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NHS England has a clear role in commissioning PrEP

On 31 May 2016, NHS England confirmed it would remove pre-exposure prophylaxis (PrEP, an HIV prevention drug which has been proven to be effective) from the NHS specialised commissioning process.

The NHS says it does not have legal power to fund PrEP because it is used as prevention rather than treatment. However, NHS England has a clear role in HIV prevention and our lawyers agree. Post-exposure prophylaxis (PEP, HIV prevention medicine taken after possible exposure that physiologically works in the same way as PrEP) is just one example of prevention it commissions through specialised commissioning. and this is why the National AIDS Trust is pursuing legal action.

NHS England also commissions other prevention work, such as immunisation and antenatal screening through section 7a agreements. NHS England has said nothing about considering similar alternative commissioning routes for PrEP.

Public health minister Jane Ellison has now announced a National Institute for Health and Care Excellence evidence review for PrEP drug Truvada and we are waiting for further information. But it seems like even further delay, with so much work having already gone into considering the case for PrEP as part of the now abandoned specialised commissioning process. The NHS is sitting on more than 18 months of hard work from an NHS working group (comprising clinicians and other experts) that demonstrated the need, efficacy and cost-effectiveness of PrEP. This work is now left on the shelf, along with this potentially life-changing drug.

If the NHS cannot fund PrEP (and we think it can), then who will? Local authorities say they are unable to do so, especially given year-on-year cuts to the already stretched public health budget. Around 5,000 people will contract HIV in the UK this year. This must be resolved quickly.

Yusef Azad

Director of strategy

National AIDS Trust

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2016.20201266

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