Scotland says yes to Truvada as PrEP

The Scottish Medicines Consortium has approved the use of Gilead’s Truvada for use in preventing new HIV infections, so called pre-exposure prophylaxis (PrEP).

The decision has been hailed as a landmark by HIV campaigners – but they warn that it could mean a ‘postcode lottery’ as the other UK nations haven’t yet matched this commitment.

The SMC decision makes Scotland the first of the UK home nations to fund the expensive drug – which has a NHS list price of £355 a month – as trials have shown it can significantly cut the number of new sexually transmitted HIV infections.

Around 5,000 people become infected with HIV in the UK every year. The rate is rising fastest among men who have sex with men, and this was the group tested in UK trials, and in whom the evidence is strongest.

In England, there has been a prolonged battle by HIV campaigners to provide wider access to the drug, with last year NHS England looking to transfer responsibility to Public Health England.

This was largely because of the drug costs  – which would be up to £20m a year to treat everyone who could benefit.

However campaigners says the treatment is very cost effective;  preventing one infection can mean a huge saving, as a lifetime’s cost of HIV treatment cost around £360,000.

Last year charity the National AIDS Trust won a court case against NHS England’s tactics.

However NHS England has only pledged to make the PrEP available through a new clinical trial, which aims to enrol 10,000 people over three years.

NHS England has persisted in looking for ways to mitigate the cost of the treatment. In contrast SMC has indicated that the drug should be made available where needed.

It says it should be used in combination with safe sex practices for pre-exposure prophylaxis to reduce the risk of HIV-1 infection in adults at high risk.

Robert McKay, National Director for Terrence Higgins Trust Scotland, applauded the SMC decision, but warned of a potential ‘postcode lottery’ in the UK.

“Today, Scotland has made history in the fight against the HIV epidemic. We are delighted that people at risk of HIV in Scotland will finally have access to this groundbreaking pill that will protect them from HIV,” said Robert.

“This makes Scotland the first country in the UK to routinely commission PrEP on the NHS.  It can now be used as a vital tool in our HIV prevention armoury – alongside condom use, regular testing and early treatment – to help bring an end to HIV transmission in Scotland.

“Preventing the spread of HIV is good news for everyone. Not only will this make a life-changing difference to each of these individuals by protecting them from a lifelong and stigmatised condition, but for every person who would have become HIV positive without PrEP,  NHS Scotland will save £360,000 in lifetime treatment costs.

“We applaud the Scottish Medicines Consortium for acting on the overwhelming evidence for the clinical effectiveness of PrEP, and taking this bold step to tackling HIV in Scotland. We are also grateful to HIV Scotland and the many other organisations and individuals who have tirelessly campaigned and enabled this decision to happen.

“NHS Boards in Scotland now need to make sure they heed the expert advice from SMC and make PrEP available to their patients who are identified as at risk of HIV as a matter of urgency.

NHS Wales makes its decision on PrEP later this month, but McKay said there was an “urgent need” for answers in England on when its trial would begin and who would have access to it.

“We must not let PrEP become a postcode lottery – it should be available to all those at risk, regardless of where they live in the UK.,” he concluded.

Don't miss your daily pharmaphorum news.
SUBSCRIBE free here.