Should we increase our PrEP focus outside of inner city areas to help achieve HIV elimination?

HIV pre-exposure prophylaxis (PrEP) is a medicine that is highly effective at preventing HIV infection when used as prescribed. A study being presented today at the 2021 National Medicines Symposium (NMS) finds that people who discontinue its use are more likely to live outside of areas with a high prevalence of gay men, potentially putting them at risk of contracting HIV.

PrEP use has increased by a factor of 10 since its introduction on the Pharmaceutical Benefits Scheme (PBS) in April 2018 and is an important part of Australia’s National HIV Strategy.

The research being presented by Kendal Chidwick from NPS MedicineWise uses data from MedicineInsight – a database of deidentified clinical data from over 700 GP practices across Australia, encompassing over 5,000 individual GPs, caring for 3.2 million people. The study examines the data from 1577 patients prescribed PrEP between April 2018 and September 2019 and looks at which of these were still taking PrEP at the end of the study.

Around two thirds of people in the study were still using PrEP at the end of the study and a fifth had stopped PrEP. The people who had stopped taking PrEP were more likely to attend practices with a low number of patients prescribed PrEP and live in socio-economically disadvantaged areas, both typically outside of inner city high-prevalence gay areas.

“It is encouraging to see PrEP being prescribed at general practices outside the high prevalence gay areas as these are not the localities that HIV prevention campaigns have typically targeted. However, our findings do highlight some potential quality use of medicines issues,” says Ms Chidwick.

“GP education and PrEP health promotion could be increased in these areas to help achieve elimination of HIV transmission,” she says.

The PrEP study is one of the lightning talks being presented at the 2021 National Medicines Symposium, this year with the theme Evaluating quality use of medicines: How do we know if we’re making a difference?