Technology IconTechnology: HIV Pre-Exposure Prophylaxis (PrEP)

OBJECTIVES

To maximise access to evidence-based biomedical HIV prevention in Australia.


CURRENT ISSUES

  • Nationally, HIV infection rates have remained static over the past decade. In 2015 there were 1,025 HIV notifications, with gay and other men who have sex with men accounting for 68% of these diagnoses. This figure is consistent with the trend over the past decade;
  • Behavioural data shows that consistent condom use is a mainstay of HIV prevention for a significant majority of gay men, but that there has been a rise in the proportion reporting unprotected sex over the past decade;
  • This points to the need to diversify the means of prevention;
  • Pre-exposure Prophylaxis (PrEP) is an evidence-based prevention tool that has the potential to break the cycle of HIV transmission among gay men in Australia. Evidence from the PROUD study, published in the Lancet, shows that for every thirteen people on PrEP, an HIV diagnosis is averted;
  • In April 2017, Australian Health Ministers recognised PrEP as a crucial component for achieving Australia’s goal of virtually eliminating HIV by 2020;
  • There is a substantial unmet need for PrEP, with modelling indicating that more than 31,000 men who have sex with men at high risk of HIV acquisition would be eligible for PrEP in Australia;
  • Enhancing access to PrEP is essential if we are to achieve the HIV prevention goals of the National HIV Strategy. This will require making PrEP accessible and affordable for those at high risk of HIV, including enabling prescribing by all General Practitioners (as opposed to limiting prescribing to existing s100 HIV prescribers);
  • At present, access to PrEP is variable across Australia, with some jurisdictions providing funding for trials of PrEP, while in other states and territories access is reliant on an individual’s capacity to pay for imported drugs. No jurisdictional trial is fully meeting need;
  • Access to PrEP via the Pharmaceutical Benefits Scheme is vital to ensure sufficient access for key populations across Australia;
  • The patented drug used for PrEP, Truvada, can be purchased on private script, but its cost is prohibitive;
  • Two generic bio-equivalents supplied by Mylan and Lupin Generic Health have been registered on the Australian Register of Therapeutic Goods (ARTG);
  • Mylan and Gilead have submitted applications to the Pharmaceutical Benefits Advisory Committee (PBAC) to have PrEP listed on the Pharmaceutical Benefits Scheme (PBS) at its 6-8 July 2017 meeting.

PROPOSED ACTIVITIES

  • That PBAC broker a fair price for PrEP that enables a positive recommendation for its listing on the PBS; and
  • Following a positive recommendation from the PBAC, that the Australian Government ensure PrEP is accessible through the PBS as quickly as possible.

IMPACT

  • Reduce new HIV acquisitions;
  • Reduce the costs of care (primary health care and public) and treatment associated with living with HIV.

COST-BENEFIT

The cost of providing PrEP under the PBS to those at high risk of HIV infection would be more than offset by savings from HIV infections averted.

ADDITIONAL INVESTMENT

As per PBAC advice