Subsidising the cost of Pre-exposure Prophylaxis (PrEP) for HIV prevention
Description
o Australia has low incidence of HIV compared to other high-income countries, though challenges remain. The Eighth National HIV Strategy 2018-2022 guides the Australian response, aiming to virtually eliminate HIV transmission in Australia by 2022. <br />
o Since 1 April 2018, antiretroviral medicines have been subsidised by the Australian Government through the Pharmaceutical Benefits Scheme (PBS) for use as Pre-exposure Prophylaxis (PrEP) for HIV. Eligible Australian patients at medium to high risk of acquiring HIV can access PrEP (via their doctor) at a subsidised price. When taken as prescribed these medicines are effective at preventing HIV infection, helping eliminate transmission.
o Listing PrEP on the PBS provides an opportunity to significantly reduce HIV transmission and is consistent with a goal of the Eighth National HIV Strategy 2018-2022 - to virtually eliminate HIV transmission in Australia by 2022. This is directly associated with SDG 3.3.1 ‘Number of new HIV infections per 1000 uninfected, by sex, age and key populations<br />
o Making PrEP for HIV affordable for all Australians contributes to their uptake across communities that may otherwise not be able to access these medications. Good health prevention programs are an integral part of keeping people well and in the workforce, supporting their contribution to economic growth and reducing poverty.<br />
o There are challenges in ensuring clinicians and eligible people that could benefit from PrEP for HIV are aware of this biomedical advance. The Australian Government continues to work to overcome these challenges by partnering with national professional and community-based organisations to produce educational materials and undertake awareness raising activities. This also contributes to SDGs to ensure quality education and cross-sectoral collaboration towards shared goals.
o Australia’s Pharmaceutical Benefits Advisory Committee (PBAC) is an independent expert body appointed by the Australian Government. Members include doctors, health professionals, health economists and consumer representatives. PBAC’s primary role is to recommend medicines for listing on the PBS.
o When recommending a medicine for listing, the PBAC takes into account the clinical conditions for which the medicine was registered for use in Australia, the clinical efficacy, safety and cost-effectiveness (‘value for money’) compared with other medicines.
o Public summary documents of PBAC meetings can be found online, and these include details of the analysis and process for the listing of PrEP for HIV on the PBS (see Resources).
o To support the listing of PrEP on the PBS, professional medical organisations were engaged by Government to consult widely and produce guidelines for effective and efficient prescribing practices for PrEP.
o The Australian Government also partnered with community and professional organisations to undertake clinical and consumer PrEP education and awareness activities for both prescribers and affected communities. This nationally consistent information informs prescribers, consumer groups and individual users of PrEP on eligibility for PrEP, how to access PrEP and how to use PrEP. These programs are subject to review for effectiveness.
o Australia also collects data on treatment initiation for PrEP for HIV and considers the uptake of PrEP over time, including the cost to the Government of subsidising PrEP on the PBS.
o The results of the Expanded PrEP Implementation in Communities-New South Wales (EPIC-NSW) study published in November 2018 shows the value of PrEP at the population level. The report showed that the roll-out of PrEP during trials has been associated with a rapid decline in recent HIV diagnoses, in not only those people receiving PrEP but also across New South Wales, Australia. The number of HIV diagnoses in men who have sex with men in New South Wales declined 25% in the 12 months after the roll out, when compared with the 12 months before. These declines after the PrEP roll-out contrast sharply with the stable number of recent HIV infections in the 2 years before the roll out. At the time the EPIC-NSW study began, PrEP had not yet been listed on the PBS.
o One area of particular interest is the impact of PrEP on rates of other sexually transmissible infections (STI). Access to PrEP on the PBS requires STI testing every 3 months. Research is ongoing to consider the impact of STI transmission in persons taking PrEP.
o The Eighth HIV Strategy 2018-2022 supports a high-quality, evidence-based and equitable response to HIV in Australia.
o Another important component of the HIV response has been the ongoing and meaningful participation of people with HIV, along with affected communities, in all aspects of the response.
o Continued engagement with consumers and health care professional organisations will maximise awareness of PrEP to increase uptake and help reduce HIV-related stigma and discrimination.
o PrEP needs to be combined with regular STI testing and education on the importance of condom use for STI prevention, along with current clinical guidelines to support provider decision-making.
o The uptake of PrEP is monitored to ensure the long term benefits of the subsidy are maintained.
Biomedical advances provide a new, highly effective avenue of disease prevention for HIV. <br />
We are already seeing a significant impact of the more widespread use of PrEP for HIV in Australia, based on research conducted through PrEP clinical trials prior to the Government listing on the PBS. This research echoes what the modelling used to support the listing of PrEP for subsidised supply predicted - PrEP roll-out can lead to declines in HIV incidence population wide, benefitting not only those people taking PrEP medication but also minimising transmission risks for all Australians and reducing the costs associated with HIV. Now that all Australian general practitioners can prescribe PrEP we expect to see this positive impact occurring across Australia. <br />
The listing of HIV PrEP on the PBS puts Australia on track to achieving the goal of virtual elimination of HIV by 2022 and supporting the SDGs for the benefit of all people across the globe.
• Pharmaceutical Benefits Advisory Committee (PBAC)
• PBAC Public Summary Documents on PrEP
• Prof Andrew E Grulich, PhD , Prof Rebecca Guy, PhD, Prof Janaki Amin, PhD, Fengyi Jin, PhD, Christine Selvey, MBBS, Jo Holden, MHPol et al. Population-level effectiveness of rapid, targeted, high-coverage roll-out of HIV pre-exposure prophylaxis in men who have sex with men: the EPIC-NSW prospective cohort study. The Lancet HIV| VOLUME 5, ISSUE 11, PE629-E637, NOVEMBER 01, 2018
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SDGs
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- Asia and Pacific
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Contact Information
Rebecca Newton, Dr