Pre-exposure Prophylaxis (PrEP) Provision in England: Recent Developments

In 2019, the provision of Pre-exposure Prophylaxis (PrEP), an anti-HIV medication, has continued to attract attention. PrEP is a drug taken by HIV-negative individuals at risk of acquiring HIV, which reduces viral replication and minimises the chance of a permanent infection developing.

Although PrEP is widely available in Scotland, access in England has initially been through an impact trial. The Terrence Higgins Trust has campaigned for PrEP to be made available through routine commissioning in all parts of the country. It states that while it is “achievable” to “end HIV transmission in the UK”, this can only happen if “we use all of the tools available to us”, including PrEP. On 29 October 2019, the Secretary of State for Health and Social Care, Matt Hancock, said that the “roll-out from a trial to routine commissioning will happen in April (2020)”. However, various campaigners remain concerned that people will contract HIV while waiting to access the medication.

The key PrEP developments since 2016 have been:

• In December 2016, NHS England committed to a large-scale PrEP trial, which aimed to establish the demand for PrEP and how long people stay on the treatment in a real-world setting.
• In October 2017, the impact trial was launched with 10,000 places. This was increased to 13,000 in June 2018 to adjust for the initial high recruitment. In early 2019, NHS England’s Programme Oversight Board agreed to expand the trial to include 26,000 participants.
• In October 2019, NHS England provided an update that 15,700 people across 153 clinics had received PrEP through the trial. Almost all trial clinics are now open and recruiting with thousands of places on the trial remaining available across all eligible at-risk groups and geographies.

The Department of Health and Social Care has stated that it will work with local authorities in England to plan for a “seamless transition” from the trial to routine commissioning in 2020/21.