Advocates left shocked by NHS England decision against providing PrEP

23 March 2016
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National Health Service (NHS) England has decided against providing pre-exposure prophylaxis (PrEP) for HIV-negative people at a high risk of HIV, sparking outrage among a number of HIV charities and service providers in the UK.

The decision has been described as a complete U-turn by National AIDS Trust (NAT) and others, and comes after an 18-month long consultation which included Public Health England, the Department of Health, NHS England and other stakeholders.

In a statement, NHS England said that ‘they were not responsible for commissioning HIV prevention services’ and that further consideration needed to be given for its use. They continued by saying that if NHS England were to commission PrEP, it could present legal challenges because it could take resources away from other treatments.

PrEP advocates were left confused, with Deborah Gold, Chief Executive of NAT calling the decision “disingenuous” and “not informed by any due process.” She went on to say, “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.”

Advocates remarked that NHS England currently pays for a number of other preventative medicines – including vaccines, post-exposure prophylaxis, some contraceptives and cervical cancer screening. 1

Yusef Azad of NAT commented: “It is extraordinary that such legal concerns were only raised at the eleventh hour, after months of work. Or was it the prospect of PrEP being agreed, and the costs for the NHS (albeit it’s cost-effective) that at some level prompted this about-face?”

Matthew Hodson, Chief Executive of GMFA said that “thousands of gay and bisexual men have been let down.”

NHS England acknowledged the benefits of PrEP in the same statement, saying that that ‘the approach can be highly effective in preventing HIV as long as the drugs are taken regularly’. It noted in particular the UK PROUD study, which showed in February of last year to be 86% effective in preventing new HIV infections among men who have sex with men (MSM), and 96% effective with mixed-status couples, when the HIV-positive partner is also on treatment.

The USA, Canada, Israel, Kenya and South Africa are among the countries that have approved PrEP. Under new World Health Organisation guidelines, PrEP is now also recommended for all populations at risk of HIV.

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