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NHS launches mass HIV prevention trials

Pre-exposure prophylaxis will be provided for around 10,000 people

Mark Gould

Friday, 04 August 2017

NHS England has launched what it claims is the world's largest single implementation trial, which will provide HIV prevention drugs to around 10,000 people at high risk of infection.

From September, pre-exposure prophylaxis (PrEP) will now be provided by the NHS through the initial three-year trial.

Sexual health clinics in London, Brighton, Manchester, Liverpool and Sheffield are expected to be amongst the first to start enrolling people in the impact trial. More clinics will join in October with full implementation across England by April 2018 at the latest. As lessons are learned from the trial, this will inform follow-on routine commissioning subsequent to the three-year trial.

Whilst HIV infection rates in England are falling due to increased prevention, diagnosis and treatment programmes, NHS England says this new intervention will now assess the full additional potential of PrEP, by gathering clinical evidence on optimal targeting, uptake and implementation on a large scale.

To support the study, NHS England has concluded a successful international competitive procurement to source the drugs for the trial. The NHS list price for PrEP drug Truvada is £355.73 for 30 tablets but the NHS says it has secured a much cheaper deal. "The contract signed this week has secured pricing consistent with the programme’s allocated budget of £10 million, which also includes on-costs for local authorities and sexual health clinics involved in delivering and monitoring the trial intervention."

Clinics will identify eligible participants who consent to the trial, including men, women, transgender people, and individuals who have a partner whose HIV status is not known to be controlled by anti-retroviral treatment. People living and registered with a GP in England will also be able to enrol for potential participation at their local participating sexual health clinic.

In addition to investing in the PrEP trial, NHS England already invests in a ‘treatment as prevention’ (known as TasP) policy to start HIV treatment earlier for people with diagnosed HIV to protect HIV-negative partners. This programme, combined with other prevention measures, has led to a drop of over 20% in new HIV diagnoses in large London clinics.

Professor Brian Gazzard, a consultant in infectious diseases, who is leading the PrEP Impact Trial, said: “This is a hugely important and ambitious trial, and one which we need if we are to accurately translate the promising findings of the PROUD pilot study to a wider risk population. There is a more diverse population of high risk individuals for whom PrEP and its associated risk reduction support could mean the difference between staying HIV negative or becoming HIV positive. The data and evidence we generate will not only be of international interest but more importantly will enable commissioners in England to plan for a PrEP programme that benefits individuals and the taxpayer.”

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