England cuts back plans for Truvada in HIV prevention

England's National Health Service has been criticised for pulling plans to introduce pre-exposure prophylaxis (PrEP), which involves giving HIV drug treatment to prevent at-risk people from contracting HIV.

HIV/AIDS charities say they are angered by NHS England's move to drastically reduce its previous plan to fund use of Gilead's Truvada (emtricitabine+tenofovir), which has been shown to prevent HIV infection.

NHS England had been consulting on the use of PrEP, funded by specialist commissioning budgets, and a decision was overdue by more than a month.

But in a statement yesterday NHS England said it had shelved plans for a national scheme. Instead NHS England said it will earmark £2 million over the next two years to run "a number" of "implementer test sites".

These will aim to provide protection to an additional 500 men at high risk of HIV infection and provide cost effectiveness data, which will help the Department of Health shape future services.

While patient advocates suspect the cutbacks have been made for cost reasons, NHS England says its decision was based on fear of legal action.

NHS England said: "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."

But HIV charities condemned the decision to scale back the plans. Deborah Gold, chief executive of the National AIDS Trust, said: "NAT shares the anger and distress felt by many thousands of people across the country at NHS England's decision to abandon its work to provide PrEP, near the very end of the process. In a shocking U-turn, NHS England has pulled the plug on over 18 months of hard work which demonstrated the need, efficacy and cost-effectiveness of PrEP."

Ian Green, Terrence Higgins Trust CEO said that over 2,500 men who have sex with men are diagnosed with HIV each year in the UK, and noted this figure had not changed in a decade.

He said that despite "huge advances" in HIV treatment, England is "struggling" with HIV prevention.

"By denying full availability of PrEP we are failing those who are at risk of HIV. Today's decision by NHS England to depart with due process, and, instead, offer a tokenistic nod to what has the potential to revolutionise HIV prevention in the UK, is shameful," said Green.

The PROUD study, published in The Lancet last autumn, made the case for national roll-out of PrEP, using real-world data from clinics in England to show that Truvada conferred even higher protection against HIV than in placebo-controlled trials.

PROUD refuted concerns that the drug would be less effective outside of clinical trials, and found no evidence of an increase in other sexually transmitted infections.

NHS England and Public Health England are to launch a process seeking expressions of interest for test sites from local authorities, and aim to confirm successful applications by June.

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