet HIV
    Issue number11
    Publication statusPublished - 1 Nov 2018


    Dive into the research topics of 'Population-level effectiveness of rapid, targeted, high-coverage roll-out of HIV pre-exposure prophylaxis in men who have sex with men: the EPIC-NSW prospective cohort study'. Together they form a unique fingerprint.

    Cite this