It's time for NHS England to 'do the right thing' and fund PrEP for HIV prevention

It is time for NHS England to "do the right thing" and fund pre-exposure prophylaxis (PrEP) for HIV prevention, argue two senior public health doctors in The BMJ today.

Directors of public health Jim McManus and Dominic Harrison, say despite overwhelming evidence that PrEP against HIV infection is largely safe, effective, and cost effective, NHS England has declined to make it available on the NHS, arguing that HIV prevention is the responsibility of local government.

Such an approach, they write, "confounds its advocacy of a health and care system integrated around the best outcomes for the citizen and perpetuates an incoherent national approach to HIV prevention."

PrEP is a way for people who don't have HIV but who are at very high risk of getting it to prevent HIV infection by taking a pill every day. Studies show that PrEP can reduce the risk of getting HIV from sex by more than 90% when used consistently.

The authors argue that, in population health, PrEP's role is comparable to the function of vaccinations and immunisations, which NHS England does fund.

In the US many citizens now access PrEP through health insurance plans, or for free via charity or voluntary sector agencies, they add, but Europe languishes in indecision.

They believe that NHS England "should admit that it can legally fund PrEP if it wants to."

They point out that local authorities "are still reeling from a 9.6% cut to 2020 in the public health grant on top of a 6.2% cut in year in 2015-16" and say if NHS England wants local authorities to fund PrEP, it has to give them the money to do it.

"Whatever route is finally chosen to fund PrEP, bouncing the decision across systems that are all funded by the same taxpayer will inevitably result in the continued and preventable further spread of HIV," they warn. "This will generate avoidable mortality and increase future NHS costs for treatment.

Perhaps it is time for NHS England just to "do the right thing," they conclude.

Earlier this month, The BMJ reported similar calls by the National AIDS Trust. The Trust is now taking the matter before a court for judicial review.