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UK countries set to divide over policy on access to HIV prevention treatment

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British nations could end up with different rules on HIV prevention drugs, after an advisory body recommended that pre-exposure prophylaxis (PrEP) should not be funded on the NHS in Wales.

The treatment has been shown to be effective in preventing high-risk groups from contracting HIV and last month Scotland became the first UK nation to approve its use for health service patients.

“This advice would lead to a postcode lottery within the UK”

Sarah Fuhrmann

Meanwhile, in England, government arm’s length bodies have said PrEP will be available to 10,000 people over the next three years as part of a major clinical trial that should “pave the way for full roll-out”. It followed a row between local councils and the NHS over who should have funding responsibility.

However, the All Wales Medicines Strategy Group (AWMSG) has today provisionally recommended that the treatment should not be made available on the NHS in Wales.

In its report on the drug Truvada – the only PrEP medication currently licensed for use – the body raised concerns about cost-effectiveness and the fact those on the course of preventative treatment must strictly adhere to the recommended dose for it to work.

The report also flagged up fears taking the drug could encourage more risky sexual behaviour that could in turn boost rates of sexually transmitted infections.

However, the final decision on whether PrEP should be funded by NHS Wales or not rests with the Welsh government.

The Terrence Higgins Trust said the decision not to recommend PrEP was “short-sighted” and, if acted on, would lead to a “postcode lottery” between UK borders.

“We are disappointed by this short-sighted recommendation to deny PrEP to people at risk of HIV in Wales,” said Sarah Fuhrmann, national director for the Terrence Higgins Trust in Wales.

“For every person who receives an HIV diagnosis, the Welsh NHS will pay on average £360,000 in lifetime treatment costs,” she said.

“PrEP can save the NHS this money in the long term, whilst taking us one step closer to ending the HIV epidemic,” said Ms Fuhrmann.

She added: “We realise this is not the final decision, but if acted upon, this advice would lead to a postcode lottery within the UK, with major inequalities between borders in terms of who is protected against HIV.”

The AWMSG told Nursing Times it was not appropriate for it comment as the appraisal process was still under way.

Gilead, the drugs company that makes Truvada, can request an independent review of AWMSG’s decision and the appraisal process would be suspended while that took place.

If the drugs company accepts the decision or there are no grounds for a review then the recommendation will go to the Welsh government for ratification.

“AWMSG is an advisory committee,” said a spokeswoman for the body. “Welsh government will make the final decision as to whether or not this medicine will be made available in the NHS Wales and will take the advice of AWMSG into account in its determinations.”

If the Welsh government agrees PrEP should not be available on the NHS, then the drugs company can request a re-appraisal now or in the future in the light of significant extra or new evidence.

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