Plans for PrEP on the NHS shelved in “a shocking U-turn”

NIAID / Via commons.wikimedia.org

The pre-exposure prophylaxis drug Truvada, which can be taken to help prevent the transmission of HIV, will not be made available on the NHS in what has been described as “a shocking U-turn” by the Government.

Last week, HIV charities and campaigners asked the Government “Where is PrEP?” A public consultation on the use of pre-exposure prophylaxis [PrEP] was expected in February, in order to begin the process of approval for distribution on the National Health Service. This next step in the provision of the daily pill seemed inevitable, after the PROUD study reported last year that PrEP had effectively reduced the risk of HIV infection by 86%.

However, despite the promising figures, and the introduction of PrEP in the US, Kenya, Israel, Canada and France, NHS England announced last night that plans for a public consultation had been shelved.

In a statement on their website, NHS England said: “While NHS England is not responsible for commissioning HIV prevention services, we are committed to working with local authorities, Public Health England, the Department of Health and other stakeholders as further consideration is given to making PrEP available for HIV prevention.”

They pledged “£2m over the next two years to run a number of early implementer test sites,” in order “to answer the remaining questions around how PrEP could be commissioned in the most cost effective and integrated way to reduce HIV and sexually transmitted infections in those at highest risk.”

The statement from NHS England went on to explain that these proposed test sites would provide protection to 500 men “at high risk of HIV infection.”

Deborah Gold, Chief executive of National AIDS Trust, said via their website that the NHS’s decision was “arbitrary” and “disingenuous”: ““NAT shares the anger and distress felt by many thousands of people across the country at NHS England’s decision to abandon its work to provide PrEP, near the very end of the process.  In a shocking U-turn, NHS England has pulled the plug on over 18 months of hard work which demonstrated the need, efficacy and cost-effectiveness of PrEP.

“Instead of a long-term policy to give PrEP to all who need it, there will be £2 million over two years for 500 gay men ‘most at risk’.  The decision is not informed by any due process; the amount of money is arbitrary; the claim that more ‘testing’ of PrEP is needed is disingenuous.  500 does not remotely cover the number of gay men at high risk of HIV nor meet the needs of heterosexuals at risk.  There is no clarity within the Department of Health, the NHS or Public Health England as to who long-term is responsible to commission and fund PrEP.

“This is simple maladministration with serious consequences.  Over 5,000 gay men will get HIV over the next two years – very many of whom would not have done so if PrEP had been delivered as proposed.”

Deborah’s thoughts were echoed by Ian Green, CEO of HIV charity Terrence Higgins Trust, who commented: “Over 2,500 men who have sex with men are diagnosed with HIV each year in the UK. This figure has not changed in a decade. It is quite clear that although we have had some huge advances in HIV treatment,  HIV prevention is something that we are still struggling with.

“By denying full availability of PrEP we are failing those who are at risk of HIV. Today’s decision by NHS England to depart with due process, and, instead, offer a tokenistic nod to what has the potential to revolutionise HIV prevention in the UK, is shameful.

“£2 million over two years for 500 gay men ‘most at risk’ is an arbitrary figure which seems ill thought out and will still deny the protection that PrEP offers to the people who most need it. We know that PrEP works and already have substantial data from a real world setting from the PROUD trial. PrEP has already been approved in the  US, Kenya, Israel, Canada, France.

“And yet, our own government refuses to take responsibility for PrEP. Today’s statement makes it no clearer who is responsible – is it the Department of Health, local authorities, the NHS or Public Health England? We need answers , we need access, and we demand both.”

Commenting on the NHS England statement, Adam Midgley wrote: “I’m absolutely astounded and devestated at this news. A totally short-sighted decision that will cost the country more in treating new HIV infections.” Paul Kirwan, another commenter on the site, added: “This is an inexplicable and damaging decision. Whoever is responsible should be ashamed.

“Hang your heads. You are condemning some people to difficult and expensive long-term treatment at great cost to the Public purse with this unnecessary delay.

“I am disgusted.”

Jake Bayley, a sexual health and HIV consultant at Newham University Hospital, told the Guardian that it was a “bitterly disappointing decision.”

“As a healthcare professional who sees patients who are newly diagnosed HIV positive every day, I witness the distress this causes both physically and emotionally,” Jake explained.

“PrEP is the most revolutionary prevention tool we have had in the last 10 years. The current prevention tools we have – condoms, risk reduction – just aren’t enough.”

“NHS England is meant to protect and advocate for the population’s health. PrEP needs to be made available to all those who are high risk immediately.”

Others took to Twitter to express their disbelief at the decision made by NHS England.

Update – 22/03/16

The British HIV Association say they “are perplexed and deeply concerned by NHS England’s decision not to take HIV pre-exposure prophylaxis (PrEP) to stakeholder testing and consideration by the Clinical Priorities Advisory Group (CPAG).”

They go on to remark: “The decision comes as a complete shock, following 18 months of hard work with NHSE and a comprehensive, expert stakeholder group, which supports this roadmap to a commissioning decision.

“In addition to the results of the PROUD study – which proved the clinical effectiveness of PrEP – our work proves that it is a safe and cost-effective intervention that will prevent hundreds of people in the UK becoming infected with HIV. We cannot understand why NHSE has only now stated that the roadmap is invalid, when there is no evidence of objections by local authorities who would be responsible for delivering this intervention.”

You can read the full statement at bhiva.org

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