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ASHM Report Back
Clinical posts from members and guests of the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM) from various international medical and scientific conferences on HIV, AIDS, viral hepatitis, and sexual health.
Population-based PrEP implementation in New South Wales, Australia
This session was delivered by Dr. Andrew Grulich (Kirby Institute, Australia).
Dr. Grulich began by stating that, 'We know PrEP works'. He presented some short soundbytes about lessons learned from PrEP trials in Australia.
-PrEP quickly attracts very high-risk gay men.
-There was high levels of adherance (proven by drug monitoring testing).
-This cohort has high levels of STI's (showing their relative HIV risk).
-No HIV seroconversions seen in about 500 person-years.
As Australia has a concentreated epidemic (~0.1% prevalence in general population v ≤15% in MSM in urban centres), the most impact that PrEP will make is to target high risk MSM. Andrew presented a model that showed that if the high risk MSM group were saturated with PrEP users, it would result in much lower incidences of HIV plus it would have a herd immmunity effect on those in the same sexual networks but not exhibiting as high risk taking behaviour.
Andrew discussed the EPIC study. He discussed how some clinics workloads were much increased due to the amount of MSM on PrEP attending their clinics. This showed that innovation was required to ensure the services continued whilst under great pressure.Thes innovations included:
-Peer led education pre-consent sessions.
-Same day PrEP precriptions.
-Nurse led dispensing/care requiriung only once or twice yearly medical review.
Dr. Grulich asked the question, 'Will PrEP end HIV?' His answer was that whilst safer sex practices and TasP has resulted in stable HIV prevalnce in NSW, it hasnt showed a reduction. He displayed a slide that showed that since the PrEP study was rolled out, HIV prevalnce has REDUCED by 23% in the second half of 2016 in NSW. He did warn that it is too early yet to say PrEP is the reason. More data and time past is required.
He concluded by saying that should PrEP be rolled out as a national startegy, federal government subsidy would be required. The cost may not be as high as first thought as the PBS is considering an application for generic Truvada to be added as a PrEP treatment.