Report of the Director of Population Health and Wellbeing

In January of this year NHS England announced plans to expand the Pre-Exposure Prophylaxis (PrEP) Impact Trial to 26,000 participants by 2020. This represents a doubling of the current number of people on the trial nationally. This report summarises the implications of the national trial expansion for Manchester.

The Committee considered the report of the Director of Population Health and Wellbeing that provided information on the implications for Manchester following the announcement by NHS England in January 2019 of the plans to expand the Pre-Exposure Prophylaxis (PrEP) Impact Trial to 26,000 participants by 2020. This represented a doubling of the current number of people on the trial nationally.

Dr Chris Ward, Consultant Physician Genitourinary Medicine, The Northern

Integrated Contraception, Sexual Health & HIV Service referred to the main points of the report which were: -

·                Providing a description of PrEP as a way for people who did not have HIV, but who were at substantial risk of HIV infection to reduce their risk of acquiring HIV;

·                Information on the eligibility criteria for the PrEP Impact Trial;

·                Information on the treatment pathway for trial participants;

·                Data on the current trials across Greater Manchester clinics, noting that this was overseen by the PrEP Programme Oversight Board that was jointly chaired by Public Health England (PHE) and NHS England;

·                At their meeting of 15 January 2019 the PrEP Oversight Board had supported in principle the recommendation to double the number of trial places so that it could address emerging questions from the trial and more robustly inform the design and rollout of a full national programme;

·                Noting that the Board had asked that a rapid engagement exercise with local authority commissioners and research sites be undertaken to assess their capacity to accept additional places; and

·                Information on the Manchester response to this announcement to expand the trial and a description of the next steps, including the consideration to be given to improving access and pre booking appointments.

Members of the Committee noted that whilst they fully supported the extension of the trial, even with a doubling of the size the demand and waiting lists remained significantly high. A Member further commented that in reality the number of people who would benefit from PrEP would be higher still. The Committee were unanimous in calling for the national roll out of PrEP, appropriately funded by the NHS.  

Dr Ward responded to comments from the Committee by stating that it was recognised that many people were registered on more than one waiting list to be accepted onto the trial. He said that to address this, work was ongoing to establish one waiting list across Greater Manchester that could be centrally administrated to remove any duplication. He said that whilst people remained on the waiting list they were encouraged to purchase PrEP online, noting that regrettably there were cases where people had contracted HIV whilst on the waiting list. He said that for those people who could not afford to purchase PrEP at approximately £19 per week, applications could be submitted to the Terrence Higgins Trust hardship fund, and if successful the individual would be provided with a code that they could use to purchase PrEP online.  Dr Ward further stated that consultants would support those smaller clinics to deliver any extended programme.

In response to a question from a Member regarding follow up appointments, Dr Ward informed the Committee that nobody was compelled to attend appointments, however national guidance recommended 3 monthly follow up appointments. He said part of the study was also to understand people’s patterns of behaviour when taking PrEP, noting that people’s attitude and understanding of risk changed depending on their relationship status.

Members noted that the number of trial places for people not in the category of ‘Men who have sex with men’ (MSM) were not recruited to in the majority of trial locations. Dr Ward commented that these places could not be reallocated to MSM patients, however work was ongoing with a range of partners to reach out to other groups identified as being of a high risk of contracting HIV, commenting that if a person came forward that met the criteria they could be allocated a place on the trial immediately as there were currently no waiting lists for this cohort. He further advised that MSM in central Manchester were aware of PrEP, however this was not always the case in other areas of Greater Manchester and work was ongoing to train health professionals on the subject of PrEP so they could raise awareness of this with patients identified as being at risk.

The Director of Population Health and Wellbeing stated that Sexual Health services were underfunded nationally and the contingency fund of £25k identified to support the additional trial clinics would invariably have an impact on the delivery of other services. He said that lobbying was ongoing to secure additional funding from NHS England. Members commented that the funding arrangements were grossly unfair, unsustainable and ultimately put peoples’ lives at risk and made reference to the motion adopted by Council at their meeting of 30 January 2019.

The Executive Member for Adult Health and Wellbeing commented that lobbying of central government for adequate funding was also ongoing at a Greater Manchester level, commenting that the decision not to fund this service could be seen as an ideological decision by the government.

Decision

The Committee notes the report.