Wales is ‘leading the way’ with plan to make HIV prevention more accessible

Access to pre-exposure prophylaxis (PrEP) should be expanded to GP practices and community pharmacies across Wales, according to the Welsh government’s draft HIV action plan.

Published last week the plan includes 26 actions for the Welsh government and its partners to take forward in order to reduce HIV transmissions and improve the lives of people living with HIV in Wales.

HIV/AIDS charity the Terrence Higgins Trust has praised Wales for ‘once more leading the way’ and setting a standard for Scotland and England to follow.

PrEP is a medication which can be taken before being exposed to HIV which works to block HIV if it gets into the body.

Administered as a tablet, PrEP  drugs commonly used to treat HIV. Different PrEP delivery methods are being researched, including use of injections and implants and it is expected that PrEP vaginal rings will be available soon.

Among steps to improve testing, treatment and care, the HIV action plan includes recommendations that primary care and specialist sexual health services should work together to improve access and delivery of PrEP.

At present the prescription for PrEP is only available via sexual health clinics and this has been identified as a barrier to some people.

During the Covid lockdowns, use of the medication fell as clinics were restricted, but the usage has now increased significantly compared to pre-pandemic rates.

The plan aims to improve awareness and accessibility of the preventative drug by making it available through GPs and community pharmacies in all health board areas, with particular emphasis on delivery in rural areas and in underserved communities.

Indisputably crucial

Richard Angell, campaigns director at Terrence Higgins Trust, which partnered with the Welsh government on the plan, said that PrEP was an “indisputably crucial” piece of the puzzle towards ending new HIV cases by 2030.

He said: “It’s already making a significant impact in driving down new transmissions among gay and bisexual men but now must urgently be made available in a wider range of settings — including via community pharmacies and from GPs — to properly maximise its huge potential for protecting against HIV.”

“PrEP’s delivery via sexual health services works for many, but we know that a significant proportion of people won’t ever step foot in these services — including those living rurally and far away from any clinic.”

Angell said that Wales was “yet again” leading the way when it comes to PrEP.

“In England, there is still no progress on expanding PrEP access, despite the clock already ticking down and promising words in its own action plan around PrEP. “Scotland now also has the opportunity to follow Wales’s lead as part of the Scottish government’s upcoming HIV elimination plan.

“We’ll continue to push all UK governments to ensure PrEP is properly utilised and no one is left behind when it comes to ending HIV by 2030.”

Commenting on the plan in the Royal Pharmaceutical Journal, Cheryl Way, chair of the Royal Pharmaceutical Society (RPS) Welsh Pharmacy Board, said that results of the Welsh government’s three-year PrEPARED study showed no new diagnoses of HIV among more than 1,200 people taking PrEP in Wales, proving the medication was highly effective.

She said: “This is clear evidence that PrEP should be made as easily accessible as possible to those who need it.”

“Increasing access to the medicines has been a long-standing issue of concern for us at the RPS and, on World Aids Day [2021], we called on governments across Great Britain to widen access to PrEP by making it available through community pharmacies.

“We’re therefore delighted to see the proposals outlined by the Welsh government to develop a model which will enable PrEP to be provided by community pharmacies across Wales.”

Way added that community pharmacists and their teams were “trusted and accessible” healthcare professionals and would be a “great additional asset” in extending reach beyond the sexual health clinics already supplying PrEP.

The Welsh government’s draft HIV Action Plan is out for consultation until the week beginning 15 September 2022.