Overcoming barriers to HIV pre-exposure prophylaxis (PrEP) coverage in Australia among Medicare-ineligible people at risk of HIV: results from the MI-EPIC clinical trial
Curtis Chan
A # * , Doug Fraser A # , Stefanie Vaccher A , Barbara Yeung A , Fengyi Jin A , Janaki Amin A B , Nila J. Dharan A , Andrew Carr C , Catriona Ooi D , Matthew Vaughan E , Jo Holden F , Cherie Power F , Andrew E. Grulich A , Benjamin R. Bavinton A and for the MI-EPIC Research Group
A The Kirby Institute, UNSW Sydney, Sydney, NSW, Australia.
B Department of Health Systems and Populations, Macquarie University, North Ryde, NSW, Australia.
C St Vincent’s Hospital, Darlinghurst, Sydney, NSW, Australia.
D Clinic 16, Sydney, NSW, Australia.
E ACON, Sydney, NSW, Australia.
F NSW Ministry of Health, Sydney, NSW, Australia.
Handling Editor: Nittaya Phanuphak
Sexual Health 18(6) 453-459 https://doi.org/10.1071/SH21096
Submitted: 5 May 2021 Accepted: 26 July 2021 Published: 13 December 2021
© 2021 The Author(s) (or their employer(s)). Published by CSIRO Publishing. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)
Abstract
Background: Overseas-born people who are ineligible for government-subsidised health care experience barriers to accessing HIV pre-exposure prophylaxis (PrEP) in Australia. This study aimed to assess a program providing free PrEP to overseas-born adults at risk of acquiring HIV.
Methods: Medicare-Ineligible Expanded Implementation in Communities (MI-EPIC) was a single-arm, open-label trial of daily tenofovir disoproxil fumarate/emtricitabine as PrEP. Six clinics recruited Medicare-ineligible adults who met HIV risk criteria in New South Wales, Australia. We recorded data on HIV and sexually transmitted infection (STI) diagnoses, and PrEP dispensing from July 2019 to June 2020. PrEP adherence as a medication possession ratio (MPR) was calculated as pills dispensed divided by days. We administered an optional survey on behaviours and attitudes to PrEP and sexual health.
Results: The 221 participants (206 men; 93.2%) had a median age of 29 years (IQR 26–34). Participants were mostly born in Asia (53.4%), Latin America or the Caribbean (25.3%), or Europe (10.9%). Adherence was high; 190 participants (86.0%) had an MPR of >60%. Of 121 survey participants, 42 (34.7%) completed the survey in a language other than English. Of participants who had not used PrEP in the 6 months before enrolment (n = 45, 37.2%), the most common reasons were cost (n = 22, 48.9%), and lack of knowledge about accessing PrEP (n = 20, 44.4%).
Conclusions: Medicare-ineligible people at risk of HIV demonstrate high adherence when given access to free PrEP and translated information. Increasing PrEP awareness and reducing barriers to accessing PrEP in this high-risk population should be priorities in HIV prevention.
Keywords: social determinants, gay men, HIV prevention, men who have sex with men, public health, pre-exposure prophylaxis, HIV/AIDS, migrants.
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