Welsh government plans to expand PrEP access to community pharmacies

Access to pre-exposure prophylaxis (PrEP) should be expanded to GP practices and community pharmacies across Wales, according to the Welsh government’s draft HIV action plan.

Published on 14 June 2022, the plan includes 26 actions for the Welsh government and its partners to take forward in order to reduce HIV transmissions and improve the lives of people living with HIV in Wales.

Recommendations include that primary care and specialist sexual health services should develop and implement a shared care model to improve access and delivery of PrEP.

“This will enable PrEP to be provided by GPs and community pharmacies in all health board areas, with particular emphasis on delivery in rural areas and in underserved communities,” the plan reads.

“In addition, health boards should explore how community organisations can support PrEP. Health boards must have care pathways in place for PrEP that meet demand.”

Richard Angell, campaigns director at Terrence Higgins Trust, which partnered with the Welsh government on the plan, said that PrEP was an “indisputably crucial” piece of the puzzle towards ending new HIV cases by 2030.

“It’s already making a significant impact in driving down new transmissions among gay and bisexual men but now must urgently be made available in a wider range of settings — including via community pharmacies and from GPs — to properly maximise its huge potential for protecting against HIV,” he said.

“PrEP’s delivery via sexual health services works for many, but we know that a significant proportion of people won’t ever step foot in these services — including those living rurally and far away from any clinic.

Angell said that Wales was “yet again” leading the way when it comes to PrEP.

“In England, there is still no progress on expanding PrEP access, despite the clock already ticking down and promising words in its own action plan around PrEP. Scotland now also has the opportunity to follow Wales’s lead as part of the Scottish government’s upcoming HIV elimination plan.

“We’ll continue to push all UK governments to ensure PrEP is properly utilised and no one is left behind when it comes to ending HIV by 2030.”

Commenting on the plan, Cheryl Way, chair of the Royal Pharmaceutical Society (RPS) Welsh Pharmacy Board, said that PrEP were “highly effective” medicines, as proven by the Welsh government’s three-year PrEPARED study, results of which showed no new diagnoses of HIV among more than 1,200 people taking PrEP in Wales.

“This is clear evidence that PrEP should be made as easily accessible as possible to those who need it,” she added.

“Increasing access to the medicines has been a long-standing issue of concern for us at the RPS and, on World Aids Day [2021], we called on governments across Great Britain to widen access to PrEP by making it available through community pharmacies.

“We’re therefore delighted to see the proposals outlined by the Welsh government to develop a model which will enable PrEP to be provided by community pharmacies across Wales.”

Way added that community pharmacists and their teams were “trusted and accessible” healthcare professionals and would be a “great additional asset” in extending reach beyond the sexual health clinics already supplying PrEP.

“Going forward, we encourage both the Westminster government and the Scottish government to act so that community pharmacies in England and Scotland are empowered to provide PrEP and extend access to those that require the medicines.”

In response to a Department of Health and Social Care written question, submitted on 6 June 2022, about the roll out of distribution of PrEP through community pharmacies, Maggie Throup, parliamentary under-secretary for health and social care, said that there were plans in the HIV Action Plan for England to “consider” the provision of PrEP in settings beyond sexual and reproductive health services, such as community pharmacy.

She said that work would begin in autumn 2022, taking evidence from the English HIV and Sexual Health Commissioners’ Group on potential barriers to the uptake of PrEP.

The Welsh government’s draft HIV Action Plan is out for consultation until the week beginning 15 September 2022.