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A government-commissioned report has revealed that recommendations for pilots to explore how HIV pre-exposure prophylaxis (PrEP) could be available via community pharmacies are being considered as “possible future opportunities”.
The ‘Roadmap for meeting the PrEP needs of those at significant risk of HIV‘, commissioned by the Department of Health and Social Care (DHSC) and produced by the independent HIV Action Plan Implementation Steering Group, said that the “DHSC and local commissioning bodies [are] to consider availability of funding to support the implementation of PrEP pilots as appropriate”.
It said: “It is concerning that the current proposal for PrEP pilots is marked as ‘possible future opportunities’, describes a single pharmacy pilot and does not include primary care”.
The report added that the DHSC was aware “more work needs to be done to ensure PrEP is accessible for all groups” and “more evidence is needed on the effectiveness of providing PrEP” outside sexual health clinics.
The Pharmaceutical Journal reported in April 2023 that the ‘PrEP access and equity task and finish group’ — established by the DHSC in October 2022 to identify ways of improving access to PrEP as part of the HIV action plan, recommended the establishment of a series of national pilots for PrEP provision in settings outside specialist sexual health clinics, including pharmacies.
In evidence submitted to the House of Commons Health and Social Care Committee pharmacy inquiry, which was published on 18 October 2023, HIV and sexual health charity the Terrence Higgins Trust, told MPs that PrEP provided via community pharmacies was a “preferable route” for groups less likely to access PrEP through sexual health services.
The roadmap said that an extra working group — including the DHSC, NHS England and clinicians — should meet for a workshop to produce guidelines and recommendations for integrated care systems “on determining the most appropriate settings locally for PrEP delivery beyond sexual health clinics”.
“This exercise must happen simultaneously to the pilots recommended in the Task and Finish Group’s report in January [2023],” it added.
Commenting on the roadmap, Richard Angell, chief executive of the Terrence Higgins Trust, said: “We can and must go further than what has been published today.
“Not enough people are able to access PrEP because, currently, the only way to obtain it is through over-stretched sexual health clinics, which have had to absorb significant cuts in funding year on year.
“More than 60% of people trying to access PrEP are stuck on long waiting lists, raising the possibility of acquiring HIV in the meantime.
“If the government is to meet its own goal of ending new HIV transmissions in England by 2030, we have to stop treating PrEP like a special medication that can only be prescribed in specialist clinics. It should be available online, through pharmacies and potentially GP services too,” he added.
In November 2021, the Royal Pharmaceutical Society (RPS) urged the government to make PrEP available through community pharmacies “as soon as possible”.
Commenting on the roadmap, James Davies, RPS director for England, said: “The HIV Action plan, published over two years ago, made it clear how community pharmacies can provide accessible and convenient healthcare services to the public.
“The apparent lack of progress in widening community access to PrEP is very disappointing, given the clear evidence of the value that local pharmacies can provide.
“Efforts to improve PrEP access must be re-energised and include pharmacy as a key partner, to enhance public health outcomes and reduce health inequalities,” he added.
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