Life-saving drug has no support

Prep

By Lauren Dorling

A life-saving HIV prevention programme has been delayed because no one wants to accept responsibility for it.

NHS England provoked outrage last month after it cancelled a public consultation on PrEP – one of the final steps to proceed public availability – and announced that it will not commission the treatment as it is up to local authorities to do so.

The Local Government Association declared this a “wholly inadequate position”, and the situation is now at an impasse as both remain resolute that it is the duty of the other to provide it.

Pre-exposure Prophylaxis involves using antiretroviral drugs to prevent people deemed ‘high risk’ from contracting the virus. AVRs are normally used in the treatment of those who are HIV positive, but a study conducted by PROUD in February found that they reduced the risk of infection in HIV negative men by 86%. The treatment is already available in the US, France, Canada, Israel, and Kenya.

Despite its decision, NHS England insisted it was committed to working with local authorities and would provide provide £2 million over the next two years to “run a number of early implementer test sites” which will provide protection to an additional 500 men and inform future arrangements for the provision of PrEP.

The LGA released a statement saying: “This is a missed opportunity to launch a groundbreaking prevention that could halt the spread of HIV, potentially save lives, and make a significant breakthrough in reducing the risk of HIV infection.

“It is not right that councils should be made to foot the bill. During the transition period to implementation of the NHS and Care Act 2010, NHS England sought to retain commissioning of HIV therapeutics, which the PReP treatment clearly falls into.

“It is, and should remain, and NHS responsibility unless it is fully funded for local authorities to pass on.”

The disagreement comes down to whether PrEP is regarded as HIV medication, the responsibility of NHS England, or prevention, the responsibility of local government.

In a circular released by the NHS in 2015, it stated that it is “the responsible commissioner for all antiretroviral drugs including where they are used in HIV prevention,” and it currently provides the drug used for PReP – brand name Truvada – for a short-treatment called ‘post-exposure prophylaxis’ to stop the virus developing in those who have been recently exposed.

Buzzfeed News asked the Department of Health a total of eleven times who was responsible for the delivery of PrEP and failed to get a straight answer.

The spokesperson said, “The responsibility, or how the programme will be implemented, and who will be implementing it, which is the same thing as who has responsibility for it, all of these issues are currently being worked through.

“Prevention is the responsibility of local authorities, treatment is the responsibility of the NHS, but what we’re doing at the moment is nailing down where PrEP will sit. I don’t have any more information than that.”

There is growing anger among charities and campaigners who argue that this stalemate will have devastating consequences.

Ian Green, chief executive of ‘Terrence Higgins Trust – provider of HIV and sexual health services in the voluntary sector – said NHS England’s decision to depart with the process and “offer a tokenistic nod to what had the potential to revolutionise HIV prevention in the UK is shameful.”

Doctor Christian Jessen, well known for his on Embarrassing Bodies, condemned the bureaucracy, tweeting, “Shameful that 2000 men will still get HIV every year because officials can’t see beyond which department should be responsible for PrEP.”

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