Impact of Public PrEP Programs

A report on the proffered papers session on day 3 of the Conference.

In this session I was particularly interested in the studies from NSW and Victoria looking at the impact of PrEP on STI trends in high risk gay and bisexual men following the introduction of PrEP after the rapid scaling up of access to PrEP.

PrEP of course targets those already at high STI risk, including recent STI in eligibility criteria. STI incidence was increasing in the years prior to ramping up of PrEP. Condomless sex in Australian gay and bisexual men had also increased from 27% in 2000 to 39% in 2015 prior to easier access of PrEP.

Both NSW and Victoria found an increased incidence of STIs following PrEP studies, especially rectal chlamydia. Overall, those who participated in the studies but had previous PrEP had no increase in STI rate, those new to PrEP had 20% more STIs than before.  The incidence of STIs was 91/100 person years in PrEPX, the Victorian program.

I found it relevant that >50% of participants had no STIs (of 2981 Vic PrEPX participants) with a small group of 13% participants accounting for 53% of all STI diagnoses with ≥3 STIs each. This was driven by numbers of partners and group sex participation rather than condom use.

The good news is that with increased frequency of testing for STIs, despite a small/moderate increase in STIs, duration of STI infection is reduced and this could reduce the ‘burden of disease’ in the community.

Now that we have PrEP PBS listing, these studies support continuing to follow the 3 monthly STI testing guidelines, particularly for the small group with many infections, and remember that there have been no new HIV infections in this group, which is of course the point of PrEP.

Author bio:

Janet is a GP working in Darlinghurst with a special interest in HIV, sexual health womens health and paediatrics.