NHS to fund PrEP for 10,000 people

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I’ve been inundated with lovely, supportive messages and congratulations all night and all morning.

There are a lot of questions about this PrEP implementation study that people quite rightly would like answers to.

The leading question at the moment is “Why do we need another trial?”

It’s a very valid and justified question and indeed echos what I have been screaming most of this year. This study will investigate how we put PrEP to use in a real life setting as a national public health intervention. Previous studies like PROUD and IPERGAY helped us understand that PrEP works really well, if taken as instructed.

This trial is about how we roll PrEP out.

My initial reaction was: It’s a start.

It’s not ideal but it’s a start.

I welcomed the announcement but I feel the need to publicly ask more questions because ultimately it means that we still have no proper PrEP commission for 3 years and the rest of the world is looking to us so we need to keep them and their agendas in the equation too.

I want to see something built into this that really tackles and addresses inequalities and recruits those that really need PrEP but aren’t able to afford it or don’t know about it.

What inevitably will happen is a mass migration of PROUD study participants and those users currently self-sourcing or utilising PEP as PrEP to populate this allocation. I’m committed to not further perpetuating the health and HIV prevention inequalities of other at risk groups outside of London and urban MSM (men who have sex with men).

I want a dedicated focus on BAME (black and minority ethnic groups) and trans* people.

I also want a clearly laid out and confirmed willingness from NHS England and Public Health England to proactively review this trial after 12 months with a view to finding budget for an additional contingency of a further 5000 (or more) participants. What I don’t want is to find ourselves 18 months in and at our capacity and then having to get into the whole wrangle, negotiating, feet dragging and complacency yet again. That would really stall the momentum that we will have gathered.

I think 10,000 participants is better than what was originally offered in the spring but we can always do more. Australia have expanded their PrEP trials. This can be done.

As a result of this provision we are going to see the number of new HIV diagnoses drop, of that there is no doubt. What I don’t want to happen at that point is for the focus to then shift to those achievements and ‘laurel resting’ to begin. Instead it should be an incentive and motivation to do more.

This announcement feels like a change in gear. It feels like an investment in actually trying to end new HIV infections in the UK instead of what we have previously seen from our health care system which has been lack lustre firefighting and band aid prevention.

I want NHS England to commit to a full commission by the end of this trail now so that we don’t have a repeat of what we saw with PROUD and their participants being exited from a study with no further access to PrEP. This needs to be in place and functioning long before the end of this trial so we have a seamless crossover for participants.

Those are my initial thoughts. I am meeting with our steering group and the larger United4PrEP coalition group this week and we will have plenty to discuss. I will update you all with more information when it is available.

iwantPrEPnow and PrEPster are fully committed to working with NHS England and Public Health England to make the best of this opportunity and we hope to be closely involved with the planning and workings of this trial.

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Click here for NHS England statement

Twitter: @Greg0wen

 

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It’s cheaper to stay HIV neg. HIV+ is expensive

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I’m writing out of pure frustration today. The more involved I become in the HIV/PrEP arena the more it seems that the solutions we are desperately searching for are already here! We just aren’t joining up the dots.

I’m going to kick off trying to defuse my frustrations by starting with PrEP. Particularly in light of last Friday’s News headlines.

The Guardian, Fri 9th October 2015

“NHS hospitals’ £930m overspend prompts calls for urgent funding”

“Fears grow that hospitals will run out of money and care standards will deteriorate unless chancellor injects more cash”

BBC News, Fri 9th October 2015

“NHS deficits hit ‘massive’ £930m”

“NHS trusts in England have racked up a £930m deficit in the first three months of the financial year – that is more than the entire overspend last year.”

“Regulators said the problems were the “worst for a generation” and demanded immediate action be taken.”

So the NHS have over spent! Big surprise… Well wake the fuck up people! If you haven’t been given enough funds to start with – and you only spend what you need to – YOU WILL TECHNICALLY OVERSPEND! I’m not exactly sure why this was worthy of such sensationalist headline attention on Friday. Although £930m is a substantial figure – we need to put it into context. They overspent by £930m in the first quarter. So if we multiply that by 4 to get a projection of what their total overspend for the year would be (at current performance) that would be an annual deficit of £3.72 billion. The NHS has a total annual budget of £95.6 billion. So that equates to an overspend of 3.6%. In any budget I have ever compiled in my previous career in accounts for staffing and marketing – we always had a contingency of 5%-10% of the overall budget to allow for the unknown or to cover things that might go wrong. However…

 “The NHS are projected to overspend on their annual budget by 3.6 percent” – isn’t such a punchy headline.

Semantics aside. £930m is still a lot of money. It’s clear that the NHS needs to save money. And this is where I keep getting frustrated. Especially in regards to HIV treatment and PrEP HIV prevention. Time for some more figures (please stick with me on this)

Every single day, here in the UK, 10 ‘men who have sex with men’ – that’s gay or bi men (cis or trans) catch HIV.

10 gay/bi guys a day get HIV.

Let that figure settle in for a moment.

HIV treatment for a positive guy (drugs + health care ie seeing Nurses and Consultants + any counselling that might be needed) costs approx. £20,000 per person, per year

So if we say 10 guys per day get HIV…there are 365 days per year…

10 x 365 = 3650 guys per year

3650 guys x £20,000 = £73,000,000 (per year)

So with our little series of calculations we can all agree that new HIV cases will cost the NHS £73m per year.

With that £73m figure in mind. Let’s work out the cost of giving 3650 guys PrEP for a year.

I’m using the price from Dean Street’s PrEP clinic website…

1 month of PrEP costs £400

 So 1 year’s PrEP costs 12 months x £400 = £4,800 per person

3,650 guys x £4,800 = £17,520,000 (per year) to keep these guys negative. Negative guys generally won’t need to be in clinics regularly or require on going health care and support for HIV – if they haven’t got it.

Now we can work out how much the NHS would SAVE if none of these 3,650 guys ever got HIV because they were all on (free NHS supplied) PrEP

£73m – £17.5m = £55.5m

STOP THE FUCKING PRESS!

We could actually (in theory) save the NHS £55.5 million per year just by getting our mates on PrEP and keeping them HIV NEGATIVE…..

Doesn’t take a genius to work it out…..

MAKE PrEP AVAILABLE FOR FREE NOW….

JOIN THE FUCKING DOTS…….

Continue reading “It’s cheaper to stay HIV neg. HIV+ is expensive”