Welsh government agree to start PrEP trials in summer

Trials for the Pre-exposure-prophylaxis (PrEP) HIV treatment will begin in Wales in summer after the government agreed to the measures.

On Friday, the All Wales Medicines Strategy Group decided to move forward with trialling the HIV drug Truvada to all those who benefit, starting from summer 2017 and running for three years. It also follows a similar decision by NHS England in December, who will also be starting PrEP trials in summer.

The treatment involves people at very high risk of HIV taking medicines daily to lower their chances of infection. Use of PrEP has been disputed due to it being effective for preventing HIV if used as prescribed, but its effectiveness reduces when it is not taken consistently by patients.

Despite this problem, the Centers for Disease Control and Prevention state that the drug reduces the risk of getting HIV from sex by more than 90%.

Though PrEP trials are now set to be rolled out across the UK, the news follows criticism from the King’s Fund last week, who said that the “labyrinthine” structure of HIV care in the UK was damaging the quality of care patients were receiving.

Vaughan Gething, Welsh health secretary, said: “There is no doubt that Truvada reduces rates of HIV infection when taken correctly and supported by wider, preventative sexual health services can help to reduce overall HIV transmission and infection rates.

“The study that I have announced will mean that all those for whom the drug is clinically appropriate can access it.” 

Gething also stated that the study will help Welsh health leaders to work out how best to provide the preventative treatment to reduce risks of HIV transmission in the country and answer some of the questions raised by the All Wales Medicines Strategy Group around incidence rates.  

“The All Wales Medicines Strategy Group is a highly regarded, independent expert group,” he said. “I acknowledge their advice that there are uncertainties regarding cost-effectiveness and that they have not recommended the drug for routine use within NHS Wales at this time.

“I am asking Public Health Wales and the HIV Expert Group to work together to deliver the study.”

And Sarah Fuhrmann, national director for HIV charity Terrence Higgins Trust in Wales, said she was heartened and relieved that the Welsh government had listened to people affected by HIV and will make PrEP available to people who need it in Wales.

“Although this is not a long-term solution, it is undoubtedly a momentous step forward for Wales, where investment in HIV prevention has been patchy at best,” she explained.

“Making PrEP available to people at risk of HIV will not only protect them from a lifelong and stigmatised condition, it will also save our NHS £360,000 in lifetime treatment costs for every person who would have become HIV positive without PrEP. Common sense has prevailed.”

However, Fuhrmann added that the trial was only a temporary answer, and that the Trust will now be looking to the government to commit to making PrEP routinely available in Wales for those at risk, as Scotland has already done.

“We must not see the same delays or uncertainty that we’ve seen in England around PrEP,” she said. “Nevertheless, this is a welcome step and we hope the trial paves the way for a long-term home for PrEP on the NHS in Wales.”

NHS England were last year locked in a feud regarding who was accountable for the drug, as it argued that councils should take responsibility for PrEP as part of their public health remit. However, the Court of Appeal upheld the ruling that NHS England, not local government, is responsible for commissioning PrEP.



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