PrEP in England: Terms and Conditions will apply

Six years after the publication of the iPrEX study, four years after its approval by the US FDA, two years after the PROUD and Ipergay studies, and after a year of legal battle, PrEP may finally be available in the UK through a large clinical trial to start later in 2017.

The commitment to provide PrEP on the NHS was long overdue, but the proposed mode of delivery raises more questions than it provides answers. Pubic Health England Prof. Kevin Fenton describes a 3-year trial enrolling 10,000 participants to address “outstanding operational, administrative and clinical questions” without much indication of how, who and what will be trialled, potentially delaying PrEP access even further.

One can’t but wonder why operational and administrative questions have not been sorted out earlier since PrEP efficacy has been known for 6 years. But this should not really come as a surprise when HIV has not made it to the NHS strategies for long-term condition management, when investment in HIV prevention has been shrinking year after year and has remained focused on one-fits all answers.

Will another £10m trial be the best way (“cost effective” in NHS lingo) to provide access to PrEP? The few questions we know the study hopes to address are valid but could be addressed through implementation programmes, as was done in the US. The UK and London where the epidemic is concentrated benefits from a network of clinics and community-based organisations that could provide the ground on which to build such implementation studies (these can no doubt be expanded nationwide).

PrEP is not just a biomedical intervention; it offers an opportunity for clever investments both in communities and health initiatives. Critically, there is a huge need to educate the public at large so that PrEP is no longer made a divisive issue. How the proposed trial will help with this is a question to keep in mind.

It has been long road from an intervention the NHS did not think it was its duty to provide to “a new ground breaking national programme for PrEP”  (Dr Jonathan Fielden, NHS England’s director of specialised commissioning). That NHS England finally accepts that PrEP has a role to play in controlling the HIV epidemic in the UK is a huge progress. That achievement is primarily the work of a few activists who took the HIV prevention world by surprise (Team Prepster and IwantPrEPnow) and a courageous, crowdfunded, legal action led by the National Aids Trust. We should not rejoice too quickly and this is certainly no cause to fall back in line behind NHS and government honey-coated promises.

NHS England must be held to account for the thousands of infections that could have been averted should it have acted earlier and did not waste resources in legal challenges. Whilst we await for more information, HIV prevention activists and advocates must remain united, alert and vigilant to any further delay in providing access to PrEP.

500 new HIV infections every month are not acceptable.


Further Reading

  • PROUD Response to NHS England announcement, PROUD Website.
  • NHS England announces major new PrEP trial for 2017. Gus Cairns, Aidsmap.
  • NHS England fudges PrEP access and delays on-demand access to PrEP by years; blocks doctors from prescribing PrEP now. Simon Collins, HIV i-Base.
  • NAT welcome new HIV prevention drug funding after court win. NAT
  • NHS England Announces It Will Provide PrEP, The HIV Prevention Drug. Patrick Strudwick, Buzzfeed.

Note: The title of this post was modified on 11 JAN 2017 to reflect that the story relates to access to PrEP in England. Of note, there is currently no better prospect for access to PrEP in other nations of the UK.

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