Postcode drug lottery for patients at risk of HIV
The efficacy of HIV-prevention drug PrEP is long-established, but access to the drug in England is restricted to participants on the NHS Impact Trial. At least 15 men who were waiting for trial places have acquired the lifelong disease – so how is limiting trial places for a crucial drug already proven to work justified?
GlobalData’s pharmaceutical writer Chloe Kent says: “England lags far behind the rest of the UK when it comes to PrEP. The drug is only accessible through the NHS Impact Trial, which launched at the end of 2017 and currently has the capacity for 26,000 total participants. NHS England supplies the drug to various participating local authorities, which ultimately control how the drug is distributed. Outside of England, PrEP is freely available for patients in Scotland and Wales.
“The drug’s efficacy is long established and the Impact Trial is taking place under the guise of assessing various logistical queries surrounding the distribution of the drug in England.
“These include finding out how many people who attend sexual health clinics are at high risk of HIV, and thus eligible for PrEP, how likely people offered the drug are to accept it, and how long they tend to use the medication for, as well as the impact of HIV and other STIs on the population. But for patients at risk of HIV, a postcode lottery that makes the drug available through certain NHS jurisdictions and not others can be incredibly frustrating.
“So, why is the Impact Trial even taking place when PrEP’s efficacy is already established?”
British HIV Association (BHIVA) chair Dr Laura Waters says: “PrEP is indeed very efficacious at preventing HIV, but at the time that was established Truvada, the branded version of the drug used for PrEP, was very expensive. By undertaking a trial we were able to use the much less expensive generic version of the drug.
“Sexual health clinics have faced significant funding cuts so the trial is also about the feasibility of offering PrEP in real-life via the already over-stretched services.”
The local authority public health budget in the UK has been cut by £700m in real terms between 2014/15 and 2019/20, which has led to sexual health service budgets being cut slashed 25%. Meanwhile, demand for sexual health services rose by 15% between 2014 and 2018 and rates of STIs such as syphilis and gonorrhoea are skyrocketing. Alongside a patent law hangover, the trial exists to assess whether supplying PrEP to patients who need it is financially feasible under austerity.
In October 2019, the government announced that the local authority public health grant would increase by 1% in real terms in 2020-2021, but this is unlikely to make a substantial difference to the funding of sexual health services.