Government U-turn on PrEP will put lives at risk

Decision by NHS England to shelve plans to make PrEP available on National Health is “shameful”, says CEO of Terrence Higgins Trust.

NHS England announced yesterday they have cancelled a planned public consultation prior to making the HIV treatment pill Truvada available on the NHS, effectively putting the brakes on the drug being available for clinicians to freely prescribe and “failing those at risk of HIV”.

HIV professions who have been waiting over a month for an expected announcement of the public consultation, have expressed “shock and disbelief” as structured plans for PrEP availability on the NHS are shelved and NHS England have announced there will be no public consultation.

Like the contraceptive pill, Truvada can be taken daily, by men who have sex with men and according to the Proud study published in February 2015 dramatically reduces the risk of HIV transmission by 86%.

NHS England are now saying that it holds no responsibility to commission HIV prevention services, but instead will provide £2m over the next two years to run a number of early implementer test sites for 500 men “most at risk”.

Ian Green, Terrence Higgins trust CEO said: “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.”

Peter Kyle, MP for Hove & Portslade, said: “THT are right to be shocked because during the election Tories were lining up to offer their support to widening the use of PrEP and backing their campaign. To abandon the consultation will deny HIV campaigners and health experts their chance to influence government policy into the future and could very well hinder the fight against HIV prevention for years to come.”

The period of public consultation would have been one of the last steps before a final decision was taken to make the drug available on the NHS for clinicians to prescribe. The drug is already available in the US, France, Canada, Israel, and Kenya .

Caroline Lucas, MP for Brighton Pavilion, added: “There is solid evidence to suggest that by widening the availability of PrEP we could cut the transmission rates of HIV. In that context it’s shameful that the Government isn’t putting its weight behind making PrEP fully available on the NHS to those who need it.”

Simon Kirby MP for Brighton Pavilion said he had raised the issue with Ministers at the Department of Health who said: “We are committed to reducing HIV and sexually transmitted infections. NHS England will be running a number of test sites to use antiretroviral drugs to prevent the spread of HIV.

“These test sites will seek show 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.

“Consistent condom use remains the best protection against all STIs, including HIV.”

The consultation response would form part of a submission to the Clinical Priorities Advisory Group (CPAG), the body that it had been thought would say ‘Yes’ or ‘No’ to PrEP, at its next meeting in June.