Discussion with a representative from Barts Health NHS Trust on the Pre-Exposure Prophylactic method of HIV prevention.
Minutes:
It was noted that it had recently been confirmed that NHS England would not currently be releasing funding for this type of HIV treatment.
The Committee was addressed by a doctor who explained that he had been a HIV consultant for two years and had worked in this field for eight years. He felt this treatment was very important and that it was disappointing that NHS England had turned down the treatment which had been approved by the World Health Organisation and in countries such as the USA, Israel and Kenya.
There were 103,000 people living with HIV in the UK and the average cost of treatment for each patient was £300,000 over their lifetime. The doctor added that the number of new HIV cases among men having sex with men was rising. PReP was given to people before they were exposed to HIV and was part of a wider HIV prevention strategy. PReP had been trialled in the UK and France where it had led to an 86% reduction in new HIV diagnoses amongst the trial groups. There were minimal side effects of the treatment and only one known case of a patient on PReP still developing HIV.
PReP could not prevent other sexually transmitted infections but also worked as an HIV treatment for women. The drug was still on patent and so currently cost £5,000 per patient per year. It was however only required to be taken during periods of high sexual activity and was also due to come off patent in mid-2017 when the cost was likely to drop significantly, possibly to as little as £40-50 per year.
With the current non-availability of PReP in the UK, there were increasing amounts of the drug being sourced from abroad which may not have undergone stringent quality controls.
The doctor felt it was disappointing that NHS England had not put PReP forward for national funding, saying it was up to Local Authorities to fund this. Most previous HIV medications had been funded by NHS England. It was noted that the same drug was used in post-exposure prophylactics which were funded by NHS England and there were reports of people obtaining these drugs in order to use them pre-exposure.
It was clarified that there were few cases of HIV infection from drug use with this only constituting 3-4% of total HIV cases.
Letters in protest at the decision by NHS England had been written by London Councils, the Local Government Association and the Association of Directors of Public Health.
The Committee was addressed by Councillor Mark Santos who declared an interest as the Cabinet Member for Health at London Borough of Redbridge. Councillor Santos was also a director of Positive East, a charity working in the HIV field. Councillor Santos felt that funding of PReP should be the responsibility of NHS England.
The level of condom use among gay men had been fairly unchanged over the last 20 years at around 50%. There was however evidence of lower risk awareness currently, particularly among younger gay men where condom use was often lower.
It was AGREED that, following the London Mayor and Assembly elections, that the Committee would write to NHS England and local MPs expressing their concern at the situation and the Committee’s view that funding of PReP should be the responsibility of NHS England. The clerk to the Committee would draft a letter to this effect.
It was further RECOMMENDED that this matter should be taken to the individual borough Health Overview and Scrutiny Committees, if this was felt appropriate.