The government will continue exploring whether HIV prevention drug Pre-Exposure Prophylaxis (PrEP) could be made available in settings other than sexual health services (SHSs), including community pharmacies, it has said in a roadmap published today.

This will include a roundtable convened by the Department of Health and Social Care (DHSC) in 2024-25 to consider available evidence and opportunities for future research.

But the Royal Pharmaceutical Society (RPS) has described the government’s ‘apparent lack of progress in widening community access to PrEP’ as ‘very disappointing’, suggesting that there is already ‘clear evidence of the value that local pharmacies can provide’.

And leading HIV and sexual health charity, the Terrence Higgins Trust (THT), said the government ‘must go further’ and make PrEP available ‘online, through pharmacies and potentially GP services too’.

In an action plan published in 2021, the government said it wanted to ‘improve access to PrEP for key population groups’ by developing a plan for provision of PrEP in settings beyond sexual and reproductive health services, including in community pharmacies.

But in the PrEP roadmap published today the government said ‘more evidence’ was needed ‘on the effectiveness of providing PrEP outside SHSs’.

It highlighted the National Institute for Health and Care Excellence (NICE) recommendation for further research on PrEP provision in other settings, ‘including if this will reach populations who could benefit from but are not currently accessing HIV PrEP’.

And it set out an action for DHSC to convene a roundtable in 2024-25 ‘to look at evidence to date and explore opportunities for further research in line with NICE’s recommendations for PrEP research’.

Commenting on the roadmap published today, James Davies, RPS director in 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’.

He added: ‘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.’

And he said that it was ‘essential’ that PrEP access be expanded to include community pharmacy settings ‘to allow individuals to more readily access this crucial preventive measure’.

‘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 told The Pharmacist.

And Richard Angell, THT chief executive, commented: ‘We can and must go further than what has been published today’.

He described the roadmap as ‘an analogue solution for a digital world’, highlighting cuts to public health funding and its impact on access to SHSs.

‘PrEP – the pill taken by people who test negative for HIV to stay negative – is a game-changer in the battle to end new transmissions of HIV by 2030.

‘However, not enough people are able to access it because currently the only way to obtain PrEP is through over-stretched sexual health clinics, which have had to absorb significant cuts in funding year on year.’

Mr Angell warned more than 60% of people trying to access PrEP ‘are stuck on long waiting lists, raising the possibility of acquiring HIV in the meantime’.

‘Long delays in appointments for PrEP treatment have driven others to buying PrEP privately online. This is neither fair nor equitable,’ he added.

In addition, he said that ‘we can and must be more ambitious’ in tackling race, gender and age inequalities in access to PrEP.

While he said that SHSs ‘must be properly funded to remain a primary route to PrEP’, he highlighted that ‘for some people, starting or managing PrEP use through an app, online services or community pharmacies would suit them better; increase access; and free up sexual health appointments for those who need clinician time’.

In particular, he called for PrEP to be made available through community pharmacies and online.

‘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,’ said Mr Angell.

‘It should be available online, through pharmacies and potentially GP services too – and we must do better in promoting it to those who could benefit.

‘This would go a long way in relieving pressure on sexual health services and provide a better service for many existing PrEP users. It would also make PrEP available to those population groups who don’t get what they need from under-funded sexual health clinics.’

And he called for ‘sustained investment’ to help SHSs ‘meet the demands of today’s digital age’.

Groups including the National Pharmacy Association (NPA) and the HIV and AIDS all-party parliamentary group (APPG) have long called for PrEP to be made available through community pharmacies.

And in September, then health minister Neil O’Brien said that the government’s roadmap would explore whether the drug could be made available from community pharmacies.