PrEPping Scotland - And Wales?
By Craig Young
4th May 2017 - 10:58 pm
the devolved National Health Service England and Welsh medicine
regulators are obstructing the public funding of PrEP (post-exposure
prophylaxis) in the context of HIV prevention, NHS Scotland has just
authorised its distribution and public funding across the northernmost
component of the United Kingdom.
April 10 2017, the Scottish Medicines Consortium announced that NHS
Scotland would fully fund the popular prophylactic combination therapy
option, placing it ahead of NHS England, which is still awaiting more
clinical trial data before it makes its decision. Dr Alan McDonald,
chair of the Scottish Medicines Consortium, said that given that
combining PrEP and condoms were the most effective option to curtail HIV
infection within gay men and other groups that may potentially
undertake risky sexual practices and that the Scottish Government was
committed to curtailing the HIV epidemic, they were in full accord with
Scottish HIV prevention groups. Previously, THT Scotland, HIV Scotland,
the Waverley Centre and National AIDS Trust had gotten together in the
PrEP4Scotland Coalition to lobby for such an outcome.
The happy outcome may have been influenced by the Scottish Health Promotion Network's paper PrEP in Scotland, produced
by their PrEP Short Life Working Group in October 2016. That report
estimated that 1700-1900 men who have sex with men would be able to
access the combination therapy, and if there was an estimated 58% uptake
of the option, that would mean 1000 men who have sex with men would
Terrence Higgins Trust Scotland and HIV Scotland both welomed the
decision, noting that it would vastly improve access to the medication
and therefore reduce HIV infection amongst Scottish gay, bisexual and
men who have sex with men, as well as saving Scotland's National Health
Service an estimated three hundred and sixty thousand pounds through its
proven protective usefulness in preventing HIV infection.
fourteen health boards will now roll out PrEP access over the next three
months. London's Gay Men's Fighting AIDS (GMFA) also welcomed the move,
although asked why NHS England was still insisting on a three year
trial, even if it was funding 10,000 places on that trial, given both
abundant clinical data from other large scale PrEP clinical trials and
NHS Scotland's commendable initiative on the issue.
NHS England was
forced to fund the trial after court action from the UK National AIDS
Trust compelled it to do so, after obstructing access beforehand.
Consequently, south of Hadrian's Wall, gay men at risk of HIV infection
have had to pay for the unsubsidised combination therapy out of their
own pockets or sidestepped the glacial NHS approach through ordering
PrEP from overseas jurisdictions, with the risk of adulteration or
substitution with placebos in that context despite paying thousands of
pounds for it.
while Scotland has decided to fully fund Truvada/PrEP, Wales may not
decide to do so. The All Wales Medicines Strategy Group has advised NHS
Wales not to prescribe PrEP to patients in the principality. However,
this decision is only a recommendation and Wales' devolved government is
under no obligation to follow their advice.
Gay Men Fighting AIDS is
not happy at this turn of events and Nick Baker, their Outreach and
Communication Manager has advised the All Wales Medicines Strategy Group
to think again, citing the PROUD clinical trial , an independent Welsh
PrEP assessment which yielded positive results. Deborah Gold, director
of the UK National AIDS Trust, concurred and urged reassessment of the
highly positive available data from large scale clinical trials, as did
Sarah Fuhrmann, director of the Terrence Higgins Trust Wales.
Wales' devolved government has decided to fund an NHS PrEP clinical
trial of its own. The trial will last for three years, which means that
its recipients will receive the drug over that period. Terrence Higgins
Trust Wales applauded the decision to fund the clinical trial, and
Wales' regional government for disregarding the All Wales Medicine
Strategy Group opinion that it not fund the HIV prevention and
prophylaxis drug in its region.
in Scotland (Scottish Health Promotion Network, October
Gus Cairns: "PrEP is approved in Scotland" AIDSmap: 10.04.2017:http://www.aidsmap.com/PrEP-is-approved-in-Scotland/page/3130498/
Lewis Corner: "Wales advised not to fund PrEP on the NHS" Gay Times: 26.04.2017:http://www.gaytimes.co.uk/news/70676/wales-advised-not-prescribe-hiv-prevention-treatment-prep/
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