Last week we, along with NAT and PrEPster, met with NHS England Chief Executive Simon Stevens to discuss the current situation around PrEP (pre-exposure prophylaxis) and access to the HIV prevention pill.
We collectively raised a number of issues in the meeting:
- Our concern that a significant number of PrEP trial sites are currently closed to gay and bisexual men – with news from Manchester that some individuals who were unable to access the PrEP trial have been diagnosed with HIV.
- That the Secretary of State for Health’s commitment to double the number of places on the trial has not been fully implemented.
- Our concern that insufficient action is being taken to prepare for routine commissioning of PrEP.
- The need for routine commissioning of PrEP to start before the trial ends to prevent any break in access to PrEP for individuals accessing PrEP through the trial.
Following that meeting, NHS England announced five steps towards better access to PrEP:
- Chelsea and Westminster NHS Trust has confirmed that they will be making more PrEP places available.
- NHS England has written to London councils asking for confirmation by end August that they will accept a full doubling of PrEP trial places.
- NHS England has also written to councils outside of London to again ask confirmation on whether they will accept full doubling of PrEP trial places by end of July.
- NHS England will recommend removing the capped number of places on the ongoing IMPACT Trial.
- NHS England re-confirmed their commitment to seamless transition from the trial to routine commissioning of PrEP and confirmed that they are exploring routes to funding future PrEP provision.
The steps NHS England has outlined are extremely welcomed. However, there remain serious barriers to getting PrEP to those who need it and still a lot of work to be done.
Issue with PrEP Impact Trial
The fact is that currently there are 43 trial sites across the country that are closed to gay and bisexual men – including seven in London.
And there doesn't seem to be a coherent plan in place to ensure that these are re-opened as a matter of urgency to ensure no one else is diagnosed with HIV because they were unable to access the PrEP trial.
We are disappointed that in London only 60% of the new trial places, announced by the Secretary of State for Health and Social Care in January, have been accepted by London’s councils. It's a breakthrough that Chelsea and Westminster NHS Trust is now able to make those extra places available – 1,500 in total. However there are still seven clinics in London that remain closed to gay and bisexual men in need of PrEP.
We are aware of the budgetary pressures faced by councils as a result of continued cuts to the public health budget and we continue to campaign alongside them for increased funding for sexual health services. However, this cannot justify the withholding of a tool that can reduce HIV transmissions. We urge London councils to work with NHS England and the Department of Health and Social Care and accept their full allocation of places as soon as possible so that no one is turned away from the PrEP trial in London.
PrEP is an effective prevention method for all who are at risk of HIV, and more must be done to ensure that all communities at risk of HIV are aware of, and have access to, PrEP as part of the trial.
Working towards a future national PrEP programme
It is a significant step forward that NHS England has committed to ensuring that there is a 'seamless' transition between the PrEP trial and full access to PrEP. Any cliff edge in access to PrEP once the trial ends in September 2020 must be avoided at all costs. We believe that routine commissioning of PrEP should begin from April 2020 and roll out alongside the PrEP trial if needed.
There is no firm commitment yet on funding for the full roll out of PrEP. We need the Department of Health and Social Care, NHS England and local councils to commit the necessary funding for routine commissioning.
Also, planning for a national PrEP programme must begin in earnest. It will take time to ensure everything is in place to roll out PrEP. Planning for this must be accelerated.
England has made huge strides in reducing HIV transmissions. With 12 diagnoses of HIV in the UK every day in 2017, PrEP is a critical tool for reducing HIV transmissions. The Government is not going to achieve its commitment to end HIV transmissions in England by 2030 without adequate access to PrEP.
In the absence of a national PrEP programme, people are being turned away from clinics who need PrEP and being put at increased risk of HIV. We are calling on the Secretary of State for Health, NHS England and local councils to take action over this unacceptable postcode lottery that is access to PrEP.
If you are trying to access the trial please visit the PrEP impact trial website.To join the trial, please contact your nearest participating clinic.
We will continue to fight for this game-changing drug to be available to all who need it.