Currently, this is not available on the NHS in England.
Despite losing court battles to campaigners, NHS England is still refusing to make PrEP available. Earlier this year Scotland announced that they will make PrEP available to those at risk. However, for England, a clinical trial is instead on the cards.
Why the delay? Well, Public Health England feels there are “significant outstanding implementation questions that should be answered prior to using PrEP in a sustained way on a substantial scale in England.”
NHS England is planning to fully fund a trial with at least 10,000 participants. This PrEP Impact Trial is due to take place over the next three years. The aim is to answer the queries which Public Health England has brought up, before rolling out the drugs on the NHS. NHS England says that they are to make available funds of up to £10millon pounds to pay for all aspects of the trial. Their latest updates state that trial drugs should be available from August 2017. The hope is the trial will begin soon after this, once ethics approval has been received. Further updates will be available once the PrEP Oversight Board have met again in July.
How PrEP Works
Someone who is HIV negative takes the antiretroviral (ARV), which ensures there is a high level of the drug in their bloodstream before being exposed to HIV. If exposure occurs, ARV in the blood prevents the virus entering the human cells and replicating. By stopping this replication process the HIV is not established and the person remains HIV negative.
Truvada is the current pill being used as PrEP. It contains two ARVs, tenofovir and emtricitabine. These particular ARVs are used because they have low side effect profiles, few issues with drug resistance and remain in the body for a relatively long time.
The PROUD study reported that there was an 86% reduction in HIV infection in gay men who were taking PrEP. These figures certainly explain why people feel this a desirable preventative treatment and one which is worth campaigning for.
Access to PrEP
Public knowledge around PrEP is on the rise, particularly within the gay community. Some people are resorting to other measures to access this drug and reduce their risk of becoming infected. Those who can afford it can pay for private prescriptions. Some choose to visit the UK’s only private PrEP clinic, based in London. A thirty day supply from here will cost £400. Others choose to buy the tablets from online pharmacies from countries outside of the UK. This is not an underground movement, whereby people are taking medication without supervision. Many sexual health clinics will now help with monitoring for side effects and give people advice about taking the drugs safely, even though they are unable to prescribe the PrEP. There are even websites which explain to people how to get Truvada by visiting the accident and emergency department, a method called “clinic hopping”. Although these sites do not condone this behaviour, it does highlight how desperate some people are to have access to this drug. These alternative methods of accessing the drugs may even be responsible for a recent drop in the rates of HIV infection in London.
In the meantime
It will be at least 3 years until the trial is completed. Until then PrEP will not be available on the NHS. Even after the trial is completed, no decision has been made for PrEP availability in the longer term. Unless you live in Scotland of course.
There is a strong feeling within certain communities that this delay in making it available on the NHS shows how much stigma still exists around HIV, even in the modern world. It is, of course, expensive, (as are a lot of new drug treatments, whatever the illness). This undoubtedly plays a part in NHS’ resistance in rolling it out without a large scale trial. In a world of funding cuts, choices about which drugs to fund are never easy. For now, those in need will have to wait.
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Any opinions above are the author’s alone and may not represent those of his/her affiliations. Any comment is based on the best available evidence at the time of writing. All data is based on externally validated studies unless expressed otherwise. Novel data is representative of the sample surveyed. An online recommendation is no substitute for seeing your own doctor and should not be taken as medical advice. Article edited for publication by Dr Hannah Arnstein
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