I haven't come across PrEP before - it is not easily accessible in Western Australia, although a few patients have obtained it through personal importation. Hence, the sessions on PrEP were of particular importance to me as I'm sure they will be filtering through to WA very soon. In particular I enjoyed the summary by Prof Jared Baeten, and I've tried to summarise my learning points below. I've combined two of his talks into one.
Firstly, I love this quote that he put up (forgotten who said it though): all truth goes through three phases: it is ridiculed, violently opposed, and then accepted as self-evident.
- PrEP works: those who had tenofovir in their system had a >90% reduction in HIV transmission
- PrEP works for high risk patients
- a single agent may work as well as dual agents (e.g. TDF only = 85%, TDF/FTC = 93%)
- adherers adhere
- not everyone used PrEP, but those who did use it tended to be consistent users
- non-adherers rarely started adhering
- there wasn't much change in behaviour after 1 month
- surprisingly, real world effectiveness was better than efficacy in the studies
- ?adherence was better in real life than in the trials
- PrEP has several additional benefits
- decreased anxiety
- increased communication and trust
- increased sexual pleasure and intimacy
- chance of developing eGRF <70 while on PrEP if your baseline is >90 is extremely small
- rising STI rates in the US have been happening for a while, even before the introduction of PrEP
- PrEP works even when STIs are present
Most of the informal feedback I've heard before today has been that PrEP is associated with an increase in STIs but if the data above is applicable to Australia, then perhaps that isn't quite true. I think the evidence if favour of PrEP is mounting, and the major obstacle in Australia is probably the cost-benefit ratio...