NHS England has set out how it plans to commission pre-exposure prophylaxis (PrEP) for HIV if it fails in its bid to overturn a High Court ruling that says commissioning the treatment does fall within its powers.
Just a week after a High Court judge ruled that local authorities and NHS England have the power to commission PrEP, NHS England launched a 45-day public consultation on the proposals.
The National Aids Trust (NAT) charity applied for the judicial review after NHS England said in March 2016 that it had no duty or power to commission PrEP because it is a preventive treatment and ill-health prevention falls under the remit of local authorities.
NHS England has been granted permission to appeal the High Court’s decision and has emphasised that its consultation is being run “without prejudice” to the outcome of that appeal.
The consultation proposes that tenofovir disoproxil fumarate (TDF)/emtricitabine should be prescribed as an intermittent regimen for men who have sex with men (MSM), trans women and trans men clinically assessed as being at high risk of HIV acquisition, unless the fully documented clinical assessment indicates the need for a daily regimen. Intermittent regimens involve taking tablets only before and after sex, and are much cheaper than daily regimens.
MSM, trans women or trans men will be eligible for PrEP if they have had a documented confirmed HIV negative test linked to a previous episode of care in the preceding year (42–365 days ago) and condomless intercourse within the previous three months likely to be repeated in the following three months. They will also be eligible if they are HIV-negative and the partner of a diagnosed person with HIV not known to be virally suppressed with whom condomless intercourse is anticipated.
Daily TDF/emtricitabine will be prescribed for heterosexuals clinically assessed as being at high risk of HIV acquisition. HIV-negative heterosexuals will be eligible if they have had condomless sex with a person with HIV not known to be virally suppressed within the past three months and expect to do so again.