A plan to make HIV prevention drug Pre-Exposure Prophylaxis (PrEP) more widely available will be published before the end of the year, health minister Neil O’Brien has said.
And he confirmed that the roadmap would explore whether the drug, which is used to reduce the chance of contracting HIV, could be made available from community pharmacies.
However, the sector’s negotiating body Community Pharmacy England (CPE) told The Pharmacist that it had not yet discussed this with the Department of Health and Social Care (DHSC).
The HIV and AIDS APPG is calling for PrEp to be made available through community pharmacies, ‘with clear financial accountability for its provision’, Mr Brine said.
‘It would be a critical part of ending new cases of HIV by 2030,’ he said, adding that this was a vision already committed to by the government.
The drug, which usually contains tenofovir disoproxil and emtricitabine and can be taken daily or on-demand to reduce the risk of becoming infected with HIV, is currently available in England, Scotland and Wales from sexual health clinics. In Northern Ireland, patients can receive an initial consultation and assessment appointments for centrally dispensed PrEP from any genitourinary medicine (GUM) clinic.
But Mr Brine said that community pharmacies were ‘well placed to prescribe PrEP’.
In particular, he said it was ‘critical’ that PrEP prescriptions be managed alongside other medications a patient might be taking, adding that community pharmacies used to carrying out medicines reviews ‘would be well placed to counsel on PrEP’.
He also said that community pharmacies are ‘well connected to other parts of the health service, where integrated care boards have ensured that the IT is right and that the relationships are right’.
And Mr Brine said that services provided by pharmacies ‘act as a bridge between secondary and primary care’, which would ‘complement sexual health prevention and treatment services and the advice that goes on’.
Health minister Mr O’Brien responded that the national HIV Action Plan Implementation Steering Group was working to develop a roadmap around improving access to PrEP, based on the recommendations of the national PrEP Access and Equity Task and Finish Group.
And he said that this plan would be published ‘before the end of the year’, and it would ‘deal with how we will work through all the knotty issues in enabling community pharmacy to provide PrEP’.
Sexual health charity Terrence Higgins Trust told The Pharmacist that one key issue that would need to be worked through would be how community pharmacies access the drug.
Currently, only prescribers can initiate the drug, and it is only available free of charge to patients via a sexual health clinic. Any other initiation in any other setting would therefore be a private prescription and incur a cost to the patient determined by the service provider.
But Richard Angell, chief executive at Terrence Higgins Trust, said that to prescribe PrEP, pharmacists would need to be able to access it from NHS England without a prescription charge, in the way that sexual health clinics currently can.
And he said that ‘with appropriate support’, community pharmacies would be ‘well placed to provide other sexual health care’, in addition to the hormonal contraception and emergency contraception (morning-after-pill) that many already provide.
‘Pharmacies are pivotal to meeting the government’s stated goals on health outcomes,’ he added.
And he said that with ‘nearly 60% of people’ waiting more than 12 weeks ‘to access what is a simple pill which can help reduce the spread of HIV’, and pharmacy representatives having been calling for PrEP to be made available in their services ‘for years’, community pharmacy had the potential to expand access to HIV prevention.
‘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 GPs surgery in England, let alone online,’ Mr Angell told The Pharmacist.
‘Neil O’Brien described issues preventing community pharmacy from providing PrEP as “knotty” – but the government’s primary care recovery plan and Pharmacy First ambition should provide an opportunity to take this forward.’
The Terrence Higgins Trust also told The Pharmacist that nothing about the legal classification of the drug would prevent it from being supplied via a patient group direction (PGD), in the same way that the Pharmacy Contraception Service is provided.
But issues around patient monitoring, including HIV and sexual health testing, and renal function in some cases, would need to be worked through.
A spokesperson for the HIV and AIDS APPG suggested that some regular testing, such as HIV and sexual health testing could be undertaken by a patient at home, while blood testing could be done in conjunction with other health services if necessary. They also urged all stakeholders to speak together on this issue.
And they added that the regular monitoring of patients through community pharmacies would increase accessibility for patients and could provide an opportunity for those who might not otherwise engage with health services to do so.
In particular, they said that it could increase access for those living in rural areas, as well as under-reached demographics such as women and people from Black and minority ethnic communities.
The Royal Pharmaceutical Society (RPS) has also called for PrEP to be made available through community pharmacies.
James Davies, RPS director for England, said: ‘PrEP is a ground-breaking tool in the fight against HIV and we are united with patient groups who have long been calling for widening access through community pharmacies.’
And he said that the government’s update on the PrEP roadmap was ‘a welcome step, but long overdue.’
‘Pharmacists are trusted health professionals and play a key role in reducing health inequalities and enhancing patient access to treatment,’ he added.
‘I would urge the government to refocus its efforts and engage with patient groups and other stakeholders so we can harness the full potential of community pharmacies in contributing to a healthier and HIV-free future.’
What can community pharmacies do now to support those living with and at risk of HIV?
A spokesperson for the HIV and AIDS APPG told The Pharmacist that community pharmacies could play a key role in reducing stigma around HIV and AIDS.
And they emphasised the importance of clinical staff understanding advances in treatment of the disease.
‘A lot of people haven’t kept up to date with the advancements in HIV, such as the U=U message’, they said.
The U=U message is an international campaign raising awareness that effective HIV treatment can reduce a person’s HIV viral load to an undetectable level, usually within six months, which then makes the virus untransmissible to their partners. Patients on effective treatment are therefore not infectious.
The spokesperson also suggested that community pharmacies could be valuable places to display and signpost patients to information abut sexual health and HIV testing and treatment, which is free to access.
And they added that this could be particularly important in rural areas or those with large immigrant populations.
‘Community pharmacies are in a prime position to help with that awareness on tackling HIV stigma and get the information out there about where to go get tested for STIs,’ they said.