Community pharmacies could be asked to target high risk or underserved groups with pre-exposure prophylaxis (PrEP) to prevent HIV infection, but only if specialist clinics are shown to not be capable of reaching everyone they should, The Pharmaceutical Journal has learned.
The English HIV and Sexual Health Commissioners’ Group (EHSHCG), a network of local authority and clinical commissioning group commissioners across England, said that first there was “work to do” to fully understand the barriers to PrEP uptake in level 3 sexual health clinics before access is expanded to other settings.
In March 2021, the Department of Health and Social Care (DHSC) confirmed that it would consider provision of PrEP outside of sexual health clinics and, in the government’s action plan towards ending new HIV transmissions by 2030, published in December 2021, it said that the EHSHCG were going to explore the acceptability of delivering PrEP in settings such as drug and alcohol services and pharmacies.
However, a year on, progress is yet to be made on expanding access to other healthcare settings.
When asked by The Pharmaceutical Journal why this was, James Woolgar and Isabel Carrick and Sue Burridge, the chair and deputy chairs of the EHSHCG, respectively, explained in a joint response that the focus of the group was to determine why high-risk groups and underserved populations who would benefit from PrEP were not accessing it and to identify the potential barriers to access.
“We are doing this collectively to help inform the commissioning of PrEP through sexual health clinics and potential targeted outreach and possibly beyond,” the response said.
“Essentially, there is work to do to fully understand whether indeed level 3 sexual health clinics are ‘not’ the place for this, and if that comes out in our findings, we have also made provisions in the brief to ask people ‘where their ideal access point might be’ (so a venture off into settings to some degree). The whole evidence base needs building up on all of this, consistently and clearly.”
They also said there were also “other issues”, such as licensing (currently only level 3 clinics are permitted), that would need to be overcome to enable PrEP to be provided in other settings.
“So, whilst our work may well highlight different places, pharmacies, GPs etc. for key access points people want, we can’t guarantee at this stage that we can make that happen 100%.”
Debbie Laycock, head of policy at Terrence Higgins Trust, a leading HIV and sexual health charity, said she was “incredibly disappointed” to hear that there could be a “roll-back” in the government’s commitment to expanding PrEP to settings outside of sexual health clinics.
“The fight for PrEP access was long and difficult — it took years. But the fight isn’t over while its benefits are being felt so unequally,” she said.
“The drug has been a game-changer for gay and bisexual men, but we must do everything we can to increase awareness and access to PrEP in all communities. Access to PrEP among women and black people of African heritage through [an] NHS England-run trial showed worryingly low uptake, with data revealing just 4% of those accessing the drug were from groups other than gay and bisexual men.”
Laycock added that the evidence was “clear” that not all communities who could benefit from the HIV prevention pill were accessing it via sexual health settings.
“The HIV action plan committed to additional routes for PrEP access,” she added.
“This needs to include provision through community pharmacists, GPs, community settings and specific locations, such as prisons.
“We are calling for the piloting of PrEP in other settings as a matter of urgency. Every delay is a further failure to support the needs of all who could benefit from PrEP and address the inequalities that are already so stark.”
The EHSHCG said that “all headline recommendations” would be communicated to government departments to help with the next steps around improving access to PrEP.
The Royal Pharmaceutical Society said in November 2021 that there was a “clear opportunity” to drive down rates of HIV infection by expanding provision of PrEP to community pharmacies and GP practices as part of the government’s HIV action plan.