Evaluating PrEP and HIV Treatment as Prevention in Australia

This stream covered quite a range of issues in regards to PrEP and it's use.

Dr Zablotska told us that community surveys show informal prep is currently being used in AustraliaPrEP was being accessed were through state based PrEP demonstration projects or through self importation. It was important to know the likely eligibility and demand for PrEP in the community. Based on the highest risk group ie MSM and using national statistics, self reported data and guidelines - conservatively it was estimated that eligibility and demand for PrEP ranged from 2500 to 6000 cases.

Dr John de Wit presented data on the change in sexual behaviours and risk reduction in men who are on PrEP. Using baseline and 3 month questionnaires from VicPREP - nothing changed in subjects with regular partners, in either frequency of sex or risk reduction practices. In subjects with casual partners - there was no change either BUT there is a moderate reduction in condom use in casual partners, specifically an increase in 'never used a condom' and a decrease in 'most of the time' in the last 3 months.

This was definitely a difference between trials/extension projects vs demo projects. It is possible that there was a selective change in risk reduction practices, based on informed decision making to balance risk and pleasure. A focus on 'real world' use of PrEP would have to be on sustained education and support on sexual risk reduction strategies, including condom use. This would especially be important for other STIs. This was my take home message from these sessions.

Dr de Wit then spoke about the early experience of men using PrEP in the VicPREP demonstration project. Although 53.9% of subjects reported missing ANY prep doses, the median number of doses missed was 1 dose. This didn't alter the effectiveness of PrEP. The main reason? Forgetfulness!