PrEP: Further delay, further HIV transmissions
NAT responds to the Government announcement of a NICE Evidence review on PrEP
Jane Ellison MP, Parliamentary Under-Secretary of State for Public Health, announced on Tuesday 7 June in the House of Commons a NICE Evidence Review to look into the case for PrEP, and in particular its cost-effectiveness. The review should report in advance of the previously announced £2m pilot towards the end of the year, and will apparently feed in to that pilot.
NAT considers this to be an unnecessary review and just a further delaying tactic as Government and NHS continue to shirk their responsibility to prevent HIV transmissions.
The NHS England PrEP working group spent 18 months examining the case for PrEP and developing a commissioning proposal, before NHS England abandoned their work. This work already included two separate cost effectiveness analyses.
The duty of the Government and NHS England is clear – to identify the appropriate commissioning body for PrEP and allow that body to assess the conclusions of the working group (seeking only any further information which they consider is still needed). The commissioner should then move as soon as possible to commission PrEP comprehensively, cost-effectively and fairly to those at significant risk of HIV.
Many of the points made by the Minister and also by Simon Stevens, NHS England Chief executive, when before the Health Committee earlier that day, are distractions and misunderstandings:
- A NICE review focussing on cost-effectiveness cannot have any relevance to a pilot providing PrEP to just 500 men. And the evidence for the clinical effectiveness of PrEP has already been repeatedly and conclusively made.
- Whilst the ARV used in PrEP is not licensed for that use, the same is true of the drugs used for PEP (post-exposure prophylaxis) and for preventing mother-to-child transmission. It is no barrier to commissioning in England.
Whilst PrEP is kicked by the Government further and further down the road, those on the PROUD trial remain completely in the dark as to what will happen to them when the current supply of drugs runs out. In some clinics drugs may run out in the near future. We face the prospect of men on PROUD no longer being able to access PrEP and as a result some of them acquiring HIV. As a matter of urgency NHS England, the Government and Public Health England need to discuss with the drug company and clinics how to maintain supply of PrEP. We cannot wait for any ‘pilot’ for this to be sorted out.