NHS refuses to fund HIV prophylaxis - again

Gilead’s Truvada will not be widely available for HIV pre-exposure prophylaxis (PrEP) after all.

Despite a legal challenge, England's National Health Service (NHS) has reiterated that it will not provide a national scheme and upheld a decision to limit PrEP to a few small pilot clinics, treating only a few hundred patients.

The decision has been branded “shameful” by HIV campaigners.

After the PROUD study showed that Truvada (emtricitabine+tenofovir) can considerably reduce the chances of catching HIV, it looked like NHS England would fund PrEP services for at-risk men.

But earlier this year it emerged that NHS England had decided against funding because it is down to local authorities to commission HIV prevention services under a law passed in 2013.

The National AIDS Trust appealed – but NHS England said its Specialised Services Commissioning Committee yesterday confirmed its previous decision to limit PrEP to pilot sites, with funding of £2 million.

An NHS England spokesperson said: “We have listened carefully to stakeholders, and will continue to work with Public Health England and other partners on reducing HIV transmissions, but our external legal advice is clear that NHS England does not have the legal power to commission PrEP.”

Secretary of State Jeremy Hunt has the option to delegate commissioning of such services to NHS England – but it looks unlikely that he will do so.

A Department of Health spokesperson said: "Work is still on-going on PrEP. Up to £2 million will be invested in a pilot programme and Public Health England is working to identify the most effective places to introduce it. We look forward to discussing future commissioning with stakeholders.”

Deborah Gold, chief executive, of the National AIDS Trust, said: “NHS England is sitting on something that could be the beginning of the end for the HIV epidemic – if only it were made available. The refusal to commission it for all those at significant risk is astonishing. Seventeen people are being diagnosed with HIV every day. We are extremely disappointed and we will now be looking at our options, including further legal action.”

Ian Green, chief executive of Terrence Higgins Trust, said: “Today is a shameful day for HIV prevention. This country used to lead the way in the fight against the HIV epidemic, but today, our national health service has washed its hands of one of the most stunning breakthroughs we’ve seen; a pill which, if taken correctly, is almost 100% effective in preventing HIV. A pill which is already available in America, Canada, France, Kenya and soon to be in Australia.”

Photo courtesy Public Health Image Library