Update on commissioning and provision of Pre Exposure Prophylaxsis (PREP) for HIV prevention
Over the last year, doctors, patient groups, Public Health England (PHE), NHS England and the Department of Health (DH) have worked together to investigate the role that Pre Exposure Prophylaxis (PrEP) could play in preventing HIV in those at the highest risk
PrEP is a new way of using anti-retroviral drugs (ARVs) – usually used for treating people with diagnosed HIV- to stop those at very highest risk from contracting the virus.
Recent evidence – including from the UK PROUD study – shows this approach can be highly effective in preventing HIV as long as the drugs are taken regularly. Evidence of effectiveness is strongest for men who have condomless sex with multiple male partners.
So far, published studies suggest that PrEP does not lead to increases in other sexually transmitted infections, although longer term data is needed to be certain that PrEP can make a significant contribution to sexual health and well-being.
Commissioning PrEP – the legal framework
As set out in the Local Authorities (Public Health Functions and Entry to Premises by Local Healthwatch Representatives) Regulations 2013, local authorities are the responsible commissioner for HIV prevention services.
Including PrEP for consideration in competition with specialised commissioning treatments as part of the annual CPAG prioritisation process could present risk of legal challenge from proponents of other ‘candidate’ treatments and interventions that could be displaced by PrEP if NHS England were to commission it.
Expanding PrEP funding – next stages of rollout
While NHS England is not responsible for commissioning HIV prevention services, we are committed to working with local authorities, Public Health England, the Department of Health and other stakeholders as further consideration is given to making PrEP available for HIV prevention.
Specifically, given the potential benefits in this area, NHS England is keen to build on the excellent work to date and will be making available up to £2m over the next two years to run a number of early implementer test sites.
These will be undertaken in conjunction with Public Health England and will seek to answer the remaining questions around how PrEP could be commissioned in the most cost effective and integrated way to reduce HIV and sexually transmitted infections in those at highest risk. These test sites will aim to provide protection to an additional 500 men at high risk of HIV infection as well as inform future arrangements for the commissioning and provision of this innovative intervention.
In addition, NHS England is keen to explore how a period of further support can be offered to the participants enrolled in the PROUD study and is committed to making funding available where there is a clinical need for additional help.
NHS England and Public Health England will launch a process to seek expressions of interest for the test sites from local authority areas with a view to confirming successful applications by June 2016. These will run over the next two years and will aim to test the ‘real life’ cost effectiveness and affordability of PrEP as part of an integrated HIV and STI prevention service.
The DH and partners will consider the relevant findings from the test sites to inform respective commissioning responsibilities for HIV care and treatment and HIV prevention.
In July 2015 NHS England approved a policy for the earlier treatment of people with diagnosed HIV to help reduce the onward transmission of the virus. It is intended that the benefits of this policy together with the PrEP early implementer sites will continue to reduce new HIV infections.
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