{"id":1076,"date":"2015-03-25T14:06:51","date_gmt":"2015-03-25T14:06:51","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=1076"},"modified":"2015-03-25T14:06:51","modified_gmt":"2015-03-25T14:06:51","slug":"reported-86-effectiveness-for-msm-prep-by-proud-study-makes-this-intervention-a-viable-option-for-uk-health-services","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2015\/03\/25\/reported-86-effectiveness-for-msm-prep-by-proud-study-makes-this-intervention-a-viable-option-for-uk-health-services\/","title":{"rendered":"Reported 86% effectiveness for MSM PrEP by PROUD study makes this intervention a viable option for UK health services"},"content":{"rendered":"<p>The Conference on Retroviruses and Opportunistic Infections has recently taken place. \u00a0At that event the UK PROUD (<strong><span style=\"text-decoration: underline\">PR<\/span><\/strong>e-exposure <strong><span style=\"text-decoration: underline\">O<\/span><\/strong>ption for reducing HIV in the <strong><span style=\"text-decoration: underline\">U<\/span><\/strong>K: immediate or <strong><span style=\"text-decoration: underline\">D<\/span><\/strong>eferred) study of pre-exposure prophylaxis (PrEP) for MSM reported its results, prior to publication in the coming months.\u00a0 The headline figure is an astonishing <strong>86%<\/strong> for the reduction of risk of infection in the intervention group.\u00a0 Hitherto, results of PrEP trials, largely conducted in Africa, have often been disappointing. \u00a0This is probably on account of poor adherence (<a href=\"https:\/\/blogs.bmj.com\/sti\/wp-admin\/post.php?post=1045&amp;action=edit\">VOICE D( STI\/blog)<\/a>; <a href=\"https:\/\/blogs.bmj.com\/sti\/wp-admin\/post.php?post=918&amp;action=edit\">Haberer &amp; Bangsberg (STI\/blog)<\/a>; <a href=\"https:\/\/blogs.bmj.com\/sti\/wp-admin\/post.php?post=813&amp;action=edit\">Hendrix &amp; Bumpus (STI\/blog)<\/a>).\u00a0 The good result achieved here is no doubt attributable to good adherence. \u00a0It demonstrates, as these earlier trials have not, the true effectiveness of PrEP.<\/p>\n<p>The UK trial included 545 participants at 13 practices. 276 were randomized to receive PrEP immediately, while the remaining 269 received it after a year.\u00a0 Earlier PrEP trials have been blind and placebo-controlled. \u00a0But this design had the advantage of demonstrating the effectiveness of PrEP in real life. The participants were aware if they were taking the active drug and could have changed their sexual behaviour accordingly.\u00a0 Given one of the major concerns around PrEP is that of risk compensation &#8211; i.e. taking advantage of the protection of PrEP to engage in more risky behaviour than they would otherwise (<a href=\"https:\/\/blogs.bmj.com\/sti\/wp-admin\/post.php?post=970&amp;action=edit\">Marcus &amp; Grant (STI\/blog)<\/a>; <a href=\"https:\/\/blogs.bmj.com\/sti\/wp-admin\/post.php?post=954&amp;action=edit\">Baeten &amp; Celum (STI\/blog)<\/a>) &#8211; this was a valuable aspect of the trial.<\/p>\n<p>In the period to October 2014, there were <strong>22<\/strong> HIV infections &#8211; <strong>3<\/strong> in the immediate, and <strong>19<\/strong> in the deferred group.\u00a0 This gives us the headline figure of 86%.\u00a0 At this point, ethical considerations dictated that the study design be changed so all participants received PrEP from then on.\u00a0 Initially, this study was intended to be a pilot, and to be followed by a larger scale trial. \u00a0The decisiveness of the interim findings, however, led to cancellation of that further study.\u00a0 (For an interesting commentary on the need for researchers to keep pace with changing ethical parameters, see <a href=\"https:\/\/blogs.bmj.com\/sti\/wp-admin\/post.php?post=693&amp;action=edit\">Cohen &amp; Sugarman (STI\/blog)<\/a>). \u00a0Cost-effectiveness analyses are apparently underway.\u00a0 No details are given in the report. \u00a0But evidently the high effectiveness observed in the study will allow investigators to present a far more positive case for PrEP than has been warranted by earlier trials (see <a href=\"http:\/\/sti.bmj.com\/content\/87\/Suppl_1\/A350.2.abstract?sid=a288a0b2-af68-40d5-8b61-1ea27b632395\">Borquez &amp; Hallett (STI)<\/a>; <a href=\"https:\/\/blogs.bmj.com\/sti\/2012\/11\/08\/can-hiv-prep-for-msm-be-a-cost-effective-intervention\/?preview=true&amp;preview_id=750&amp;preview_nonce=046d8499b9\">Gomez &amp; Hallett (STI\/blog)<\/a>; <a href=\"http:\/\/sti.bmj.com\/content\/87\/Suppl_1\/A36.1.abstract?sid=a288a0b2-af68-40d5-8b61-1ea27b632395\">Cremin &amp; Garnett (STI)<\/a>).\u00a0 They are also working with stakeholders on how PrEP services could be commissioned across NHS and local authorities.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The Conference on Retroviruses and Opportunistic Infections has recently taken place. \u00a0At that event the UK PROUD (PRe-exposure Option for reducing HIV in the UK: immediate or Deferred) study of pre-exposure prophylaxis (PrEP) for MSM reported its results, prior to publication in the coming months.\u00a0 The headline figure is an astonishing 86% for the reduction [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/sti\/2015\/03\/25\/reported-86-effectiveness-for-msm-prep-by-proud-study-makes-this-intervention-a-viable-option-for-uk-health-services\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":152,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2012,2796,2380,4352,4357,1614],"tags":[],"class_list":["post-1076","post","type-post","status-publish","format-standard","hentry","category-hiv-infection","category-homosexual","category-pre-exposure-prophylaxis","category-preventative-effect-of-art","category-risk-compensation","category-united-kingdom"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.6 - 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