The new NSW HIV Strategy, released on 1 December 2015, aims for the virtual elimination of HIV transmission in NSW by 2020. HIV treatment as prevention has been ramped up over the 3 years to 2015, but despite this, and substantial ongoing investment in community-wide promotion of safe sexual behaviour, new HIV diagnoses in NSW have declined only slightly. EPIC-NSW is a large-scale, targeted implementation study which aims for the rapid roll-out of PrEP (a HIV prevention method in which people who do not have HIV take a pill every day to reduce their risk of becoming infected with HIV) to at least 3,700 individuals at high risk of HIV, in order to rapidly decrease HIV transmission.
At least 3,700 participants at high risk of HIV, mostly gay and bisexual men, will be commenced on PrEP according to NSW PrEP Guidelines. By rapidly rolling out PrEP over a 12 month period, and following participants for 2 years, we expect a reduction of about 50% in new HIV diagnoses in NSW due to decreased infection in the cohort, and by a larger percentage due to the interruption of chains of transmission. The rapid and large-scale roll-out of PrEP will greatly aid us in achieving the goal of the virtual elimination of HIV transmission by 2020.
The study is an implementation research project to mimic the conditions that will occur when PrEP is rolled out at the population level. There is no control arm. The study is conducted within the Clinical Trials Notification framework. All follow-up information will be electronically extracted from clinical records by linking to the ACCESS study database. TDF/FTC as PrEP will be prescribed according to the NSW guidelines. The first 24,000 bottles of TDF/FTC will be provided by Gilead Sciences and the remaining medications will be supplied by Mylan Laboratories Ltd (a subsidiary of Alphapharm) funded by the NSW Ministry of Health.
The study has enrolled over 4,000 study participants by the third week of November 2016. Recruitment and follow-up are on-going.
The study aims to rapidly reduce new HIV infections in NSW and to allow us to reach the goal of the virtual elimination of HIV. The study is highly ambitious, and is leading the world in the scale, rapidity and targeting of the roll-out of PREP.
- ACON – New South Wales
- Australasian Society for HIV, Viral Hepatitis & Sexual Health Medicine (ASHM)
- Local Health Districts – New South Wales
- NSW Health
- Positive Life NSW
- General practitioners who specialise in HIV
- and NSW publicly funded sexual health clinics and private practices