The NHS in Scotland will make PrEP, the drug regime that prevents HIV, available to people at risk of infection in a move that is expected to see Scotland become the first country within the UK to provide it.
The Scottish Medicines Consortium (SMC), which advises the Scottish NHS on the provision of new drugs, said in a statement on Monday that the drug – brand name Truvada – "was accepted to help prevent sexually transmitted HIV-1 infection in adults who are at high risk of being infected ... and should be used in combination with safer sex practices such as using condoms".
The statement added: "Patient groups highlighted that current prevention methods have not managed to reduce the spread of HIV in Scotland over the last ten years."
Although it comes nearly six months after NHS England pledged to give the medication to 10,000 people in a three-year trial south of the border, Scotland's decision, unencumbered by trial protocol, means that Scottish patients will likely receive it earlier.
George Valiotis, chief executive of HIV Scotland, told BuzzFeed News that he anticipated that it would likely take approximately three months for PrEP to be given to patients. He applauded the SMC for its evidence-based decision.
"It's terrific news," he said. "What this does is it finally gives a new option in terms of HIV prevention. What we've seen is that we needed something else to break that glass ceiling of new infection rates, which haven't been changing significantly. We know it works, we know it's cost effective, and now we can actually put it into practice."
PrEP – pre-exposure prophylaxis – involves HIV-negative people taking an antiretroviral drug (Truvada), which is similarly effective at blocking the transmission of HIV as condoms. But because this prevention method is not taken moments before intercourse it bypasses many of the barriers to condom use and is therefore seen by sexual health experts as a "game-changing" tool in reducing the rates of HIV infection.
HIV organisations welcomed the SMC's announcement, which follows years of campaigning across the UK by charities, doctors, and activists to ensure those at risk have the drug. It is already available in several countries, including France, Canada, South Africa, and the US.
PrEP4Scotland, a group of organisations comprising HIV Scotland, Terrence Higgins Trust Scotland, Waverley Care, and the National AIDS Trust, which have been working towards the provision of PrEP in Scotland, welcomed the news in a joint statement: “We applaud the SMC for taking this bold step to tackling HIV in Scotland. PrEP provides opportunities to reinvigorate how people at higher risk of HIV exposure engage with testing and prevention opportunities, and it is a vital opportunity to make a real reduction in the number of new HIV transmissions.”
Robert McKay, national director for Terrence Higgins Trust Scotland, separately said: “Today, Scotland has made history in the fight against the HIV epidemic, becoming the first country in the UK to routinely commission PrEP on the NHS.
"People at risk of HIV in Scotland will finally have access to this groundbreaking pill that will protect them from HIV."
He added: "It can now be used as a vital tool in our HIV-prevention armoury – alongside condom use, regular testing, and early treatment – to help bring an end to HIV transmission in Scotland. Not only will this make a life-changing difference to each of these individuals by protecting them from a lifelong and stigmatised condition, but for every person who would have become HIV-positive without PrEP, NHS Scotland will save £360,000 in lifetime treatment costs.
Deborah Gold, chief executive of the National AIDS Trust, said: “NAT are delighted at the announcement that PrEP will be made available throughout Scotland within a matter of weeks. This game-changing prevention tool has the potential to massively reduce HIV rates and turn Scotland into a model internationally of how to do HIV prevention well."
The SMC's decision also follows a high-profile legal battle between the National AIDS Trust and NHS England last year that led to the announcement of the drug being given to 10,000 people south of the border over three years in a large-scale trial.
Public Health England told BuzzFeed News that it would begin "this summer" – without specifying a date or month – but would likely be after the drugs are given to patients in Scotland.
Gold added: "We have to contrast the speed and decisiveness of the Scottish process with delays in the other three UK nations, and especially in England. Scotland’s example underlines the need for the English health system to follow suit as soon as possible. Thousands of HIV transmissions can and should be prevented by the prompt and effective roll-out of PrEP across the country.”
Her comments were echoed by McKay, from the Terrence Higgins Trust, who said: "We urgently need answers on when exactly the trial will begin and who will have access to it, and ultimately, assurance that the NHS will retain responsibility for PrEP in England when the trial comes to an end. We must not let PrEP become a postcode lottery – it should be available to all those at risk, regardless of where they live.”
During 2016, rates of HIV infections in England plummeted by around 30%, a drop attributed by epidemiologists to members of the public accessing cheaper, non-branded (called "generic") versions of the PrEP drug from abroad, through websites such as www.IWantPrEPNow.co.uk.
A decision regarding the NHS provision of PrEP in Wales is expected on April 26.