Free HIV-preventing PrEP drugs offered to gay men on the NHS from next month
Drugs that can prevent HIV infections will be offered to gay men for free via an NHS trial starting next month.
Pre-Exposure Prophylaxis (PrEP) drug Truvada can drastically reduce people’s chances of being infected with HIV, and is available in a number of countries to high-risk groups including sex workers, men who have sex with men, and people in serodiscordant relationships.
However, the uptake of PrEP in the UK was marred by a legal battle over who should bear the cost of the intervention – with NHS England losing a court challenge after arguing cash-strapped local councils had responsibility for funding PrEP.
But today, NHS England announced it will spend £10 million to begin providing the groundbreaking drugs to people at ‘high risk’ of HIV infection as part of a pioneering three-year trial.
The trial, starting next month, will provide PrEP drugs to an estimated 10,000 people, in what will be the largest single study of its type in the world.
The body says the trial will assess the effectiveness of PrEP by “gathering clinical evidence on optimal targeting, uptake and implementation on a large scale”.
Experts believe that PrEP could be cost-effective in the long term if it leads to even a small drop in new HIV infections, due to the lifetime cost of treating HIV.
Patients will be able to join the trial via sexual health clinics from next month.
Sexual health clinics in London, Brighton, Manchester, Liverpool and Sheffield are expected to be amongst the first to start enrolling people in the impact trial from early September.
More clinics will join in October, with full implementation across England by April 2018 at the latest. As lessons are learned from the trial, this will inform follow-on routine commissioning subsequent to the three year trial.
Simon Stevens, Chief Executive of NHS England, said: “This major new intervention should complement and supercharge the wide-ranging and increasingly successful effort to prevent HIV.
“It’s another milestone in more than three decade’s worth of progress in tackling one of humanity’s major health challenges.”
Deborah Gold of the National AIDS Trust, which led the court challenge against NHS England, said: “This is a pivotal moment in the fight against HIV. PrEP, if targeted properly at those in need and at risk, offers the possibility of transforming the English HIV epidemic.
“From September, people at high risk of HIV will have access via this NHS funded trial in England to an empowering new tool that is truly individually controlled and not subject to negotiation with a partner, leading to the improvement of many, many lives. We warmly welcome this announcement.”
Reacting to the announcement, Labour’s Shadow Minister for Public Health, Sharon Hodgson, said: “The start of the PrEP trial is welcome and long overdue after months of delays and heel-dragging by the Government.
“The evidence shows just how transformative this drug can be as part of our approach to HIV prevention and ending the transmission of this life-changing infection. This trial will take us one step closer to fully understanding the benefits of PrEP.
“Now it is important that this trial is rolled out as quickly as possible across the country to protect individuals who are exposed to HIV and help take us one step closer to ending the spread of HIV in society.”
Liberal Democrat Shadow Health Secretary Norman Lamb said: “Thousands of people will breathe a sigh of relief that a start date for this important trial has finally been announced. PrEP epitomises the well-known maxim that prevention is better than cure, and has been proven to be highly effective in dramatically reducing the risk of HIV infection. The Government and NHS England must now make sure that all those in high-risk groups can access PrEP as quickly as possible.
“However, this announcement follows the LGA’s stark warning that sexual health services are ‘at a tipping point’ due to the Government’s cuts to local authority budgets. As a matter of urgency, the Government must end this short-sighted approach and reverse the disastrous cuts to public health grants we have seen in recent years.”
Ian Green, Chief Executive of Terrence Higgins Trust said: “We’re pleased that NHS England has announced a start date for the much anticipated PrEP trial. This PrEP trial has been gaining momentum in England, and is vital as we work towards ending HIV transmissions across the UK.
“The priority must now be to make sure that the trial reaches everyone at risk of HIV, and that it is rolled out speedily across the whole country, by the end of this year at the very latest. Spring 2018 is not soon enough.
“Now that the PrEP trial drug has been procured, we’re well on the way to protecting over 10,000 people at risk of HIV. To make sure no-one at risk of HIV is left behind, it is crucial that at the end of this trial in three years time, a clear process for routinely commissioning PrEP on the NHS is agreed.”
Professor Brian Gazzard, Consultant in Infectious Diseases, Chair of St Stephen’s AIDS Trust and Chief Investigator for the PrEP Impact Trial, said: “This is a hugely important and ambitious trial, and one which we need if we are to accurately translate the promising findings of the PROUD pilot study to a wider risk population.
“There is a more diverse population of high risk individuals for whom PrEP and its associated risk reduction support could mean the difference between staying HIV negative or becoming HIV positive. The data and evidence we generate will not only be of international interest but more importantly will enable commissioners in England to plan for a PrEP programme that benefits individuals and the taxpayer.”
Nick Phin, Deputy Director of National Infections Service at PHE, said: “The trial will provide insight into how PrEP is used across the country. We are working closely with the group who is running the trial and will be collecting data and supporting with understanding usage across the country.”
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Health Minister Steve Brine MP said: “This trial will not only change the lives of those who participate, but it will give us further evidence on how we can use PrEP in the long-term fight against HIV – building on the good progress we have already made.”
Greg Owen co-founder of iwantPrEPnow, said: “iwantPrEPnow welcomes the news that IMPACT will start recruiting in September and will fully support NHS England and PHE to make the trial as accessible and equitable as possible. This is most certainly a step in the right direction and we would like to see all clinics onboard before 2018.”
Dr. Will Nutland co-founder of PrEPster said: “PrEPster applauds the commencement of the IMPACT trial. International evidence on PrEP clinical efficacy is now so compelling that access to PrEP through the trial will have a significant impact on HIV in England.
“PrEPster will work alongside our colleagues for swift implementation across the country, and for diverse recruitment to the trial.”