With the objective to eliminate HIV transmission for 2030 now signed into political action by Montreal’s Fast-Track City Initiative, combined prevention measures are the key to eliminating HIV transmission. There is little evidence to link decreases in HIV incidence with increased rates of individuals initiating PrEP or changes in other combined prevention strategies.
To examine the effects of combined prevention on rates of HIV transmission, we measure annual trends in HIV incidence, PrEP consults, PEP episodes, number of individuals screened annually, mean number of HIV tests per individual annually, and at the proportion of seropositive patients having an undetectable viral load from 2011–2016 at Actuel, a large sexual health clinic serving a majority MSM population in Montreal. HIV incidence was calculated based on the number of HIV diagnoses per 100 individuals screened per year.
From 2011 to 2016, HIV incidence dropped by 56%, from 2.31 to 1.03 new HIV diagnoses per 100 individuals screened annually (Table 1). Meanwhile, the number of consultations for PrEP increased exponentially and gradual increases were observed in number of PEP treatments and proportion of seropositive patients having an undetectable viral load, which reached 95% by 2016. Both the number of individuals screened annually and the number of tests per person increased from 2011 to 2016, by 47% and 31%, respectively.
This data shows a major drop in HIV incidence within the past five years. This decline, in parallel with the exponential increase in PrEP initiations, confirms the importance of ensuring PrEP is available to everyone who should need it. It is important to underline, however, this decline was already in progress and is likely attributable, at least in part, to progress towards treatment as prevention and other preventive efforts. Also, these results only represent the experience of one major clinic in Montreal. Continued efforts to monitor the potential influence of PrEP and other combined prevention methods on new HIV cases at a population level are essential.