Since the nPEP communication strategy was established, inappropriate nPEP use for low risk exposures has decreased, and completion of nPEP treatment and HIV testing of nPEP clients at three to four month follow-up have increased. Between 2008 and 2010, nPEP awareness among gay men participating in the PGCPS decreased after having increased since 2002.
Similar decreases were also reported from Gay Community Periodic Surveys in other states [8, 9]. However in these states, at least 50% of participants in 2010 knew that nPEP was currently available, a higher proportion than that seen in Perth (40%). In previous nPEP awareness surveys in the US  and the UK , awareness ranged from 36%  to 56%  among MSM.
The 2010 PGCPS had a significantly higher proportion of participants under the age of 25 years (40.0%) compared to the previous surveys (21.9% to 27.6%), which may have accounted for the apparent decline in nPEP awareness among PGCPS respondents. Another possible reason for this decline could lie in the methods used as part of the communication strategy. The promotion materials used to raise awareness about nPEP, and the channels used to disseminate these materials, have only changed slightly since the communication strategy began in 2005. The PGCPS results from 2010 suggest that a fresh approach should be considered, which could include opportunities to engage recent trends in social marketing, such as the use of social media.
The improvement in nPEP prescribing practices and rate of completion previously reported in WA  were sustained in the May 2008 to December 2010 period (Reporting Period Three). The nPEP completion rate in WA is similar to the rate reported in an nPEP study in the UK .
In contrast to the evaluation of the nPEP communication strategy in 2009 , an improvement in testing rates among nPEP recipients was observed for the first time in WA. The rate of post-nPEP HIV testing three to four months after the initial visit increased from 38% to 51.9% between Reporting Periods Two and Three. This compares favourably with the Victorian nPEP program which reported that 34% of nPEP clients had been tested at three month follow-up . Hospitals in the UK  and France  have also reported low follow-up testing of nPEP clients after three months (35% and 29% respectively). Studies examining testing rates over time further highlight the challenge of improving post-nPEP testing. For example a UK study of nPEP recipients found no significant change in HIV testing rates at three month follow-up, before and after the introduction of the national nPEP guidelines and a communication strategy . The higher rate of follow-up testing in WA may reflect inclusion of clients tested at the four month period in the analysis.
The recommendation for HIV testing beyond the three month follow-up period will soon be removed from the revised national nPEP guidelines. This is consistent with the British Association for Sexual Health and HIV (BASHH) guidelines in the UK . With only a minority of clients tested after six months, the removal of six month HIV testing from the WA nPEP guidelines would enable clinicians to focus efforts on recalling patients to be tested at three to four months, particularly as recent progress has been seen for this period of follow-up.
A number of limitations need to be considered in the interpretation of these evaluation findings. Firstly, while the majority of 'sexuality sensitive' doctors surveyed in this evaluation were aware about the availability of nPEP, this was limited by the low survey response rate. Secondly, the evaluation of nPEP awareness among health care providers focused solely on ‘sexuality sensitive’ doctors. The generalisation of these evaluation findings as an indicator of nPEP awareness among ‘sexuality sensitive’ doctors and other relevant health care providers is therefore limited. Finally, it is difficult to conclude from the methods used in this evaluation the extent to which the communication strategy has led to the improvements reported here. This evaluation was a pre- and post-study of the nPEP communication strategy and potential confounders which may have contributed to the observed results were not examined. Exploring the views of nPEP clinicians and clients in future evaluations could identify whether the communication strategy has influenced nPEP awareness and practices.