{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:10:06Z","timestamp":1790554206522,"version":"4.1.0"},"reference-count":23,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T00:00:00Z","timestamp":1767052800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"NHS England"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"accepted":{"date-parts":[[2025,10,26]]},"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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 \u22652 visits during the study period.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Across 157 trial SHS, 165\u2009270 MSM attended during the study period, of whom 20\u2009349 were enrolled in the trial. HIV incidence was calculated among 102\u2009842 MSM, including 17\u2009770 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)).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/sextrans-2025-056566","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T16:51:36Z","timestamp":1767631896000},"page":"299-304","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Foundations for progress: insights from the PrEP Impact Trial supporting change to PrEP delivery and implementation in England"],"prefix":"10.1136","volume":"102","clinical-trial-number":[{"clinical-trial-number":"nct03253757","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1900-8892","authenticated-orcid":false,"given":"Dana","family":"Ogaz","sequence":"first","affiliation":[{"name":"UK Health Security Agency, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Holly","family":"Mitchell","sequence":"additional","affiliation":[{"name":"UK Health Security Agency, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Chiavenna","sequence":"additional","affiliation":[{"name":"UK Health Security Agency, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Cartier","sequence":"additional","affiliation":[{"name":"Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Bell","sequence":"additional","affiliation":[{"name":"UK Health Security Agency, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rainer","family":"Golombek","sequence":"additional","affiliation":[{"name":"Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andre","family":"Charlett","sequence":"additional","affiliation":[{"name":"UK Health Security Agency, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sajjida","family":"Jaffer","sequence":"additional","affiliation":[{"name":"Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ross","family":"Harris","sequence":"additional","affiliation":[{"name":"UK Health Security Agency, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Diamente","sequence":"additional","affiliation":[{"name":"Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2060-7286","authenticated-orcid":false,"given":"Hamish","family":"Mohammed","sequence":"additional","affiliation":[{"name":"UK Health Security Agency, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2395-8452","authenticated-orcid":false,"given":"Chris James","family":"Ward","sequence":"additional","affiliation":[{"name":"Manchester University NHS Foundation Trust, Manchester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"McSorley","sequence":"additional","affiliation":[{"name":"London North West University Healthcare NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"O Noel","family":"Gill","sequence":"additional","affiliation":[{"name":"UK Health Security Agency, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann","family":"Sullivan","sequence":"additional","affiliation":[{"name":"Chelsea and Westminster Hospital NHS Foundation Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3020-9916","authenticated-orcid":false,"given":"John","family":"Saunders","sequence":"additional","affiliation":[{"name":"UK Health Security Agency, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,12,30]]},"reference":[{"key":"2026071602100841000_102.5.299.1","doi-asserted-by":"crossref","first-page":"e790","DOI":"10.1016\/S2352-3018(23)00256-4","article-title":"HIV pre-exposure prophylaxis and its implementation in the PrEP Impact Trial in England: a pragmatic health technology assessment","volume":"10","author":"Sullivan","year":"2023","journal-title":"Lancet HIV"},{"key":"2026071602100841000_102.5.299.2","unstructured":"Department of Health and Social Care . HIV drug prep to be available across England 2020. Available: https:\/\/www.gov.uk\/government\/news\/hiv-drug-prep-to-be-available-across-england [Accessed 3 May 2024]."},{"key":"2026071602100841000_102.5.299.3","unstructured":"The PrEP Impact Trial Protocol (v6.0). 2020. Available: https:\/\/www.prepimpacttrial.org.uk\/protocol [Accessed 3 May 2024]."},{"key":"2026071602100841000_102.5.299.4","first-page":"s2","article-title":"BHIVA\/BASHH guidelines on the use of HIV pre-exposure prophylaxis (PrEP) 2018","volume":"20 Suppl 2","author":"Brady","year":"2019","journal-title":"HIV Med"},{"key":"2026071602100841000_102.5.299.5","unstructured":"PrEP Impact Trial: A pragmatic health technology assessment of PrEP and implementation . Trial protocol v6.0. 2020. Available: https:\/\/www.prepimpacttrial.org.uk\/protocol"},{"key":"2026071602100841000_102.5.299.6","doi-asserted-by":"crossref","DOI":"10.2807\/1560-7917.ES2014.19.48.20981","article-title":"Improving surveillance of sexually transmitted infections using mandatory electronic clinical reporting: the genitourinary medicine clinic activity dataset, England, 2009 to 2013","volume":"19","author":"Savage","year":"2014","journal-title":"Euro Surveill"},{"key":"2026071602100841000_102.5.299.7","unstructured":"Office for National Statistics . NOMIS: official census and labour market statistics. 2025. Available: https:\/\/www.nomisweb.co.uk\/ [Accessed 1 Jan 2025]."},{"key":"2026071602100841000_102.5.299.8","unstructured":"Office for National Statistics . Sexual orientation: age and sex, England and Wales: Census 2021, 2021. Available: https:\/\/www.ons.gov.uk\/peoplepopulationandcommunity\/culturalidentity\/sexuality\/articles\/sexualorientationageandsexenglandandwales\/census2021 [Accessed 25 Sep 2023]."},{"key":"2026071602100841000_102.5.299.9","doi-asserted-by":"crossref","DOI":"10.2807\/1560-7917.ES.2017.22.25.30553","article-title":"Fall in new HIV diagnoses among men who have sex with men (MSM) at selected London sexual health clinics since early 2015: testing or treatment or pre-exposure prophylaxis (PrEP)?","volume":"22","author":"Brown","year":"2017","journal-title":"Euro Surveill"},{"key":"2026071602100841000_102.5.299.10","unstructured":"Migchelsen SJ , Daahir U , Macdonald C , et al . Sexually transmitted infections and screening for chlamydia in England: 2024 report. 2025. Available: https:\/\/www.gov.uk\/government\/statistics\/sexually-transmitted-infections-stis-annual-data-tables"},{"key":"2026071602100841000_102.5.299.11","unstructured":"Kitt HS , Chau A , Okumu-Camerra C . HIV testing, prep, new hiv diagnoses and care outcomes for people accessing hiv services: 2024 report. London The annual official statistics data release (data to end of December 2023) UK Health Security Agency; 2024. Available: https:\/\/www.gov.uk\/government\/statistics\/hiv-annual-data-tables\/hiv-testing-prep-new-hiv-diagnoses-and-care-outcomes-for-people-accessing-hiv-services-2024-report"},{"key":"2026071602100841000_102.5.299.12","doi-asserted-by":"publisher","DOI":"10.1111\/HIV.12498"},{"key":"2026071602100841000_102.5.299.13","unstructured":"UK Health Security Agency . UKHSA hiv and sti data publication guidelines. 2024. Available: https:\/\/www.gov.uk\/government\/publications\/hiv-and-sti-data-sharing-policy\/ukhsa-hiv-and-sti-data-publication-guidelines [Accessed 11 Nov 2024]."},{"key":"2026071602100841000_102.5.299.14","unstructured":"British Association for HIV (BHIVA), British Association for Sexual Health and HIV . BHIVA\/BASHH Guideline on the Use of HIV Pre-exposure Prophylaxis - 2024 Draft out for Consultation. 2024. Available: https:\/\/www.bashh.org\/_userfiles\/pages\/files\/draft_bashh_bhiva_prep_guidelines_240924_v30_final.pdf"},{"key":"2026071602100841000_102.5.299.15","unstructured":"NHS England . PrEP trial updates. 2017. Available: https:\/\/www.england.nhs.uk\/commissioning\/spec-services\/npc-crg\/blood-and-infection-group-f\/hiv\/prep-trial-updates\/#june [Accessed 2 May 2024]."},{"key":"2026071602100841000_102.5.299.16","doi-asserted-by":"crossref","first-page":"892","DOI":"10.1111\/hiv.13149","article-title":"The success of HIV combination prevention: The Dean Street model","volume":"22","author":"Girometti","year":"2021","journal-title":"HIV Med"},{"key":"2026071602100841000_102.5.299.17","unstructured":"Department of Health and Social Care . Roadmap for meeting the PrEP needs of those at significant risk of HIV. 2024. Available: https:\/\/www.gov.uk\/government\/publications\/roadmap-for-meeting-the-prep-needs-of-those-at-significant-risk-of-hiv\/roadmap-for-meeting-the-prep-needs-of-those-at-significant-risk-of-hiv [Accessed 3 May 2024]."},{"key":"2026071602100841000_102.5.299.18","unstructured":"Department of Health and Social Care . Towards Zero: the HIV Action Plan for England - 2022 to 2025. 2021. Available: https:\/\/www.gov.uk\/government\/publications\/towards-zero-the-hiv-action-plan-for-england-2022-to-2025 [Accessed 3 May 2024]."},{"key":"2026071602100841000_102.5.299.19","doi-asserted-by":"publisher","DOI":"10.1111\/hiv.13492"},{"key":"2026071602100841000_102.5.299.20","doi-asserted-by":"crossref","unstructured":"Mohammed H , Migchelsen SJ , Duffell S , et al . Enhancing surveillance of sexually transmitted infections in england with gender identity and behavioural data: the gumcad sti surveillance system. SRH [Preprint]. doi:10.1101\/2025.04.15.25325802","DOI":"10.1101\/2025.04.15.25325802"},{"key":"2026071602100841000_102.5.299.21","unstructured":"UK Health Security Agency . New HIV diagnoses, AIDS, deaths and people in care by country and region data tables: UK Health Security Agency, London. 2023. Available: https:\/\/www.gov.uk\/government\/statistics\/hiv-annual-data-tables [Accessed 3 May 2024]."},{"key":"2026071602100841000_102.5.299.22","doi-asserted-by":"crossref","first-page":"1300","DOI":"10.1111\/hiv.70045","article-title":"HIV seroconversions and genotypic viral resistance profiles in the PrEP impact trial","volume":"26","author":"Cartier","year":"2025","journal-title":"HIV Med"},{"key":"2026071602100841000_102.5.299.23","unstructured":"Mitchell H , Enayat Q , Buitendam E , et al . Routine commissioning of hiv pre-exposure prophylaxis (prep) in england: monitoring and evaluation framework. London UK Health Security Agency; 2022. Available: https:\/\/assets.publishing.service.gov.uk\/media\/62272619e90e0710be035556\/UKHSA-PrEP-monitoring-and-evaluation-framework-for-England-2022.pdf"}],"container-title":["Sexually Transmitted Infections"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/sextrans-2025-056566","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T09:10:41Z","timestamp":1784193041000},"score":1,"resource":{"primary":{"URL":"https:\/\/sti.bmj.com\/lookup\/doi\/10.1136\/sextrans-2025-056566"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,30]]},"references-count":23,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,7,16]]},"published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1136\/sextrans-2025-056566"],"URL":"https:\/\/doi.org\/10.1136\/sextrans-2025-056566","relation":{},"ISSN":["1368-4973","1472-3263"],"issn-type":[{"value":"1368-4973","type":"print"},{"value":"1472-3263","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,30]]}}}