That was EPIC! Results from Australia’s biggest PrEP trial.

Rounding off the decade, EPIC-NSW, Australia’s largest PrEP trial, concluded in the final months of 2019.

If this is the first time you are hearing about it, EPIC-NSW stands for Expanded PrEP Implementation in Communities in NSW, which is a study that made PrEP available at scale in NSW, without a cost to those who were eligible to join. Just under 10,000 participants joined the study, most of which were gay men, making it one of the largest PrEP studies in the world.

So what did we see from this EPIC process?

New HIV diagnoses in trial participants

Out of the 9,596 people who participated in EPIC-NSW, there were 30 who contracted HIV during the trial. That may seem like a lot, and any infection is one too many, but in the absence of PrEP, based on the data for this group of gay and bisexual men, the trial would have expected more than 400 new HIV diagnoses which is a huge reduction and an incredible result!

You’re probably wondering, ‘wait, PrEP is supposed to be super effective at preventing HIV! How did this happen?’ Well the answer is not in the effectiveness of the medication, rather in the adherence of taking it correctly – not using PrEP as directed was a factor in all participants who became HIV positive.

Adherence to PrEP and STIs

Throughout the study, while there was generally good adherence, some groups found it more difficult to follow the correct daily dosing strategy than others, such as younger participants, those who lived in suburbs with lower concentrations of gay men, and those who reported both using crystal (methamphetamine) and having previously had a rectally transmitted infection (or STI) at the start of the study. This highlights that while PrEP is a great option for many, some people may require extra help to make sure they take it correctly. Of course, PrEP may not suit everyone – which is where other HIV prevention options, like condoms, should be considered.

If remembering to take your PrEP is difficult, there are ways you can prompt yourself to take it each day. It could be as simple as using a pill organiser and taking it when you brush your teeth in the morning or setting a recurring alarm or reminder on your smartphone.

As anticipated, there was a relatively high rate of STI diagnoses within the study cohort,. That said, diagnoses were quite stable over time, confirming that those accessing PrEP through the study were at high risk of HIV, and therefore good candidates for PrEP.

How did PrEP impact new HIV diagnoses in NSW as a result of the trial?

While it might be tricky to completely detangle the effects of PrEP uptake from other crucial efforts towards ending new HIV transmissions (increasing HIV testing rates and the benefits of using treatment as prevention more broadly) there certainly was an impact. We have seen a large, sustained decline in new HIV infections across NSW from the point the study was initiated, highlighting the role that PrEP has played in bringing new diagnoses in NSW to their lowest level on record!

A comparison was made between the number of recently acquired HIV infections in men who have sex with men (MSM) in the six months before EPIC-NSW enrolment began and the six months following the end of enrolment and there was a 44% decline in recently acquired HIV infections; an unprecedented reduction in HIV transmission.

How do I get PrEP?

Interested in starting PrEP? You can learn all about PrEP and how to access it here. If you are interested in starting on PrEP but do not have access to Medicare or are born overseas then you could consider joining MI-EPIC, a follow-on study of the EPIC-NSW study for those who aren’t able to access PrEP through the Pharmaceutical Benefits Scheme.

If you were involved in EPIC-NSW, or even if you are taking PrEP now, we want to take the chance to thank you for doing your part in looking after your sexual health and that of your partners! The study has certainly proven that PrEP really can make an epic impact.