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Clinical
Original article
Preparing for PrEP: estimating the size of the population eligible for HIV pre-exposure prophylaxis among men who have sex with men in England
  1. Holly D Mitchell1,
  2. Sarika Desai1,
  3. Hamish Mohammed1,
  4. Koh Jun Ong1,
  5. Martina Furegato1,
  6. Victoria Hall1,
  7. Monica Desai1,
  8. John Michael Saunders1,2,
  9. Gwenda Hughes1,
  10. Nigel Field1,3,
  11. O Noel Gill1
  1. 1 Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service, National Infection Service, Public Health England, London, UK
  2. 2 Centre for Clinical Research in Infection and Sexual Health, Institute for Global Health, University College London, London, UK
  3. 3 Centre for Molecular Epidemiology and Translational Research, Institute for Global Health, University College London, London, UK
  1. Correspondence to Dr Hamish Mohammed, Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service, National Infection Service, Public Health England, London NW9 5EQ, UK; hamish.mohammed{at}phe.gov.uk

Abstract

Objectives The size of the population of men who have sex with men (MSM) who may be eligible for HIV pre-exposure prophylaxis (HIV-PrEP) in England remains unknown. To plan for a national PrEP implementation trial, we estimated the number of MSM attending sexual health clinics (SHCs) that may be eligible for HIV-PrEP in England.

Methods Sexually transmitted infection (STI) surveillance data from 2010 to 2015 from the GUMCAD surveillance system were used to estimate the annual number of HIV-negative MSM who may be eligible for HIV-PrEP in England. Based on national eligibility criteria, we identified HIV-negative MSM attending SHCs with a HIV-negative test in the past year and used diagnosed bacterial STI (past year) in this group as a proxy for condomless sex and eligibility for HIV-PrEP. We estimated HIV incidence per 100 person-years (py) in these groups in 2014.

Results During 2010–2015, the number of HIV-negative MSM attending SHCs with a HIV-negative test in the past year doubled from 14 643 to 29 023, and HIV incidence in this group was 1.9 (95% CI 1.6 to 2.2) per 100 py in 2014. In the same period, the subgroup with a bacterial STI diagnosis (past year), and therefore considered potentially eligible for HIV-PrEP in this analysis, increased from 4365 (30%) to 10 276 (35%). HIV incidence in this subgroup was 3.3 (95% CI 2.7 to 4.0) per 100 py in 2014.

Conclusions In 2015, approximately 10 000 HIV-negative MSM were considered potentially eligible for HIV-PrEP based on clinic history in GUMCAD. These data were used to inform the initial recruitment target for the PrEP Impact Trial and will inform future evaluations at a population level.

  • gay men
  • HIV
  • surveillance
  • policy
  • public health

https://doi.org/10.1136/sextrans-2019-054009

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    Footnotes

    • HDM and SD are joint first authors.

    • Handling editor Tristan J Barber

    • Contributors HDM, SD and ONG designed the analysis and developed the methodology. HM, KJO, MF and NF provided support with data analysis and interpretation of the data. HDM wrote the first draft of the manuscript with advice from NF and HM. All authors read the manuscript and provided comments.

    • Funding This work was conducted by Public Health England as part of routine public health surveillance. No additional funds were received for this analysis.

    • Competing interests JMS, MD and ONG are sub-investigators for the PrEP Impact Trial in England and members of the trial management group. No other potential conflicts of interest to disclose.

    • Patient consent for publication Not required.

    • Ethics approval As GUMCAD is a routine public health surveillance activity, no specific consent was required from the patients whose data were used in this analysis. PHE has permission to handle data obtained by GUMCAD under section 251 of the UK National Health Service Act of 2006 (previously section 60 of the Health and Social Care Act of 2001), which was renewed annually by the ethics and confidentiality committee of the National Information Governance Board until 2013. Since then the power of approval of public health surveillance activity has been granted directly to PHE.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Data are available upon reasonable request.