Response to NHS England announcement (5th December 2016)

NHS England yesterday announced that they will not be rolling out PrEP as a new specialised service. Instead, they will make up to £10 million available to Public Health England to enrol at least 10,000 participants over the next 3 years in a clinical trial of PrEP (https://www.england.nhs.uk/2016/12/hiv-prevention-pregramme/).

We are disappointed that PrEP will not be available on the NHS in the near future. Nonetheless, we are glad that at least 10,000 people will be offered PrEP, as even this limited availability has the potential to dramatically reduce the number of new HIV infections reported each year, when delivered as part of a comprehensive HIV prevention package.

The PROUD trial demonstrated that the offer of PrEP:

• can attract individuals at high risk of HIV
• can be delivered through sexual health clinics
• dramatically reduces the risk of HIV infection
• is cost effective when efficiently targeted towards people at risk of HIV.

Early next year we will release new evidence on long-term use of PrEP collected over the 4 years of the PROUD trial, which will provide additional insights for PrEP implementation.

The NHS England announcement claims that an additional clinical trial is necessary in order to address “significant outstanding implementation questions” around uptake, preferred dosing methods, duration of use, HIV incidence and STI incidence. We look forward to further details about the trial design including the control group, and how these research questions will be measured.   We hope that the plan is to build on evidence from PROUD, instead of merely repeating the important work that has already been completed, and the PROUD team are willing to support the Public Health England trial team to achieve this. 

There are important outstanding questions about uptake, adherence and duration of use PrEP among populations who were not included in PROUD, and we look forward to hearing about plans to actively include heterosexual women and men, BAME communities, and trans women and trans men in the new clinical trial.

We remain eager to hear from NHS England how they will partner with Local Authorities to commission PrEP as part of a comprehensive prevention package in the near future.