HIV pre-exposure prophylaxis (PrEP) has been shown to be highly effective in men who have sex with men (MSM) at an individual level but its population-level impact is not clear. The authors were interested in whether rapid, targeted and high-coverage roll-out of PrEP in an MSM epidemic would reduce HIV incidence in the cohort prescribed PrEP and state-wide in New South Wales (NSW), Australia. They performed an implementation cohort study of daily co-formulated tenofovir disoproxil fumarate and emtricitabine as HIV PrEP. 3700 high-risk MSM were recruited, with a median age was 36 years. 83% of participants attended a visit at 12 months or later. Over 4100 person-years, two men became infected with HIV (incidence 0·048 per 100 person-years). Both had been non-adherent to PrEP. HIV diagnoses in MSM in NSW decreased from 295 in the 12 months prior to PrEP roll-out to 221 in the 12 months after (relative risk reduction [RRR] 25·1%, 95%CI 10·5-37·4%). There was also a decline in both recent HIV infections (from 149 to 102, RRR 31·5%, 95%CI 11·3–47·3%) and in other HIV diagnoses (from 146 to 119, RRR 18·5%, 95%CI -4·5 to 36·6%). Therefore PrEP implementation is associated with a rapid decline in HIV diagnoses in New South Wales, and was greatest for recent infections.
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