‘HIV prevention wonder drug’ must be available on the NHS NOW
A ‘game-changing’ pill which can prevent HIV must be made available on the NHS now, a leading sexual health expert said today.
If used in the correct manner, pre-exposure prophylaxis (PrEP) treatment, can be effective in stopping transmission of the virus in almost all cases.
In March, NHS England decided the treatment was a preventative service, and is therefore not the health service’s responsibility to fund.
But, last month, the authority pledged to re-evaluate the drug after the National AIDS Trust launched a legal challenge.
Now, Dr Michael Brady, medical director of the Terrence Higgins Trust, has argued the treatment must be made available to those HIV-negative people at risk of acquiring HIV.
Dr Michael Brady, medical director of the Terrence Higgins Trust, has called on NHS England to stop delaying and make pre-exposure prophylaxis (PrEP) drug treatment available to those most at risk of HIV infection
He said: ‘PrEP is undoubtedly an essential addition to our approach to combination HIV prevention and needs to be available now.’
Past research has shown PrEP, when used in combination with increased HIV testing and HIV treatment, could prevent 7,400 new infections between now and 2020.
Until recently, the best data had come from the US and developing countries.
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But, following the pivotal PROUD study, which found PrEP reduced HIV incidence by 86 per cent, there is now very strong evidence on the efficiency and cost-effectiveness of PrEP in the UK, Dr Brady argued.
Despite this, he said, those most at risk of HIV in the UK remain unable to access the ‘important HIV prevention measure’.
In an editorial in the SAGE journal Therapeutic Advances in Chronic Disease, Dr Brady said: ‘If this plan for limited access were to go ahead, clinicians would have to provide PrEP on a “first-come, first-served’ basis and would very quickly find themselves having to deny access to PrEP to men who we know are at very high risk of HIV acquisition.’
WHAT IS PRE-EXPOSURE PROPHYLAXIS?
Pre-exposure prophylaxis, or PrEP, is a way for people who do not have HIV but who are at substantial risk of getting it to prevent HIV infection by taking a pill every day.
The pill (brand name Truvada) contains two medicines (tenofovir and emtricitabine) that are used in combination with other medicines to treat HIV.
When someone is exposed to HIV through sex or injection drug use, these medicines can work to keep the virus from establishing a permanent infection.
When taken consistently, PrEP has been shown to reduce the risk of HIV infection in people who are at high risk by up to 92per cent.
PrEP is much less effective if it is not taken consistently.
PrEP is a powerful HIV prevention tool and can be combined with condoms and other prevention methods to provide even greater protection than when used alone.
But people who use PrEP must commit to taking the drug every day and seeing their health care provider for follow-up every three months.
Source: Centres for Disease and Control Preventions
Following calls from clinicians, local authorities, directors of public health, politicians, activists and community originations, in a promising step forward in the campaign, NHS England have now said that they will carefully consider its position on commissioning PrEP.
But as Dr Brady argues ‘the sector must maintain pressure to ensure PrEP is made available as soon as possible.’
He concluded: ‘We have delayed implementing PrEP in the UK for too long and to continue to deny access to those who most need it will result in unnecessary HIV infections and avoidable costs to the NHS of life-time HIV treatment and care.’
A spokesman for NHS England told MailOnline last month, that the body is ‘carefully considering’ its position.
The decision in March caused national outrage from health campaigners – particularly those in the LGBT sector.
The National AIDS Trust started legal action on April 12 after 18 months of work which ‘demonstrated the need, efficacy and cost-effectiveness of PrEP from an NHS working group comprising experts from across the HIV sector’.
Chief executive Deborah Gold, said at the time, she welcomed the ‘change of mind’ by NHS England.
‘NHS England had previously told us that it was impossible for them to reconsider their decision,’ she said.
‘Faced with legal action, they have now changed their mind. We trust that NHS England, when it re-evaluates its position, will come back with a resounding yes.’
Describing the drug as ‘one of the most exciting prevention options since the HIV epidemic began’ she said it offered a prospect of real success in combating the virus.
‘To deny the proper process to decide whether to commission PrEP, when 17 people are being diagnosed with HIV every day, is not only morally wrong but legally wrong also.’
Trials of PrEP have found, if taken properly, it can be effective at stopping transmission of the virus in most cases.
The drug is given to healthy people who are at high risk of contracting the virus, for example, men who have condomless sex with multiple male partners.
It is endorsed by the World Health Organisation and is already available in countries including the US, Canada, France and Israel.
Last month NHS England said it would re-evaluate it’s original decision not to make PrEP drugs available on the NHS, after the National AIDS Trust launched a legal challenge. Pictured is artwork of HIV virus in the blood
Last month, HIV campaigners said NHS England’s decision was met with ‘shock and disbelief’ and that those who are at risk of HIV were being ‘failed’.
HIV charity Terrence Higgins Trust (THT) has welcomed the new ‘promising step’ in the fight for PrEP availability.
Speaking last month, Ian Green, CEO at THT, said: We’ve been working closely with the HIV sector to challenge the earlier shameful decision, following universal outrage after NHS England abandoned its own public consultation process on PrEP.
‘Having written to and met NHS England to discuss this, this U-turn is a promising step in the campaign for HIV prevention.
‘However, we remain sceptical and need answers from NHS England on when access to PrEP will be available to those who need it.’
He said more than 2,500 men who have sex with men are diagnosed with HIV each year in the UK.
‘Every day that access to PrEP is delayed, seven men who have sex with men (MSM) are diagnosed with HIV, despite advances in HIV prevention.
‘Whilst we are encouraged by this change of heart we will ensure the pressure is maintained so that PrEP is available on the NHS to those at risk’.
A statement on the NHS England said: ‘Final decisions on PrEP have not yet been taken, and we have agreed to consider representations from some stakeholders before deciding on next steps on the appropriate way forward.’
Currently, PrEP is given to people enrolled in research trials across the UK and is available privately.