UK Court rules PrEP funding within NHS England's legal jurisdiction

Earlier this week, the High Court of Justice ruled that it is within the jurisdiction of England’s National Health Service to commission pre-exposure prophylaxis for HIV prevention, a role which the health care provider contended is legally the responsibility of local government.

On advice of Queen’s Counsel, NHS England has appealed the court’s decision and its interpretation of the National Health Service Act 2006, according to a release from the department. In the meantime, however, NHS England will continue to support pilot programs examining the cost efficiency of PrEP rollout.

“Of course, this does not imply that PrEP — at what could be a cost of £10-20 million a year — would actually succeed as a candidate for funding when ranked against other interventions,” Jonathan Fielden, MBChB, director of specialized commissioning and deputy national medical director of NHS England, said in the release.

HIV advocacy organizations and public health experts have criticized NHS England’s decision not to publicly support PrEP. In an editorial published in The BMJ last month, Jim McManus, AFBPsS, FFPH, CSci, CPPsychol, director of public health for the Hertfordshire County Council, United Kingdom, and Dominic Harrison, Dip H Ed, MPH, FFPH, director of public health for Blackburn with Darwen Borough Council, U.K., called the department’s pilot testing programs a “delaying tactic,” and argued that local health authorities lacked the proper funding to commission the preventive treatment themselves.

“Despite overwhelming evidence that [PrEP] against HIV infection is largely safe, effective and cost-effective, NHS England has declined to make it available on the NHS, arguing that HIV prevention is the responsibility of local government,” they wrote. “Such an approach confounds its advocacy of a health and care system integrated around the best outcomes for the citizen and perpetuates an incoherent national approach to HIV prevention.”

The High Court’s recent decision was applauded by the National AIDS Trust, whose calls for public funding and rollout echoed those of McManus and Harrison.

“Over 4,000 people are getting HIV every year in the UK — we desperately need further prevention options to add to condom use,” Deborah Gold, MA, chief executive of the National AIDS Trust, said in a press release following the ruling.

“PrEP works. It saves money and it will make an enormous difference to the lives of men and women across the country who are at risk of acquiring HIV. The delay to commissioning PrEP is both unethical and expensive.” – by Dave Muoio

Reference:

National AIDS Trust v. NHS England, CO/2979/2016. https://www.judiciary.gov.uk/wp-content/uploads/2016/08/nat-v-nhs-judgment.pdf. Accessed: Aug. 5, 2016.

McManus J, et al. BMJ. 2016;doi:10.1136/bmj.i3515.

Disclosure: Gold reports that her organization receives funding from Gilead Sciences. Harrison and McManus are responsible for local authority sexual health budgets, and McManus is a board member of the Association of Directors of Public Health as well as a trustee of Catholics for AIDS Prevention and Support. Infectious Disease News was unable to confirm Fielden’s disclosures at the time of publication.