The rollout of a free PrEP program in Scotland in 2017 led to a drop in HIV diagnoses even among MSM who did not take PrEP, a study published in AIDS found.
In addition to free PrEP, the Scottish model includes testing for blood-borne viruses and STIs, as well as comprehensive monitoring and adherence support. Almost all PrEP was prescribed at publicly funded clinics. Despite an all-inclusive program rollout, only 2% of prescriptions during the study period went to people who are not MSM. The study included 16,723 MSM, 3,256 of whom (19.5%) were prescribed PrEP.
Overall, new HIV diagnoses dropped by 20% during a time span beginning two years before free PrEP was introduced and ending two years thereafter. HIV incidence declined 75% among MSM who were prescribed FTC/TDF (emtricitabine/tenofovir disoproxil fumarate, Truvada) for prevention—and declined 32% among those without such a prescription.
HIV diagnoses at first clinic visit also fell after 2017, while the frequency of testing increased, allowing for earlier detection of seroconversions. The number of people living with HIV who had a suppressed viral load modestly rose during the study, so not all credit for the reduction in HIV incidence among people not on PrEP goes to the little blue pill.
Of note, study data only came from MSM who access sexual health clinics; PrEP needs to be promoted to people who do not attend such clinics, study authors noted. It also must be expanded to young people, transgender women, and others, Noah Kojima and Jeffrey D. Klausner of the University of California-Los Angeles wrote in a commentary also published in AIDS. To do so, new formulations targeted at biologic women, as well as long-acting versions, are needed.
PrEP alone won’t end the epidemic, but it can when used in combination with test-and-treat, re-linking people living with HIV to care, and U=U, Kojima and Klausner wrote: “It is important to remember that the HIV epidemic could be put to an end with our current tools, knowledge, and understanding, if properly implemented.”