This blog was originally written for BMJ Clinical Evidence and posted on blogs.bmj.com/ce/
Last week saw a landmark shift in the pre-exposure prophylaxis (PrEP) for HIV debate in England. After 18 months of work with key stakeholders-including clinicians, commissioners, and community advocates-NHS England announced that it was no longer able to fund a significant PrEP rollout; the outcome the Clinical Reference Group (CRG) thought that they had been working towards. The rationale given for this late stage decision is that NHS England does not commission HIV prevention. NHS England will be making up to £2m available over the next two years to run a number of early implementer test sites, which local authorities will have to bid to become.
Truvada for use as PrEP was licensed for use in the United States in July 2012. There is evidence from San Francisco that a combination HIV prevention approach, with PrEP treatment as prevention plus condoms and behavioural intervention, is having an impact upon HIV incidence.