Trial will make HIV prevention drugs available on NHS from September

BMJ 2017; 358 doi: (Published 03 August 2017) Cite this as: BMJ 2017;358:j3758
  1. Gareth Iacobucci
  1. The BMJ

Pre-exposure prophylaxis (PrEP) to prevent HIV infection will be available on the NHS when a landmark clinical trial starts in September 2017, NHS England has announced.

The three year trial will provide HIV prevention drugs to an estimated 10 000 people through sexual health clinics, which will identify eligible participants at risk of infection, including men, women, transgender people, and participants whose partner’s HIV is not known to be controlled by antiretroviral treatment.

The announcement comes after NHS England lost an appeal in 2016 against a High Court ruling that the NHS was responsible for commissioning PrEP for HIV prevention.1 NHS England had previously argued that local councils should be responsible for commissioning preventive services.

Leading HIV charities have welcomed the trial as a pivotal moment in the fight against HIV infection in England. As well as investigating the number of people attending genitourinary medicine clinics who are eligible for PrEP and gathering evidence on the optimal targeting of eligible people, the trial will assess PrEP’s impact on the incidence of HIV and other sexually transmitted infections. The findings will then inform routine commissioning after the three year trial period ends, NHS England said.

Sexual health clinics in major cities such as London, Brighton, Manchester, Liverpool, and Sheffield will be among the first to start enrolling participants in September, and nationwide implementation is expected by April 2018.

NHS England said that it had signed a contract to source the PrEP drugs for the trial, which was costed within the programme’s overall £10m (€11m; $13.1m) budget.

Simon Stevens, chief executive of NHS England, said, “This major new intervention should complement and supercharge the wide ranging and increasingly successful effort to prevent HIV. It’s another milestone in more than three decades’ worth of progress in tackling one of humanity’s major health challenges.”

Deborah Gold, chief executive at the National AIDS Trust, said, “This is a pivotal moment in the fight against HIV. PrEP, if targeted properly at those in need and at risk, offers the possibility of transforming the English HIV epidemic.

“From September, people at high risk of HIV will have access via this NHS funded trial in England to an empowering new tool that is truly individually controlled and not subject to negotiation with a partner, leading to the improvement of many, many lives. We warmly welcome this announcement.”

Ian Green, chief executive of Terrence Higgins Trust, also welcomed the news, adding, “The priority must now be to make sure that the trial is rolled out speedily across the country and that no one at risk of HIV is left behind.”

Brian Gazzard, consultant in infectious diseases, the chair of St Stephen’s AIDS Trust, and chief investigator for the PrEP Impact Trial, said, “This is a hugely important and ambitious trial, and one which we need if we are to accurately translate the promising findings of the PROUD pilot study [of PrEP] to a wider risk population.

“The data and evidence we generate will not only be of international interest but more importantly will enable commissioners in England to plan for a PrEP programme that benefits individuals and the taxpayer.”


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