NHS launches consultation on HIV-preventing drugs after losing legal battle

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NHS England has launched a consultation into the future of HIV-preventing PrEP drugs, after a legal bid overruled a claim not to be responsible for the issue.

Pre-Exposure Prophylaxis (PrEP) drug Truvada can reduce people’s chances of being infected with HIV by up to 99 percent if taken daily – and is available in a number of countries to at-risk groups including sex workers, gay men, and people in serodiscordant relationships.

Health experts say rolling out PrEP in the UK would be cost-effective if it leads to even a small reduction in HIV infections, as the lifetime cost of just one HIV infection can be up to £380,000.

NHS England had claimed earlier this year that it was not responsible for commissioning PrEP, suggesting it is up to local councils – but a court battle last month concluded that the NHS does have responsibility.

The body has today week opened a consultation into the future of PrEP treatments on the NHS.

A proposal says: “NHS England proposes to routinely commission Pre Exposure Prophylaxis for the treatment of adults at high risk of HIV acquisition in accordance with the criteria outlined in this document.

“The groups of people considered to be at high risk and covered by this policy are:

– High risk Men who have sex with Men (MSM), trans women and trans men who have had anal sex without a condom in the last 3 months and likely to again in the next 3 month
-Partners of people living with HIV where they are not known to be on successful HIV treatment. When people with HIV are on effective treatment they have an ‘undetectable’ level of HIV in their body which means they are very unlikely to transmit HIV to others and PrEP adds no benefit. If they do not have an undetectable viral load (i.e. they are not on treatment or have stopped treatment) then PrEP is beneficial.
-Heterosexuals assessed to be at similar high risk to MSM.

It adds: “Deciding if someone needs PrEP is based on an assessment by sexual health staff.

“If PrEP is considered suitable then a HIV test will be done to confirm that person is still HIV-negative.

“Prescriptions will be for no more than 3 months and people using PrEP will be asked to attend for regular sexual health check-ups (every 3 months) and kidney checks (urine test and occasional blood tests).

“PrEP does not prevent transmission of other infections and clinics will provide advice about risk reduction including the use of condoms.”

The consultation page states: “There has already been extensive engagement on this policy and it has been developed with the support and input of lead clinicians and patient and public representatives.

“This approach has helped ensure that the views of key stakeholders have informed and influenced the development of the policy to date. We now wish to test the policy proposal further with wider groups of stakeholders.”

However the document notes that the consultation “is being run without prejudice to the outcome of an appeal following a judicial review” – as NHSE is still pursuing an appeal  contending that it is not responsible for commissioning PrEP.

Ian Green, Chief Executive of HIV charirt Terrence Higgins Trust, said: “We welcome the news that the long-awaited public consultation on PrEP is finally here, after more than 18 months of delays and false promises.

“This is a vital step that must take place before a decision is made on making the treatment available to those at greatest risk of HIV.

“We will fully engage with this consultation over the coming weeks. Many people have felt powerless in the face of the apathy from NHS England on this vital HIV game-changer – but now is the time to mobilise.

“We urge anyone who wants to see the end of the HIV epidemic in the UK to respond to the consultation before 23rd September and let their voice be heard.

“However there is a real risk this consultation could be a wasted process if NHS England successfully appeals last week’s High Court ruling, which states that they are indeed responsible for the provision of PrEP.

“We strongly urge NHS England to withdraw their unnecessary appeal which will mean more delays for patients, and more people becoming needlessly infected with HIV.”