The Association of Directors of Public Health (ADPH) and the Local Government Association (LGA) call for a major extension of access to PrEP to help end the epidemic of HIV in the UK.
TWO years on since NHS England announced the PrEP Trial, 10,000 people have been recruited onto the trial. However, many people continue to find it difficult to access PrEP with some people having become infected with HIV when this could have been prevented.
ADPH and LGA say they fully support PrEP as part of an effective HIV prevention strategy, with the potential to save lives. Their only concern is the unfunded cost to councils as a result of rolling PrEP out, whether as part of expanding the number of people on the PrEP Trial or in a future national HIV PrEP programme.
They are calling for the forthcoming NHS long-term plan to commit to fully fund expanded access to the HIV PrEP Trial ensuring that both unresolved implementation questions are addressed and that local authority sexual health services are adequately resourced to support this extension.
Professor Jim McManus, ADPH Vice President, said: “PrEP is now even more affordable on the NHS. With the NHS saving substantial sums from the drug being cheaper as well as from fewer people needing treatment, we see no reason why NHS England should not extend the roll out of the trial to more people.
“While NHS England pays for the drug, local councils have to meet the costs of extra attendances and tests at sexual health services. These additional costs fall at a time when government is cutting public health budgets.
“The savings made by NHS England switching to generic Truvada would help cover the trial-associated service costs of extending recruitment to the PrEP trial and significantly reduce the burden on local authorities to support this important study.
Cllr Ian Hudspeth, Chairman of the Local Government Association’s Community Wellbeing Board, said: “The outcome of the trial, which will be the largest single study of its type in the world, will help inform the potential rolling out of the provision of PrEP nationwide. It is crucial that at the end of this trial next year, a clear process for routinely commissioning PrEP on the NHS is agreed.
“The forthcoming NHS long-term plan should commit to extending the trial and government should support the extension through local authority funded sexual health services. Local authorities have invested hundreds of millions in providing sexual health services since taking over responsibility for public health five years ago, and we firmly believe that PrEP could significantly reduce levels of HIV in the community.
“As a matter of urgency, the government must end this short-sighted approach and reverse the planned cuts to public health grants we have seen in recent years.”
Debbie Laycock, Head of Policy and Public Affairs at Terrence Higgins Trust, said: “PrEP is almost 100% effective at preventing HIV when taken as prescribed and we welcome the acknowledgement from LGA and ADPH that PrEP is an essential part of HIV prevention.
“We firmly believe PrEP has a key role in ending new HIV transmissions in the UK, but currently access in England is capped and the PrEP trial will be full in a matter of months. After that there’s no clarity whatsoever about what happens and we are still waiting for a timeline for PrEP being made routinely available. That’s why we’re so frustrated by the seemingly endless issues which are stalling PrEP from being made accessible to all who need it in England. This inaction jeopardises the hard-fought progress that’s been made in the fight against HIV.
“We know that individuals who have been refused access to the PrEP trial have gone on to be diagnosed with HIV, which is why we are pleased LGA and ADPH agree with us that extra places on the trial are urgently needed – especially when the trial looks like being entirely full early next year. It’s also why we’re strongly urging local government and NHS England to quickly come together to overcome the hurdles and divisions in opinion which are preventing PrEP from being made more widely available.
“Because the reality is that for every day that NHS England and local government disagree on who’s responsible for funding and implementing PrEP access, more trial sites are filling up and more people are being turned away. We urgently need a commitment to be made for more places on the trial and a firm timetable for making PrEP routinely available in England published. Further delays are unacceptable and both the Department of Health and Social Care and Public Health England have a responsibility to show leadership and ensure that a solution is found – and quickly.”
Deborah Gold, chief executive of NAT (National AIDS Trust) continued: “We strongly agree with the ADPH and LGA that there is an overwhelming need to address the imminent lack of places on the PrEP trial. People vulnerable to HIV are the victims of a complex system in which the Department of Health and Social Care, NHS England, Public Health England and local government must all play their part.
“For a programme to be effective in getting PrEP to all those who need it, it must be part of a properly funded sexual health service. Yet at the moment sexual health services have been the casualty of cuts to public health that take no regard of the crucial treatment and prevention services provided by them. We call on all those responsible to work together to urgently solve this impasse, and ensure that no-one else acquires HIV having been turned away from the trial.”
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