Enumerating the population eligible for funded HIV pre-exposure prophylaxis (PrEP) in New Zealand
Peter J. W. Saxton A C and Susan M. McAllister B
+ Author Affiliations
- Author Affiliations
A Gay Men’s Sexual Health research group, Department of Social and Community Health, School of Population Health, University of Auckland, Private Bag 92109, Auckland 1142, New Zealand.
B AIDS Epidemiology Group, Department of Preventive and Social Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand.
C Corresponding author. Email: p.saxton@auckland.ac.nz
Sexual Health 16(1) 63-69 https://doi.org/10.1071/SH18058
Submitted: 29 March 2018 Accepted: 19 September 2018 Published: 9 January 2019
Abstract
Background: Pre-exposure prophylaxis (PrEP) became publicly funded in New Zealand (NZ) on 1 March 2018. PrEP could have a substantial population-level effect on HIV transmission if scaled up rapidly. An accurate estimate of the size of the PrEP-eligible population would guide implementation. Methods: We drew on nine sources to estimate the PrEP-eligible population, namely Statistics NZ data, Pharmaceutical Management Agency (PHARMAC) data on adults receiving funded antiretroviral treatment (ART), expert advice, estimates of the HIV care cascade, surveillance of undiagnosed HIV in a community sample of gay and bisexual men (GBM), surveillance of HIV diagnoses, NZ Health Survey data on sexual orientation among males, behavioural surveillance among GBM and behavioural data among people living with HIV (PLWH) from the HIV Futures NZ study. From these sources we derived three estimates relating to GBM, non-GBM and total eligible population. Sensitivity analyses examined different assumptions (GBM denominators, proportion PLWH diagnosed, proportion of diagnosed PLWH treated). Results: We estimated that 17.9% of sexually active HIV-negative GBM would be eligible for PrEP, equating to 5816 individuals. We estimated that 31 non-GBM individuals would be eligible for PrEP. Thus, in total, 5847 individuals would be eligible for PrEP, comprising 99.5% GBM and 0.5% non-GBM. Sensitivity analyses ranged from 3062 to 6718 individuals. Conclusions: Policy makers can use enumeration to monitor the speed and scale in coverage as implementation of publicly funded PrEP proceeds. Sexual health and primary care services can use enumeration to forecast PrEP demand and plan accordingly. Better quality data, especially on transgender adults in NZ, would improve the accuracy of estimates.
Additional keywords: condomless anal intercourse, enumeration, homosexual, methamphetamine, sexually transmissible infection.
References
[1] Molina J-M, Capitant C, Spire B, Pialoux G, Cotte L, Charreau I, Tremblay C, Le Gall J, Cua E, Pasquet A, Raffi F, Pintado C, Chidiac C, Chas J, Charbonneau P, Delaugerre C, Suzan-Monti M, Loze B, Fonsart J, Peytavin G, et al On-demand preexposure prophylaxis in men at high risk for HIV-1 infection. N Engl J Med 2015; 373 2237–46.| On-demand preexposure prophylaxis in men at high risk for HIV-1 infection.Crossref | GoogleScholarGoogle Scholar | 26624850PubMed |
[2] McCormack S, Dunn D, Desai M, Dolling D, Gafos M, Gilson R, Sullivan A, Clarke A, Reeves I, Schembri G, Mackie N, Bowman C, Lacey C, Apea V, Brady M, Fox J, Taylor S, Antonucci S, Khoo S, Rooney J, et al Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial. Lancet 2016; 387 53–60.
| Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial.Crossref | GoogleScholarGoogle Scholar | 26364263PubMed |
[3] Grant RM, Anderson PL, McMahan V, Liu A, Amico KR, Mehrotra M, Hosek S, Mosquera C, Casapia M, Montoya O, Buchbinder S. Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: a cohort study. Lancet Infect Dis 2014; 14 820–9.
| Uptake of pre-exposure prophylaxis, sexual practices, and HIV incidence in men and transgender women who have sex with men: a cohort study.Crossref | GoogleScholarGoogle Scholar | 25065857PubMed |
[4] World Health Organization (WHO). Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. 2015. Available online at: http://www.who.int/hiv/pub/guidelines/earlyrelease-arv/en/ [verified 30 November 2018].
[5] US Department of Health and Human Services. Initiation of antiretroviral therapy. 2017. Available online at: https://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-arv-guidelines/10/initiating-art-in-treatment-naive-patients [verified 30 November 2018].
[6] European AIDS Clinical Society. EACS guidelines. 2018. Available online at: http://www.eacsociety.org/files/2018_guidelines-9.1-english.pdf [verified 30 November 2018].
[7] British HIV Association (BHIVA). BHIVA/BASHH guidelines on the use of HIV pre-exposure prophylaxis (PrEP) 2018. 2018. Available online at: https://www.bhiva.org/file/5b729cd592060/2018-PrEP-Guidelines.pdf [verified 30 November 2018].
[8] Wright E, Grulich A, Roy K, Boyd M, Cornelisse V, Russell D, O’Donnell D, Whittaker B, Crooks L, Zablotska I. Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine HIV pre-exposure prophylaxis: clinical guidelines. J Virus Erad 2017; 3 168–84.
| 28758027PubMed |
[9] Dickson N, Lee B, Foster T, Saxton P. The first 30 years of HIV in New Zealand: review of the epidemiology. N Z Med J 2015; 128 31–48.
| 26913906PubMed |
[10] Saxton PJ, Hughes A, Giola M. HIV prevention today: with coordinated action, we can end transmission. N Z Med J 2015; 128 8–15.
| 26913903PubMed |
[11] Punyacharoensin N, Edmunds WJ, De Angelis D, Delpech V, Hart G, Elford J, Brown A, Gill ON, White RG. Effect of pre-exposure prophylaxis and combination HIV prevention for men who have sex with men in the UK: a mathematical modelling study. Lancet HIV 2016; 3 e94–e104.
| Effect of pre-exposure prophylaxis and combination HIV prevention for men who have sex with men in the UK: a mathematical modelling study.Crossref | GoogleScholarGoogle Scholar | 26847231PubMed |
[12] Cambiano V, Miners A, Dunn D, McCormack S, Ong KJ, Gill ON, Nardone A, Desai M, Field N, Hart G, Delpech V. Cost-effectiveness of pre-exposure prophylaxis for HIV prevention in men who have sex with men in the UK: a modelling study and health economic evaluation. Lancet Infect Dis 2018; 18 85–94.
| Cost-effectiveness of pre-exposure prophylaxis for HIV prevention in men who have sex with men in the UK: a modelling study and health economic evaluation.Crossref | GoogleScholarGoogle Scholar | 29054789PubMed |
[13] PHARMAC. Decision to fund HIV pre-exposure prophylaxis (PrEP). Wellington, New Zealand: PHARMAC; 2018. Available online at: https://www.pharmac.govt.nz/news/notification-2018-02-07-prep/ [verified 5 September 2018].
[14] Statistics New Zealand. National population estimates. Available online at: https://www.stats.govt.nz/assets/Uploads/National-population-estimates/National-population-estimates-At-30-June-2018/Download-data/national-population-estimates-at-30-june-2018-population-by-sex-age-csv.csv [verified 30 November 2018].
[15] PHARMAC. New Zealand pharmaceuticals ART collection data 2005–2017. PHARMAC data report. Wellington, New Zealand: PHARMAC; 2017.
[16] Raymond N, Bargh K, Aung KL, Rice J. Cascade of care for people living with HIV infection in the Wellington region. N Z Med J 2016; 129 41–51.
| 27356251PubMed |
[17] Saxton PJ, Dickson N, Griffiths R, Hughes A, Rowden J. Actual HIV prevalence and undiagnosed infections in a community sample of men who have sex with men in Auckland, New Zealand. BMC Public Health 2012; 12 92
| Actual HIV prevalence and undiagnosed infections in a community sample of men who have sex with men in Auckland, New Zealand.Crossref | GoogleScholarGoogle Scholar | 22296737PubMed |
[18] Murphy B, Dickson NP, Gribben CB, Righarts A, Saxton P, Connor J. Experience of diagnosed sexually transmitted infections in a large national survey of New Zealand adults. Presented as the New Zealand Sexual Health Society Conference; 7–9 September 2017; Christchurch, New Zealand. Available online at: https://www.nzshs.org/docman/conferences/2017-conference-in-christchurch/saturday-9th-september/339-sexual-identity-in-a-large-national-survey-of-new-zealand-adults/file [verified 20 December 2018].
[19] Saxton P, Dickson N, Hughes A, Ludlam A. Gay Auckland Periodic Sex Survey (GAPSS) and Gay men’s Online Sex Survey (GOSS): basic frequency tables 2002–2014. Auckland, New Zealand: The University of Auckland; 2014.
[20] Grierson J, Thorpe R, Pitts M, Hughes A, Saxton P, Smith J, Smythe E, Thomas M. HIV Futures New Zealand 2 [Mate āraikore a muri ake nei (Tuarua)]. Monograph Series no. 66. Melbourne, Vic., Australia: Australian Research Centre in Sex, Health and Society, La Trobe University; 2008.
[21] Saxton P, Newcombe D, Ahmed A, Dickson N, Hughes A. Illicit drug use among New Zealand gay and bisexual men: prevalence and association with sexual health behaviours. Drug Alcohol Rev 2018; 37 180–7.
| Illicit drug use among New Zealand gay and bisexual men: prevalence and association with sexual health behaviours.Crossref | GoogleScholarGoogle Scholar | 28439922PubMed |
[22] Clark TC, Lucassen MF, Bullen P, Denny SJ, Fleming TM, Robinson EM, Rossen FV. The health and well-being of transgender high school students: results from the New Zealand adolescent health survey (Youth’12). J Adolesc Health 2014; 55 93–9.
| The health and well-being of transgender high school students: results from the New Zealand adolescent health survey (Youth’12).Crossref | GoogleScholarGoogle Scholar | 24438852PubMed |
[23] Smith DK, Van Handel M, Wolitski RJ, Stryker JE, Hall HI, Prejean J, Koenig LJ, Valleroy LA. Vital signs: estimated percentages and numbers of adults with indications for pre-exposure prophylaxis to prevent HIV acquisition – United States, 2015. MMWR Morb Mortal Wkly Rep 2015; 64 1291–5.
| Vital signs: estimated percentages and numbers of adults with indications for pre-exposure prophylaxis to prevent HIV acquisition – United States, 2015.Crossref | GoogleScholarGoogle Scholar | 26606148PubMed |
[24] Zablotska IB, Selvey C, Guy R, Price K, Holden J, Schmidt HM, McNulty A, Smith D, Jin F, Amin J, Cooper DA. Expanded HIV pre-exposure prophylaxis (PrEP) implementation in communities in New South Wales, Australia (EPIC-NSW): design of an open label, single arm implementation trial. BMC Public Health 2018; 18 210
| Expanded HIV pre-exposure prophylaxis (PrEP) implementation in communities in New South Wales, Australia (EPIC-NSW): design of an open label, single arm implementation trial.Crossref | GoogleScholarGoogle Scholar | 29394918PubMed |
[25] Hoornenborg E, Krakower DS, Prins M, Mayer KH. Pre-exposure prophylaxis for MSM and transgender persons in early adopting countries. AIDS 2017; 31 2179–91.
| Pre-exposure prophylaxis for MSM and transgender persons in early adopting countries.Crossref | GoogleScholarGoogle Scholar | 28991023PubMed |
[26] St Stephens Clinical Research. PrEP impact trial: a pragmatic health technology assessment of PrEP and implementation. Protocol no. SSCR104. Version 2.0, 24 July 2017. London, UK: St Stephens Clinical Research; 2017. Available online at: https://docs.wixstatic.com/ugd/f75c00_f1c229feb1f1471189bc99c9d697b0e5.pdf [verified 5 September 2018].
[27] Saxton PJ, Azariah S, Franklin R, Forster R, Werder S, Jenkins R, Myers J, Rich J, Te Wake W, Fisher M. Baseline characteristics of gay and bisexual men in an HIV pre-exposure prophylaxis demonstration project with equity quotas in Auckland, New Zealand. Sex Health 2018;
| Baseline characteristics of gay and bisexual men in an HIV pre-exposure prophylaxis demonstration project with equity quotas in Auckland, New Zealand.Crossref | GoogleScholarGoogle Scholar | 30274568PubMed |
[28] Hughes A, Saxton P. Geographic micro-clustering of homosexual men: implications for research and social policy. Soc Policy J N Z 2006; 28 158–78.
[29] Ludlam AH, Saxton P, Dickson N, Hughes A. General practitioner awareness of sexual orientation among a community and Internet sample of gay and bisexual men in New Zealand. J Prim Health Care 2015; 7 204–12.
| General practitioner awareness of sexual orientation among a community and Internet sample of gay and bisexual men in New Zealand.Crossref | GoogleScholarGoogle Scholar | 26437044PubMed |
[30] National HIV Forum. Consensus statement on comprehensive HIV prevention in Aotearoa/New Zealand. 2017. Available online at: https://hivconsensus.org.nz/ [verified 2 September 2018]
[31] New South Wales Government. NSW HIV Strategy 2016-2020. 2015. Available online at: https://www.health.nsw.gov.au/endinghiv/Publications/nsw-hiv-strategy-2016-2020.PDF [verified 5 September 2018].
[32] New South Wales Government. NSW HIV surveillance data reports. 2018. Available online at: http://www.health.nsw.gov.au/endinghiv/Pages/tools-and-data.aspx [verified 5 September 2018].
[33] Holt M. Progress and challenges in ending HIV and AIDS in Australia. AIDS Behav 2017; 21 331–4.
| Progress and challenges in ending HIV and AIDS in Australia.Crossref | GoogleScholarGoogle Scholar | 28004219PubMed |
[34] Holt M, Lea T, Mao L, Zablotska I, Lee E, Hull P, de Wit JB, Prestage G. Adapting behavioural surveillance to antiretroviral-based HIV prevention: reviewing and anticipating trends in the Australian Gay Community Periodic Surveys. Sex Health 2017; 14 72–9.
| Adapting behavioural surveillance to antiretroviral-based HIV prevention: reviewing and anticipating trends in the Australian Gay Community Periodic Surveys.Crossref | GoogleScholarGoogle Scholar | 27567489PubMed |
[35] Saxton P, Giola M, Coughlan E, Rich J, Azariah S, Ludlam A, O’Toole C, Pohl M, Myers J. Implementing HIV pre-exposure prophylaxis (PrEP): let’s not get caught with our pants down. N Z Med J 2018; 131 64–73.
| 30161114PubMed |
