MI-EPIC stands for ‘Medicare Ineligible – Expanded PrEP Implementation in Communities in NSW’.
MI-EPIC is a follow-on study of the original EPIC-NSW study, which recruited participants from 1 March 2016 to 30 April 2018. For more information on the original EPIC-NSW study, please refer to About EPIC-NSW.
MI-EPIC will commence recruitment from June 2019 to March 2020. The study aims at enrolling HIV negative individuals who are at high-risk of HIV (as per the NSW PrEP Guidelines) and ineligible for Medicare. Individuals who are Medicare ineligible currently have to purchase PrEP at full price in Australia or purchase PrEP online overseas by self-importation.
The total duration of the extension study is up to 12 months (from the commencement of recruitment to the last study follow-up). An individual may participate for up to 12 months in the study but could be as little as 3 months. Study medication will expire at the end of July 2020.
MI-EPIC is run by the Kirby Institute and funded by the NSW Government, in collaboration with a number of partners such as sexual health services and clinics, NSW Health and Local Health Districts, ACON, Positive Life NSW, the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (Australia’s HIV professional organisation for clinicians), and other community organisations.
It is important to note that this study is not evaluating the effectiveness of PreP itself, as this has already been demonstrated in a number of studies including the EPIC-NSW Study. Rather this study aims to provide extended study PrEP access to Medicare ineligible individuals and explore the barriers and challenges to starting and continuing on PrEP in this population group, both in previously enrolled EPIC-NSW participants and new Medicare ineligible participants.
The study has Human Research Ethics approval from the St Vincent’s Hospital Sydney Human Research Ethics Committee and from ACON’s Ethics Committee.
Who is eligible for MI-EPIC?
Eligibility for MI-EPIC will be based on the NSW PrEP Guidelines, and you must be ineligible for Medicare.
Who decides who can participate in MI-EPIC?
People participating in MI-EPIC will be assessed against the eligibility criteria by clinicians at participating sites.
The PrEP ‘Program’
Going on PrEP isn’t just about taking a pill every day. It should be considered a health program taken in partnership with a clinician.
Firstly and most importantly, it is essential that you are tested for HIV prior to commencing PrEP. Starting PrEP when you are already HIV positive could lead to the virus becoming resistant to antiretroviral treatments, which may reduce your treatment options into the future.
When you have your HIV test, discuss with your clinician when your last potential exposure was so that you can both be confident that you are not in the window period (the time between when an infection occurs and it is detectable by an HIV test). Before commencing PrEP and during PrEP it is important to inform your team looking after you, if you have any symptoms which are consistent with HIV seroconversion such as sweats, fevers or other flu-like symptoms.
Working with a Clinician
Forming a good relationship with your clinician is one of the most important things that you can do for your health. When it comes to PrEP, you are potentially going to be having some detailed discussions about your sexual practices and other relevant issues such as alcohol and other drug use. All sites participating in the MI-EPIC study are staffed by experienced clinicians and you should feel comfortable about having detailed discussions about your sexual practices with them.
Sexual Health Checks
As part of the PrEP program, regular check-ups for HIV and sexually transmissible infections (STIs) should be part of your routine. It is recommended that anyone taking PrEP has a full sexual health check every three months. If you are taking part in MI-EPIC, you will need to see your clinician quarterly for comprehensive sexual health testing and new scripts for PrEP.
It is important to know if you have an STI and testing is the only way to be sure, as many STIs can have no symptoms. When left untreated, STIs can cause health complications and you may be passing them on to your sexual partners.
A sexual health check is easy. You should have STI tests of your urine, vagina, throat, anus and blood, including a test for HIV, for a complete sexual health check, depending on your sexual risk and sexual practices. Your clinician will advise you as to what specific testing regime is right for you. If you do get an STI, a clinician can assist you with contacting your previous sexual partners so that they can get tested as well.