Abstract

OBJECTIVE: Scale-up of HIV pre-exposure prophylaxis (PrEP) has raised concerns regarding its impact on clinic capacity and access to HIV testing. We describe enrolment in PrEPX, a large PrEP implementation study in Victoria, Australia, and the impact of PrEP uptake and maintenance on existing health services. METHODS: We describe enrolment between 26 July 2016 and 31 March 2018 and trends in HIV testing among PrEPX participating and non-participating gay and bisexual and other men who have sex with men (GBM) at five study clinics participating in a sentinel surveillance system (ACCESS). We evaluated HIV and STI testing trends using segmented linear regression across the pre-study (January2015-June2016) and PrEPX study (July2016-March2018) periods. FINDINGS: 2049 individuals registered interest in study participation: 72% enrolled into the study. Study clinics enrolled participants rapidly; of 4265 people enrolled in PrEPX (98% GBM), 1000 enrolled by week-three, 88% (n=876) of whom enrolled at ACCESS sites.Pre-study period HIV testing rates were increasing at all ACCESS sites. In the month PrEPX commenced, there was an additional 247 HIV tests among PrEPX participants (p<0.01) and no significant change among non-PrEPX GBM (p=0.72). Across the study period, HIV testing increased by 7.2 (p<0.01) and 8.9 (p<0.01) tests/month among PrEPX participants and non-PrEPX GBM, respectively. HIV testing increased among non-PrEPX GBM at sexual health clinics (18.8 tests/month, p<0.01) and primary care clinics (7.9 tests/month, p<0.01). Similar trends were observed across testing for all measured STIs. CONCLUSIONS: Rapid PrEP scale-up is possible without a reduction in HIV testing among GBM not using PrEP.

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