Evidence is increasingly clear that HIV treatment reduces the likelihood of someone transmitting the virus. In response, governments and health organisations around the world have moved to make 'treatment as prevention' a feature in their strategies for preventing and reducing HIV. Research is needed to understand if the implementation of treatment as prevention can actually have an impact on new HIV infections beyond a clinical context and in the 'real world'.
This study seeks to determine if the massive efforts to scale up both testing and treatment for HIV in Australia can lead to a reduction in new infections among gay and bisexual men.
This project harnesses routinely collected clinical and laboratory data to construct two large cohorts of gay and bisexual male patients, one comprising approximately 13,000 HIV positive men and the other approximately 40,000 HIV negative men. Through these cohorts it is possible to calculate the proportion of HIV positive men with viraemia (i.e., viral loads loads exceeding 200 RNA copies/mm3) and compare that with the incidence of HIV among men in the negative cohort. Analyses will be employed to adjust for behavioural and demographic variables associated with infection, including the uptake of HIV pre-exposure prophyalxis. Analyses will also be conducted to assess incidence and predictor of HIV treatment initation, repeat HIV testing, and viral suppression.
The result of this study will provide a direct measure of HIV treatment impact on incidence among gay and bisexual men. It will also provide details on factors associated with treatment uptake, HIV testing and viral suppression.
Studying the impact of HIV treatment as prevention is important not only for evaluating a major new public health initiative but has practical implications for the design of effective policy and practice.
- National Health and Medical Research Council (NHMRC) Project Grant (DPAPP1082336)