{
  "abstract": "Objectives The HIV pre-exposure prophylaxis (PrEP) Impact Trial demonstrated the feasibility and effectiveness of PrEP in England, providing critical evidence to inform national commissioning. Using trial data, we assess regional variation in delivery and examine how service provision differences impacted outcomes across the PrEP Prevention Care Continuum (PPCC) (ie, those at risk of HIV acquisition, those eligible for PrEP, PrEP uptake and coverage).Methods We assessed PPCC outcomes among HIV-negative men who have sex with men (MSM) attending trial sexual health services (SHS) from October 2017 to February 2020. Outcomes were stratified by SHS region (London, Outside London) and MSM throughput, defined as the mean annual number of MSM attendees, to approximate differences in service structure and provision based on attendee composition. HIV incidence per 100 person-years was calculated for SHS in and outside of London, restricted to those with ≥2 visits during the study period.Results Across 157 trial SHS, 165 270 MSM attended during the study period, of whom 20 349 were enrolled in the trial. HIV incidence was calculated among 102 842 MSM, including 17 770 trial participants. PrEP uptake ranged from 42% to 92%, and coverage from 16% to 31%, varying by MSM throughput strata and consistently higher among London SHS. HIV incidence was significantly lower in trial participants (London: 0.07 (95% CI 0.04 to 0.14); Outside London: 0.22 (0.13 to 0.36)) versus non-trial attendees (London: 0.98 (0.88 to 1.10); Outside London: 0.93 (0.82 to 1.04)).Conclusions This analysis supports ongoing enhancements to PrEP delivery across England. Findings highlight the success of varied service models, including those not traditionally focused on MSM populations. High HIV seroconversions among individuals without clear markers of risk for HIV acquisition support the need for broader, less restrictive PrEP access, aligned with recent updates to national guidance. To evaluate the long-term impact of PrEP on HIV and sexually transmitted infection (STI) incidence, consistent, high-quality data reporting to national surveillance remains essential.",
  "authors": [
    {
      "affiliations": [
        "UK Health Security Agency, London, UK"
      ],
      "name": "Dana Ogaz"
    },
    {
      "affiliations": [
        "UK Health Security Agency, London, UK"
      ],
      "name": "Holly Mitchell"
    },
    {
      "affiliations": [
        "UK Health Security Agency, London, UK"
      ],
      "name": "Chiara Chiavenna"
    },
    {
      "affiliations": [
        "Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"
      ],
      "name": "Andrea Cartier"
    },
    {
      "affiliations": [
        "UK Health Security Agency, London, UK"
      ],
      "name": "James Bell"
    },
    {
      "affiliations": [
        "Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"
      ],
      "name": "Rainer Golombek"
    },
    {
      "affiliations": [
        "UK Health Security Agency, London, UK"
      ],
      "name": "Andre Charlett"
    },
    {
      "affiliations": [
        "Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"
      ],
      "name": "Sajjida Jaffer"
    },
    {
      "affiliations": [
        "UK Health Security Agency, London, UK"
      ],
      "name": "Ross Harris"
    },
    {
      "affiliations": [
        "Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"
      ],
      "name": "Victor Diamente"
    },
    {
      "affiliations": [
        "UK Health Security Agency, London, UK"
      ],
      "name": "Hamish Mohammed"
    },
    {
      "affiliations": [
        "Manchester University NHS Foundation Trust, Manchester, UK"
      ],
      "name": "Chris James Ward"
    },
    {
      "affiliations": [
        "London North West University Healthcare NHS Trust, London, UK"
      ],
      "name": "John McSorley"
    },
    {
      "affiliations": [
        "UK Health Security Agency, London, UK"
      ],
      "name": "O Noel Gill"
    },
    {
      "affiliations": [
        "Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"
      ],
      "name": "Ann Sullivan"
    },
    {
      "affiliations": [
        "UK Health Security Agency, London, UK"
      ],
      "name": "John Saunders"
    },
    {
      "affiliations": [],
      "name": "The Impact Study Group"
    }
  ],
  "title": "Foundations for progress: insights from the PrEP Impact Trial supporting change to PrEP delivery and implementation in England",
  "uid": "6e9c0048-853d-511e-8c05-d73806d3ba4f"
}