Roadmap to provide PrEP via community pharmacies will be ready by ‘end of the year’, government says

A proposal for how pre-exposure prophylaxis (PrEP) could be made available from community pharmacies will be produced by the end of 2023, according to the government.

Speaking at a Westminster Hall debate on 14 September 2023, health minister Neil O’Brien said the government’s HIV action plan implementation steering group was “working to develop a PrEP roadmap” based on the Department of Health and Social Care-established PrEP access and equity task and finish group’s recommendations to improve access to PrEP.

“I can say today that the roadmap will be out before the end of [2023], and it will deal with how we will work through all the knotty issues in enabling community pharmacy to provide PrEP”, said O’Brien.

News of the roadmap came in response to a question from Steve Brine, House of Commons Health and Social Care Committee chair — also co-chair of the all-party parliamentary group on HIV and AIDS — who asked O’Brien “what progress has been made towards the commitment to make PrEP available beyond sexual health services and when it will be available in community pharmacies?”

Describing pharmacy availability of PrEP as “a critical part of ending new cases of HIV by 2030”, Brine said: “We are calling for the HIV prevention pill, PrEP — pre-exposure prophylaxis — to be available through community pharmacies, with clear financial accountability for its provision.”

Brine said the move would be “a game changer for HIV prevention”.

PrEP has been routinely available in specialist sexual health services since 2020. Local authorities in England are responsible for commissioning access to most sexual and reproductive health services, including HIV prevention, testing and access to PrEP, through the public health grant, with funding of £3.5bn in 2023/2024.

According to documents seen by The Pharmaceutical Journal earlier in 2023, the PrEP access and equity task and finish group — established by the Department of Health and Social Care (DHSC) in October 2022 to identify ways of improving access to PrEP as part of the HIV action plan — made several recommendations to improve access to PrEP and reduce HIV transmission in England.

One recommendation was that “national health bodies, in partnership with local commissioners, should commission a series of pilots providing PrEP in a variety of settings outside specialist sexual health clinics, including online, pharmacies, GPs, a community setting, a contraceptive clinic and a non-specialist sexual health setting”.

Richard Angell, chief executive at Terence Higgins Trust, said pharmacies were “pivotal” to meeting the government’s stated goals on health outcomes and called the promised expansion of PrEP into pharmacies “a huge step forward”.

However, he added: “Nearly two years on from the publication by the UK government of the England HIV Action Plan, PrEP still isn’t available in a single pharmacy or GP surgery in England, let alone online. As of today, nearly 60% of people are waiting more than 12 weeks to access what is a simple pill, which can help reduce the spread of HIV.

“Unlocking the potential of pharmacies — which are often on the frontline of community healthcare — will be vital in tackling wider health inequalities, expanding PrEP access and helping end new cases of HIV by 2030,” he added.

Jim McManus, president of the Association of Directors of Public Health and a contributor to the HIV national action plan, said: “Currently, a significant proportion of eligible people are not coming forward for PrEP treatment despite it being one of our most effective tools in transmission prevention. In order to achieve an 80% reduction in new HIV infections by 2025, we need to improve access and delivery of PrEP.

“In our recommendations to the government, made together with the Terrence Higgins Trust, the task and finish group suggested a number of possible options, including pharmacies.”

McManus added: “Ultimately, until we are able to run and gather evidence from pilot schemes, it is impossible to say how effective delivery in different places will be. What is clear however is that to expand the provision of PrEP, which is a complex treatment, in the community, funding for sexual health services must be increased so that the appropriate training and resources can be provided.”

In November 2021, the Royal Pharmaceutical Society urged the government to make PrEP available through community pharmacies “as soon as possible”.

A spokesperson for Community Pharmacy England (CPE) told The Pharmaceutical Journal it hadn’t had any discussions with the Department of Health and Social Care on the provision of PrEP in community pharmacies.