Australian PrEP trial leads to unprecedented reductions in HIV transmission

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Recent HIV infections in gay and bisexual men in New South Wales (NSW) have declined by almost one-third following the trial of an HIV prevention medication called PrEP (Pre-Exposure Prophylaxis), according to Kirby Institute research published today in The Lancet HIV. These globally unprecedented reductions provide strong evidence to support the large-scale, targeted provision of PrEP to prevent HIV transmission.

Journal/conference: The Lancet HIV

Organisation/s: The University of New South Wales

Funder: NSW Ministry of Health

Media Release

From: The Kirby Institute for Infection and Immunity in Society

(SYDNEY, Thursday 18 October 2018) Recent HIV infections in gay and bisexual men in New South Wales (NSW) have declined by almost one-third following the trial of an HIV prevention medication called PrEP (Pre-Exposure Prophylaxis), according to Kirby Institute research published today in The Lancet HIV. These globally unprecedented reductions provide strong evidence to support the large-scale, targeted provision of PrEP to prevent HIV transmission.

The new research, funded by NSW Health, reports the findings from the NSW PrEP trial (called EPIC-NSW), which was launched in March 2016. When taken daily, PrEP prevents HIV negative people from acquiring the virus. The EPIC-NSW trial is the first study globally to measure the impact of PrEP on reducing HIV in a large population.

Professor Andrew Grulich from the Kirby Institute at UNSW Sydney led the trial. “The speed of the decline we’ve seen in new HIV infections in gay and bisexual men is a world first. In the year following the trial, state-wide new HIV infections in this population decreased by one third, from 149 infections in the 12 months prior, to 102 in the 12 months after. These numbers are the lowest on record since HIV surveillance began in 1985,” said Professor Grulich. “Our research tells us that these reductions are a result of PrEP, implemented on a background of high and increasing HIV testing and treatment rates.”

The declines were highest among Australian-born gay and bisexual men (48.7%) and gay and bisexual men living in the ‘gay suburbs’ of Sydney (51.8%). “These communities had the highest uptake of PrEP, and in these populations, new HIV infections have halved since the trial began,” said Professor Grulich. “However, we did not see the same reductions across the board.  Reductions were lower in non-English speaking immigrants with a smaller 21% decline among those born in Asia. We need to improve education and promote access to PrEP, particularly amongst culturally and linguistically diverse men who have sex with men, and those outside the gay neighbourhoods of Sydney.”

NSW was the first state in Australia to trial PrEP at a large scale. The EPIC-NSW trial enrolled 9,714 HIV negative people at high risk of HIV and provided them with PrEP. The study ceased enrolling on 30 April 2018, following PrEP being made available through the Pharmaceutical Benefits Scheme. “Now that PrEP has been listed on the PBS, and is available across Australia, we need to focus our attention on ensuring equitable access for all people at risk of HIV,” said Professor Grulich.

Professor Grulich credits the success of EPIC-NSW to a collaborative approach and the commitment of multiple partners across clinics, community and researchers, as well as leadership from the NSW government. Dr Kerry Chant, the NSW Chief Health Officer also highlighted the importance of collaboration. “NSW has a long history of successful partnerships in HIV prevention.  It’s these partnerships that have led to the success of EPIC-NSW and serve as a blueprint for other states and countries aiming to eliminate HIV transmission,” said Dr Chant.

“The results from EPIC-NSW provide an important evidence-base to inform our response to HIV globally,” added Professor Grulich. “We now know that PrEP implemented quickly, at a large scale, and targeted to high-risk populations can help turn the HIV epidemic around.”

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This trial was funded by the New South Wales Government’s Ministry of Health. A significant proportion of treatment for the trial was provided by Gilead Sciences.


Stakeholder comment:

The decline in HIV notifications demonstrates that we are starting to get results from our collective efforts in reducing HIV transmissions which, alongside greater access to PrEP, includes high rates of testing, wider and earlier uptake of treatment and continued condom use. The success of EPIC-NSW also demonstrates the commitment of people in our communities in the HIV response. Gay men and men who have sex with men (MSM) have consistently shown that they’re committed to ending HIV and have adopted the use of new technologies such as PrEP as soon as they become accessible. We thank gay men and MSM, both HIV positive and HIV negative, for their commitment and action to end HIV transmission, and we remain steadfast in our commitment to further driving down infection rates.”

Nic Parkhill, CEO, ACON

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