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NHS to fund large trial of pre-exposure prophylaxis for HIV prevention

BMJ 2016; 355 doi: https://doi.org/10.1136/bmj.i6537 (Published 05 December 2016) Cite this as: BMJ 2016;355:i6537
  1. Susan Mayor
  1. London

NHS England has announced that it will fund a large clinical trial of pre-exposure prophylaxis (PrEP) to prevent HIV in at least 10 000 people over the next three years.

The initiative follows a legal battle over who should fund PrEP. NHS England initially took the position that local councils should commission preventative services such as PrEP1 and reiterated this in May after taking legal advice.2 But the High Court ruled in August that NHS England had responsibility.3

NHS England appealed against this decision but the Court of Appeal ruled in November that the organisation did have the power to commission.4

In a statement, NHS England said that, although the evidence for the clinical effectiveness of PrEP was strong, there were “significant outstanding implementation questions” that should be answered before PrEP was used on a substantial scale. These questions will be answered by the clinical trial, paving the way for a full rollout of a PrEP programme, it said.

The clinical trial will investigate the number of people attending genitourinary medicine clinics who are eligible for PrEP and explore other ways to identify and engage eligible people, in addition to assessing PrEPs impact on the incidence of HIV and other sexually transmitted infections.

NHS England will provide up to £10 million (€12m; $13m) to cover the cost of the clinical trial and will then work in partnership with local authorities, the Local Government Association, and Public Health England to implement the findings as part of a wider national programme.

Jonathan Fielden, director of specialised commissioning and deputy national medical director of NHS England, said that the trial, in addition to 10 new specialised treatments being made available on the NHS, had, “in part, been made possible by the willingness of many pharmaceutical and device companies to come forward with lower and more responsible prices. Continuing this constructive joint working will enable us to fund more new drugs and treatments in the future.”

Kevin Fenton, director of health and wellbeing at Public Health England, said: “Currently 13 500 people are living in the UK with undiagnosed HIV and we are still seeing around 5000 new infections each year. Given that we are in the fourth decade of this epidemic there are too many new infections occurring, we need to use all tools available to save lives and money.”

Ian Green, chief executive of the Terrence Higgins Trust, said: “With 17 new HIV diagnoses made every day, we need to be bold and ambitious in our approach to prevention—and this must include access to PrEP for all who need it.”

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