PrEP (HIV Pre-exposure Prophylaxis) is a pre-exposure medicine – prophylaxis means to prevent infection and can reduce the risk of contracting HIV when taken as instructed.
PrEP contains existing HIV treatment drugs tenofovir disoproxil and emtricitabine and was used in the PrEP Impact Trial that involved 157 sexual health services and more than 24,000 participants from October 2017 and July 2020. The trial confirms PrEP’s real-world effectiveness at preventing HIV acquisition and should be more widely used by eligible groups.
PrEP, which contains existing HIV treatment drugs tenofovir disoproxil and emtricitabine, works by stopping HIV from entering the body and making copies of itself. It can either be taken as a daily pill or an ‘event’ basis before sexual intercourse.
Preventing HIV transmission
John Saunders, deputy head of program delivery and service improvement for the STI and HIV division, from The UK Health Security Agency (UKHSA), said: “This trial has further demonstrated the effectiveness of PrEP in preventing HIV transmission and has, for the first time, shown the protective effect reported by earlier trials, but at scale and delivered through routine sexual health services in England.
“Now we know just how effective PrEP is in real-world settings, substantially reducing the chance of acquiring HIV. It’s vital that all those who can benefit from PrEP can access it. HIV testing and PrEP is available for free from sexual health services.”
While studies have previously been carried out on the effectiveness of PrEP within clinical settings, this is the largest real-world study involving trial participants at sexual health clinics, offering a chance to see just how effective the drug is when used in everyday life.
John Stewart, national director for specialised commissioning at NHS England and co-chair of the PrEP Impact Trial Oversight Board, said: “Not only did the trial directly prevent many cases of HIV, help normalise the use of PrEP, remove stigma and pave the way for a routinely commissioned clinically and cost-effective PrEP service; but it also made a very real contribution towards our goal of ending new cases of HIV by 2030.
“Everyone involved should be immensely proud of what they have achieved.”
The Lancet HIV
Findings from the study, led by UKHSA and Chelsea and Westminster Hospital NHS Foundation Trust and funded by NHS England via the National Institute of Health and Care Research (NIHR), have now been published in medical journal The Lancet HIV.
The study was critical in informing routine commissioning of HIV PrEP which has been in place since October 2020. Findings from the study, which has confirmed the effectiveness of England’s approach on PrEP, will now support the ongoing delivery of the government’s HIV Action Plan to help achieve the goal of zero HIV transmissions by 2030.
Roger Chinn, chief medical officer at Chelsea and Westminster NHS Foundation Trust, said: “As a leading centre for HIV care and research in England, we have seen first-hand how PrEP has significantly reduced the transmission of HIV in our own population – transforming the lives of so many.
“By sponsoring this latest trial, we are proud to be supporting increased access to PrEP with the shared aim of ending new HIV infections by 2030.”
Ending HIV transmission in England by 2030
Professor Kevin Fenton, the government’s chief advisor on HIV and chair of the HIV Action Plan Implementation Steering Group, said: “Advances in medicines in treating HIV have been life-changing for so many people – and PrEP has been central to that. It is a powerful tool that reduces the risk of acquiring HIV. Expanding access to, and the uptake of PrEP is key to our ambition to end HIV transmission in England by 2030, and a public health priority.
“Our National HIV Action Plan is clear on the key role of PrEP in preventing HIV transmission and there is ongoing work to develop a roadmap to guide our efforts to improve equitable access, uptake and use of PrEP to meet the needs of key populations at significant risk of HIV.”
He added that more than £3 billion has been provided to local authorities to fund public health services in England, including sexual health services. From 2020 this covers PrEP provision, making it available to anyone accessing sexual health services at risk of HIV.
“PrEP can help protect you – and is available for free from sexual health services” he added.
Shaping the delivery of HIV prevention
Ann Sullivan is chief investigator for the PrEP Impact Trial and consultant physician in infectious diseases and HIV at Chelsea and Westminster Hospital NHS Foundation Trust.
She added that the PrEP Impact Trial has further demonstrated the effectiveness of PrEP in preventing HIV transmission and has provided key insights, including identifying subgroups where more work is needed to increase access to PrEP and prevent HIV transmissions.
She said: “It is reassuring that this research has further confirmed the protective effect of PrEP reported by earlier trials when taken correctly and delivered through routine clinical services, which will continue to shape the delivery of HIV prevention across England.”
The PrEP Impact Trial involved 157 sexual health services. Eligible participants were aged 16 years or older and considered HIV-negative on the day of enrolment. The main outcomes assessed were PrEP need, uptake, and use, and HIV and sexually transmitted infection (STI) incidence.
An HIV test is free and provides access to PrEP if needed. No matter your gender or sexual orientation, getting regularly tested, using condoms and PrEP (if you’re eligible), are essential to protect your and your partner’s health.