NHS England confirms it will not fund HIV prevention pill

BMJ 2016; 353 doi: (Published 02 June 2016) Cite this as: BMJ 2016;353:i3126
  1. Nigel Hawkes
  1. London

NHS England has confirmed its decision not to fund pre-exposure prophylaxis (PrEP) for the prevention of HIV infection, to the anger of AIDS charities.

Prevention of HIV is the job of local authorities, NHS England said in explaining its decision—but even if it were not, in competition with other specialist areas of care, PrEP would not necessarily have won its bid for NHS England’s financial support.

Deborah Gold, chief executive of the National Aids Trust, called the decision “astonishing.” Every day 17 people have HIV diagnosed, she said, and PrEP could be the beginning of the end of the HIV epidemic, if it were made available. “We are extremely disappointed and we will now be looking at our options, including further legal action,” she said.

Ian Green, chief executive of the Terrence Higgins Trust, said it was a shameful day for HIV prevention. “This country used to lead the way in the fight against the HIV epidemic, but today, our national health service has washed its hands of one of the most stunning breakthroughs we've seen—a pill which, if taken correctly, is almost 100% effective in preventing HIV.

“It defies belief that, after 18 months of false hope, delays, and U turns in the battle to see PrEP made available on the NHS to people at high risk of HIV, today we are in a worse position than when we started.”

NHS England first indicated that it believed PrEP was outside its jurisdiction on 21 March this year, explaining that under the Local Authorities (Public Health Functions and Entry to Premises by Healthwatch Representatives) Regulations 2013 the task of preventing the spread of HIV fell to local authorities.1

If it continued to discuss the possibility of commissioning PrEP it could be open to legal challenge from the backers of other specialised services, it said. The National Aids Trust took legal advice and challenged the decision, which led to further discussions.

But on 31 May NHS England’s specialised services commissioning committee accepted the legal advice that it did not have the power to commission PrEP. It remained willing to work with other commissioners to explore how to make PrEP available and is working with Public Health England to run a number of test sites, costing £2m (€2.6m; $2.9m) over the next two years.

NHS England does not contest that PrEP, which involves treating men who have sex with men with prophylactic doses of a combined formulation of emtricitabine and tenofovir (Truvada), can be highly effective. This was shown by the UK based PROUD trial, whose investigators expressed consternation when NHS England first intimated it could not support funding for PrEP.2


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