Tag Archives: NHS England

The NHS consultation for #PrEP ENDS TOMORROW! Make sure your voice is heard!

Prep Infographic

The NHS public consultation on a proposed clinical consultation commissioning policy on Pre-Exposure Prophylaxis (PrEP) for HIV ends tomorrow (Friday, 23rd September)

This consultation is necessary in order to make PrEP available to people who are at risk of becoming HIV positive.  Multiple studies around the world have shown PrEP to be highly effective in reducing the risk of contracting HIV. The results of the PrOUD trial in England, released in 2015, prove that PrEP works and that concerns about it not working in a real world setting, were unfounded. Read more about the trial here: http://www.proud.mrc.ac.uk/

PrEP has been approved by the World Health Organisation and it’s already available for those deemed at risk of HIV in the United States, Canada, France and Israel.  PrEP can reduce people’s chances of contracting HIV the virus if taken daily.

If you would like more information on both PrEP trials (PROUD and IPERGAY) visit Poz.com for a more detailed look (https://prodlb.poz.com/article/PrEP-CROI-26978-7841)

There are arguments for and against providing PrEP for free on the NHS.  That it could encourage risky sexual behaviour but it’s not always about risky behaviour. You, and you alone are responsible for your own sexual health.  If your sexual partner(s) dislike using condoms, you can stay protected by taking PrEP.  This is about taking ownership of your sexual health.  PrEP is another tool to sexual health which will reduce HIV nationally and help save the NHS vital money it needs for other services.

The following gives a breakdown and suggests the NHS could actually save money on HIV treatments if they were to adopt PrEP.

  • PrEP cost per year: (Media figure) £10m -£20m. Assume higher figure of £20m per year.
  • New HIV diagnoses in the UK per year: Approx 4000 people.
  • Cost over average lifespan estimated at £365,000 for treatment. (Assume average lifespan of 36 years for ease of calculation as some people are diagnosed in their teens, some in the mid 60’s) making an assumed cost of treatment per person per year at approximately £10,000.
  • New HIV diagnoses: Extra cost, year on year of £40m
  • Assume PrEP rolled out on 1st January 2017 and 50% is effective (i.e. that it reduces new HIV diagnoses in the UK by half. Likely to be more effective than this but let’s play out a worst case scenario).
  • In 2017, 2000 new cases of HIV are prevented saving £20m. This is a year on year saving.  PrEP however in an unchanging cost.  In 2018, 2000 new cases of HIV are prevented, saving £20m and the cost of treating the prevented 2017 cases in 2018 is also saved making a total of £40m saved this year.
  • It’s easy to see how this goes, although likely to be an upper limit to savings year on year after a few years, it won’t keep going up indefinitely.
  • PrEP does not merely pay for itself after one year but actively makes savings to the NHS budget in expensive HIV treatments, allowing other drugs to be funded.
  • This calculation assumes worst case figures here, the actual savings are likely to be higher.
  • In 2018 Gilead’s patent on Truvada (the PrEP treatment) may run out. If and when it does, further savings can be made.

Above breakdown via @THTorguk

We have been responding to the challenges of HIV for 30 years.  HIV will not go away unless we invest in, and try out proven methods to reduce the risk of HIV infection.  PrEP has been proven to work and we urge you, as someone who wants to see the end of HIV to respond to the consultation and get your voice heard.  If we work together, we could eradicate HIV in our lifetimes.

The NHS consultation is open until Friday, 23 September.  Many people have felt powerless in the fight to make PrEP available on the NHS, and now you have the power to make it so.

Visit the follow link for further detailed information and to participate in the survey.

https://www.engage.england.nhs.uk/consultation/specialised-services

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The NHS consultation for #PrEP is live now! Make sure your voice is heard.

Prep Infographic

The NHS have launched their 45 day public consultation on a proposed clinical consultation commissioning policy on Pre-Exposure Prophylaxis (PrEP) for HIV.

This consultation is necessary in order to make PrEP available to people who are at risk of becoming HIV positive.  Multiple studies around the world have shown PrEP to be highly effective in reducing the risk of contracting HIV. The results of the PrOUD trial in England, released in 2015, prove that PrEP works and that concerns about it not working in a real world setting, were unfounded. Read more about the trial here: http://www.proud.mrc.ac.uk/

PrEP has been approved by the World Health Organisation and it’s already available for those deemed at risk of HIV in the United States, Canada, France and Israel.  PrEP can reduce people’s chances of contracting HIV the virus if taken daily.

If you would like more information on both PrEP trials (PROUD and IPERGAY) visit Poz.com for a more detailed look (https://prodlb.poz.com/article/PrEP-CROI-26978-7841)

There are arguments for and against providing PrEP for free on the NHS.  That it could encourage risky sexual behaviour but it’s not always about risky behaviour. You, and you alone are responsible for your own sexual health.  If your sexual partner(s) dislike using condoms, you can stay protected by taking PrEP.  This is about taking ownership of your sexual health.  PrEP is another tool to sexual health which will reduce HIV nationally and help save the NHS vital money it needs for other services.

The following gives a breakdown and suggests the NHS could actually save money on HIV treatments if they were to adopt PrEP.

  • PrEP cost per year: (Media figure) £10m -£20m. Assume higher figure of £20m per year.
  • New HIV diagnoses in the UK per year: Approx 4000 people.
  • Cost over average lifespan estimated at £365,000 for treatment. (Assume average lifespan of 36 years for ease of calculation as some people are diagnosed in their teens, some in the mid 60’s) making an assumed cost of treatment per person per year at approximately £10,000.
  • New HIV diagnoses: Extra cost, year on year of £40m
  • Assume PrEP rolled out on 1st January 2017 and 50% is effective (i.e. that it reduces new HIV diagnoses in the UK by half. Likely to be more effective than this but let’s play out a worst case scenario).
  • In 2017, 2000 new cases of HIV are prevented saving £20m. This is a year on year saving.  PrEP however in an unchanging cost.  In 2018, 2000 new cases of HIV are prevented, saving £20m and the cost of treating the prevented 2017 cases in 2018 is also saved making a total of £40m saved this year.
  • It’s easy to see how this goes, although likely to be an upper limit to savings year on year after a few years, it won’t keep going up indefinitely.
  • PrEP does not merely pay for itself after one year but actively makes savings to the NHS budget in expensive HIV treatments, allowing other drugs to be funded.
  • This calculation assumes worst case figures here, the actual savings are likely to be higher.
  • In 2018 Gilead’s patent on Truvada (the PrEP treatment) may run out. If and when it does, further savings can be made.

Above breakdown via @THTorguk

We have been responding to the challenges of HIV for 30 years.  HIV will not go away unless we invest in, and try out proven methods to reduce the risk of HIV infection.  PrEP has been proven to work and we urge you, as someone who wants to see the end of HIV to respond to the consultation and get your voice heard.  If we work together, we could eradicate HIV in our lifetimes.

The NHS consultation is open until Tuesday 23 September.  Many people have felt powerless in the fight to make PrEP available on the NHS, and now you have the power to make it so.

Visit the follow link for further detailed information and to participate in the survey.

https://www.engage.england.nhs.uk/consultation/specialised-services

Thanks for reading, let us know what you think in the comments below, or you can find us on FacebookTwitter or Instagram!

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NHS watchdog to weigh cost of HIV prevention drug Prep

PrEPHead

The NHS watchdog NICE has been asked by government to look at the cost of providing an HIV prevention treatment known as PrEP.

Story via BBC
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It comes as campaigners have said they will seek a judicial review of NHS England’s decision not to commission the treatment.

Prep is a daily pill that cut the risk of HIV infection by more than 90%.

Head of NHS England Simon Stevens says more evidence is needed about the cost versus benefits.

Speaking to the Health Committee he said: “Prep has great potential and all of us would like to see it more widely available in this country.”

He said the legal issue about who should provide the treatment – NHS England or local authorities which are responsible for prevention-related services – would be resolved, but the other question was whether it was cost-effective to roll it out as a preventive treatment.

“This particular drug is not yet licensed for prophylactic treatment for HIV.

“Frankly, the prices that the manufacturer is seeking to charge probably also need to take a substantial haircut to represent value.”

It’s not publicly known how much the manufacturer of a Prep drug called Truvada is asking for, and drug companies often reach an agreement to offer the NHS a reduced price. The book cost for 30 tablets is £355.

As part of a trial, NHS England has promised £2m in funding to treat about 500 people with Prep over the next two years.

The number of people living with HIV in the UK continues to increase and the number living with undiagnosed HIV remains high.

In 2014, an estimated 103,700 people were living with HIV. An estimated 18,000 (17%) were unaware of their infection.

Condoms can prevent the spread of HIV but they are not 100% reliable and, of course, they must be used to work.

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NHS England reconsiders decision over HIV PrEP drug

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The HIV virus. Pre-Exposure Prophylaxis is a new way of using antiretroviral drugs that has been proven to stop HIV transmission in almost every case Photograph: GeoStock/Getty Images

NHS bosses in England will reconsider whether it is their responsibility to fund a new treatment that can prevent the spread of HIV.

Pre-Exposure Prophylaxis (PrEP) is a new way of using antiretroviral drugs that has been proven to stop HIV transmission in almost every case.

Story via
guardianlogo

Last month NHS England said HIV prevention responsibilities lay with local councils as it announced it would no longer consider whether to offer the treatment, the National Aids Trust (NAT) said.

There was public outcry when NHS England said it was not their decision to make and the NAT threatened the health body with legal action.

However, NHS England said on Tuesday that its specialised commissioning committee will consider whether to put PrEP back into the NHS decision-making process.

“NHS England had previously told us that it was impossible for them to reconsider their decision. Faced with legal action, they have now changed their mind. We trust that NHS England, when it re-evaluates its position, will come back with a resounding yes.

“PrEP is one of the most exciting prevention options to emerge since the HIV epidemic began and offers the prospect of real success in combating this virus. To deny the proper process to decide whether to commission PrEP, when 17 people are being diagnosed with HIV every day, is not only morally wrong but legally wrong also.”

An NHS England spokesman said: “Final decisions on PrEP have not yet been taken, and we have agreed to consider representations from some stakeholders before deciding on next steps on the appropriate way forward.”

Local Government Association community wellbeing spokeswoman, Izzi Seccombe, said it was pleased and encouraged by the NHS England’s decision.

“Councils are keen to work with NHS England and the Department of Health to find a solution which can enable this ground-breaking prevention method to be delivered throughout our communities,” she said.

“Councils have invested millions in providing sexual health services since taking over responsibility for public health three years ago, and this treatment could help reduce levels of HIV in the community. However, our position has always been that responsibility for funding PrEP should lie within the NHS rather than councils.

“We look forward to working with NHS England to find an agreeable way forward that will resolve this issue.”

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NHS England funds Janssen’s HIV pill: Rezolsta

Rezolsta

NHS England will release crucial funding for HIV therapy Rezolsta, its once-daily, fixed-dose combination of darunavir and the ‘pharmacoenhancer’ cobicistat.

The drug is indicated for use in combination with other antiretroviral medications for treating adults with human immunodeficiency virus-1 (HIV-1) whose virus does not carry darunavir resistance-associated mutations.

This decision means that, across England, clinicians will be able to routinely prescribe darunavir – the UK’s most prescribed protease inhibitor – combined with a ‘booster’ in a single pill to adults living with HIV-1.

“By funding treatment, NHS England is making available a treatment option for individuals who require darunavir to effectively control the HIV, but who would potentially also benefit from the convenience of fewer tablets to support their adherence to treatment,” noted Rozlyn Bekker, medical director of Janssen UK.

Less than two out of three HIV patients in the UK currently reporting 100 percent adherence after eight months of treatment, and experts believe that the fixed-dose combination of darunavir/cobicistat could help improve adherence by reducing the number of pills that a patient needs to take, the firm noted. “This is important given that optimal adherence is generally considered to be above 95 percent, the level required to prevent HIV becoming resistant to medication”, it said.

Clinical data show that once-daily darunavir/cobicistat, in combination with two nucleotide/nucleoside reverse transcriptase inhibitors, offers effective virological suppression, with virologic response rates over 48 weeks of 81 percent overall and 83 percent in treatment-naïve patients, the firm noted.

Also, just 5 percent of patients discontinued treatment due to adverse events, the most common of which were diarrhoea (27 percent) and nausea (23 percent), which were grade one or two in severity.
 

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New app to deliver HIV prevention meds without a doctor’s visit

NURX co-founders Hans Gangeskar, lower left, and A. Edvard Engesaeth work at their San Francisco, Calif., startup Tuesday morning, Jan. 26 , 2016. The company offers on-demand birth control delivery. (Karl Mondon/Bay Area News Group)

NURX co-founders Hans Gangeskar, lower left, and A. Edvard Engesaeth work at their San Francisco, Calif., startup Tuesday morning, Jan. 26 , 2016. The company offers on-demand birth control delivery. (Karl Mondon/Bay Area News Group)

It would have been unthinkable three decades ago, when San Francisco was in the grip of the AIDS epidemic and the city’s gay community was living in terror of the mysterious, deadly virus. But now, preventing HIV may be as simple as pushing a few buttons on a smartphone.

Well, it could be in this country but our NHS have just announced it has pulled the plug on its decision-making process on whether to offer PrEP on the NHS. This is a real shock and you can read NHS England’s press release here.  (You may also want to read the National AIDS Trust’s Director of Strategy’s blog on PrEP, What went wrong and what should happen now).

Anyway, back to the story retrieved from the San Jose Mercury News.
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That’s the goal of San Francisco startup Nurx. On Tuesday the company rolled out an online service that allows people to order a three-month supply of PrEP delivered to their door within 24 hours — no visit to a doctor’s office required.

Dr. Bradley Hare, director of HIV Care and Prevention at Kaiser Permanente San Francisco, said such a delivery service could increase patient access to the important medication.

“I think no one would try to argue in San Francisco that we’ve been able to get everyone on PrEP who should be on PrEP,” he said.

Taken daily, pre-exposure prophylaxis or PrEP, medication can reduce a patient’s chance of contracting HIV by more than 90 percent. PrEP use already is so common among gay men in San Francisco that some list it on their online dating profiles, but Nurx’s founders say many people who should be on the regimen still face obstacles when trying to get a prescription. Some primary care doctors don’t know about PrEP or view it with suspicion, said Nurx co-founder and CEO Hans Gangeskar, and local clinics that offer the regimen are overcrowded.

“The current health care system has failed to get PrEP to the people who need it,” Gangeskar said.

Nurx has been offering on-demand delivery of birth control pills in California since mid-December, and recently expanded to New York. The company also delivers emergency contraception.

Supporters say by eliminating time-consuming and potentially embarrassing face-to-face doctors visits for PrEP, Nurx may prompt more at-risk people to protect themselves from HIV. And as the rate of HIV diagnoses continues on a downward trend in San Francisco, Nurx could help bring the city one step closer to stopping new cases. But the service also raises the question of whether doctors can adequately treat patients they don’t see.

“It’s not a replacement for a visit,” said Dr. Wanda Filer, president of the American Academy of Family Physicians, and a practicing physician in Pennsylvania. Filer supports getting patients access to PrEP as soon as possible, but says a prescription should be followed up with an in-person doctor visit — which is not a requirement of Nurx.

“It’s important that they have someone that they feel they have a medical relationship with,” Filer said. She added an in-person visit lets the patient ask questions, and allows the doctor to provide information about vaccines, safe sex and healthy relationships.

PrEP also can have serious side effects, including kidney failure, and doctors recommend regularly monitoring users’ kidney function and testing for HIV and other STDs.

Nurx was founded by Gangeskar and A. Edvard Engesaeth, former high school classmates from Oslo, Norway. Gangeskar has a legal background and used to practice intellectual property law in Washington, D.C. Engesaeth trained as a doctor in Norway. The team secured $120,000 in seed funding from Mountain View incubator Y Combinator in November and also has some angel investors, Gangeskar said, but declined to disclose the total sum the company has raised.

To order PrEP, a user will log on to the app, answer a handful of questions about his or her sexual history and health, and visit a lab or community clinic for blood work to test for HIV, hepatitis and kidney problems. That information will be transmitted to a doctor, who may issue a prescription after evaluating the individual’s health history. A Postmates courier or UberRush driver then steps in to deliver the pills to the patient’s door.

For now, same-day service is available in San Francisco and the Peninsula, Gangeskar said, and only if users get their blood tests completed early in the day. In other parts of California, the pills will ship via the U.S. Postal Service. Nurx is hoping to further simplify the process by using mail-in blood test kits, or dispatching technicians to take blood samples at people’s homes.

The doctor also has the option to contact patients via phone, video call or secure text message to ask additional questions and provide counseling.

Nurx usually charges about $15 for same-day delivery, Gangeskar said, but the cost depends on the distance traveled. Birth control and emergency contraception are free under the Affordable Care Act, and PrEP generally is covered by insurance.

Truvada, the drug that makes up the PrEP regimen, was approved by the U.S. Food and Drug Administration in 2012. In September, Kaiser Permanente reported it found no new HIV infections among 657 San Francisco PrEP patients treated over two and a half years.

Steve Gibson, director of sexual health services for the San Francisco AIDS Foundation, said it’s not always easy to get a prescription.

“It was shocking to me to have people walk into the clinic here in the Castro and say, ‘my doctor in San Francisco didn’t know about it,’ ” Gibson said. “Or ‘my doctor in San Francisco said no because my boyfriend’s HIV negative. Or my doctor said no because he thinks I’m going to stop using condoms.’ ”

So patients flock to Strut, the foundation’s sexual health clinic for gay, bisexual and transgender men. They come from the South and East Bay, as well as from all corners of San Francisco. It’s not unusual to see 20 or 30 people waiting outside before the clinic opens, Gibson said, and there’s a monthlong wait to book a PrEP appointment.

But not everyone wants front-door delivery.

PrEP user Phillip Babcock, a 50-year-old Castro resident, said he doesn’t feel the need to disrupt his prescription refill experience.

“I’m not part of the new economy as much,” he said, “so I’m not used to having everything delivered to my house.”

 

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Hepatitis C drug delayed by NHS due to high cost

One in three people infected with hepatitis C will develop liver cirrhosis and some will get cancer. Photograph: Bsip/UIG via Getty Images

One in three people infected with hepatitis C will develop liver cirrhosis and some will get cancer. Photograph: Bsip/UIG via Getty Images

The NHS is to delay the introduction of a highly expensive drug that can save the lives of people infected with the hepatitis C virus. The move by NHS England is unprecedented, because the NHS rationing body, Nice (the National Institute for Health and Care Excellence) has approved the drug. Nice says sofosbuvir is cost-effective, because it is a cure for people who would otherwise run up huge NHS bills.

One in three people infected with hepatitis C will develop liver cirrhosis and some will get cancer. A liver transplant costs more than £50,000.

But NHS England appears to be balking at the bill for the drug, which would hit £1bn for every 20,000 people treated. Approximately 160,000 people in England alone are infected with hepatitis C, although fewer than half are aware of it.

Sofosbuvir has been hailed internationally as a breakthrough, but there is global concern over the very high cost of a drug that can save lives. Campaigners are pressing for lower prices, from the US – where it costs $1,000 a pill – to India, in a fight which they liken to that over drugs against another virus: HIV, which causes Aids. On Wednesday, they celebrated a decision by the Indian authorities not to allow a patent application for sofosbuvir by Gilead, the manufacturer, which means Indian companies may be able to make cheap copies for the developing world.

The price offered by Gilead in the UK is almost £35,000 for a 12-week course. Many patients will need a 24-week course, costing £70,000. In its final draft guidance on sofosbuvir, Nice said it was allowing NHS England to postpone implementation for four months, until the end of July instead the beginning of April. NHS England failed to comment.

Charles Gore, chief executive of the Hepatitis C Trust, said he was very concerned about the delay. Nice had allowed NHS England to make a decision based on affordability rather than cost-effectiveness. “It feels to me as if a whole new criterion has been invented by the backdoor,” he said. If the NHS could delay using a new drug by four months, it could also delay by six months or a year – or it could decide on the basis of its cash-strapped budget to use it one year but not the next.

“It is undoubtedly a high cost,” said Gore. “The unfortunate thing is there are an awful lot of people who need it. We’re talking about potentially hundreds of thousands of people. That becomes a massive budget-buster.”

NHS England has introduced a scheme to pay for the treatment of people who are very ill – many of them on liver transplant waiting lists. In April, it announced an £18.7m fund to pay for 500 patients with acute liver failure.

But Mark Thursz, professor of hepatology at Imperial College London and chair of the Hepatitis C Coalition, said there were others who needed treatment as soon as possible. “The delay is unprecedented,” he said. “What worries me about it is that if you have got advanced liver disease with hepatitis C, you could progress at any stage to the point where it is very difficult or impossible to reverse the situation or have any improvement. Opportunities are being missed by any delay.”

About 10,000 to 15,000 of people with hepatitis C infection in the UK have cirrhosis, he said. Around 5,000 have advanced disease and need treatment soon if they are not to suffer long-term damage.

Hepatitis C is spread by contact with infected blood. Some people live with it unknowingly for years having injected drugs in their youth, while some got it from blood transplants before screening for the virus was introduced. It is also thought to be spread by sharing razors or toothbrushes with those infected.

There are older drugs but the treatment lasts up to four years and has serious side-effects, including depression. Sofosbuvir is a once-daily pill, taken with one or two other drugs for 12 or 24 weeks

Stelios Karagiannoglou, Gilead’s general manager, UK and Ireland, said the company was pleased with the Nice decision. But he added: “We are disappointed that the majority of patients will not gain access to this important medicine until later this year.” He called on NHS England to commit to a scheme from April offering early treatment for people with cirrhosis.

Story via The Guardian

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