Abstract
BackgroundAustralia has increased coverage of antiretroviral treatment (ART) over the past decade, reaching 73% uptake in 2014. While ART reduces AIDS-related deaths, accumulating evidence suggests that it could also bolster prevention efforts by reducing the risk of HIV transmission (‘treatment as prevention’). While promising, evidence of community-level impact of treatment as prevention on reducing HIV incidence among gay and bisexual men is limited. We describe a study protocol that aims to determine if scale up of testing and treatment for HIV leads to a reduction in community viraemia and, in turn, if this reduction is temporally associated with a reduction in HIV incidence among gay and bisexual men in Australia’s two most populous states.MethodsOver the period 2009 to 2017, we will establish two cohorts making use of clinical and laboratory data electronically extracted retrospectively and prospectively from 73 health services and laboratories in the states of New South Wales and Victoria. The ‘positive cohort’ will consist of approximately 13,000 gay and bisexual men (>90% of all people living with HIV). The ‘negative cohort’ will consist of at least 40,000 HIV-negative gay and bisexual men (approximately half of the total population). Within the negative cohort we will use standard repeat-testing methods to calculate annual HIV incidence. Community prevalence of viraemia will be defined as the proportion of men with a viral load ≥200RNA copies/mm3, which will combine viral load data from the positive cohort and viraemia estimates among those with an undiagnosed HIV infection. Using regression analyses and adjusting for behavioural and demographic factors associated with infection, we will assess the temporal association between the community prevalence of viraemia and the incidence of HIV infection. Further analyses will make use of these cohorts to assess incidence and predictors of treatment initiation, repeat HIV testing, and viral suppression.DiscussionThis study will provide important information on whether ‘treatment as prevention’ is associated with a reduction in HIV incidence at a community level among gay and bisexual men.
Highlights
Australia has increased coverage of antiretroviral treatment (ART) over the past decade, reaching 73% uptake in 2014
National estimates from 2014 showed that 73% of people diagnosed with Human immunodeficiency virus (HIV) in Australia were on ART [6] and observational research suggests that treatment coverage has increased over time [7]
This paper describes a study titled ‘TAIPAN’ (Treatment with Antiretrovirals and their Impact on Positive And Negative Men), which aims to establish two large longitudinal cohorts between 2009 and 2017 to evaluate if the scale up HIV testing and treatment leads to a reduction in community viraemia and if this reduction is temporally associated with a reduction in HIV incidence among gay and bisexual men
Summary
Study design This study will involve a longitudinal cohort design using de-identified, electronic medical records extracted for the period 1 January 2009 to 31 December 2017. Outcome 3 Data from the positive cohort will be used to calculate the incidence of ART initiation (i.e., the point at which ART is initiated) with the follow-up period defined as the time after HIV diagnosis (person years of infection). This variable will be restricted only to men diagnosed with HIV during the study period. Trend tests over multiple years will have greater power as will combining over multiple years as per the three-year study periods relative to the implementation of treatment as prevention (see Data Analyses)
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