Drugs that can protect people from HIV infection will be available to those at risk from September, NHS England has said. PrEP (pre-exposure prophylaxis) in the form of a once-a-day pill called Truvada will be available to at least 10,000 people whose partners may be HIV-positive through sexual health clinics, which can put them forward for inclusion in a large clinical trial.
NHS England announced the trial after it lost a high court case a year ago against campaigners who argued it should provide the drug for all those at risk of infection. NHS England had said it could not pay and that local authorities should pick up the tab instead since HIV is one of the public health issues that have been devolved to them.
The NHS list price of Truvada is £355.73 for 30 tablets. However, it is currently purchased at a discounted net price for treating HIV. NHS England has allocated £10m for the trial, including the costs of the medicines and for the sexual health clinics to deliver and monitor the study.
The central question that clinical trials usually address has already been answered: the evidence has shown that people taking PrEP are protected from infection. The new trial will gather evidence on how to run a PrEP programme on a large scale. Sexual health clinics in London, Brighton, Manchester, Liverpool and Sheffield will be the first to enrol people, with full implementation by April next year.
“This major new intervention should complement and supercharge the wide-ranging and increasingly successful effort to prevent HIV,” said NHS England’s chief executive, Simon Stevens. “It’s another milestone in more than three decades worth of progress in tackling one of the humanity’s major health challenges.”
Deborah Gold, the chief executive of the National Aids Trust which brought the court case, said: “We already know that PrEP brings down rates of HIV infection, changing lives for those at risk and saving public money. We now need to work with NHS England, local authorities and the sexual health sector to make sure the widest possible range of eligible people at high risk of HIV have access to the trial. We will continue to monitor the uptake of PrEP, aiming to learn as much as possible about how to get PrEP to all those who need it most.
“This is a pivotal moment in the fight against HIV. PrEP, if targeted properly at those in need and at high risk of HIV, offers the possibility of transforming the English HIV epidemic. From September, people at high risk of HIV will have access via the NHS in England to an empowering new tool that is truly individual controlled and not subject to negotiation with a partner, leading to the improvement of many, many lives.”
Ian Green, the chief executive of the Terrence Higgins Trust, said: “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, a clear process for routinely commissioning PrEP on the NHS is agreed.”
