NHS England has announced that it will fund a "major extension" of Public Health England's HIV prevention programme to help reduce the incidence of the disease across the country.
The joint initiative comes on the back of a recent Court of Appeal ruling that NHS England, alongside local authorities, has the power (but not the obligation) to fund the provision of anti-retroviral drugs for the prevention of HIV in an approach known as pre-exposure prophylaxis (PrEP).
In the first instance, a large scale clinical trial will be launched in early financial year 2017/18, involving at least 10,000 participants over the next three years, to help answer remaining questions over implementation before a full roll-out of the programme in England.
Up to £10 million will be made available to fund all aspects of the trial. Detailed planning will now take place to ensure the launch and the clinical trial phase can begin as swiftly as possible, with the next steps to include asking Gilead, the manufacturer of the branded PrEP drug Truvada (emtricitabine and tenofovir disoproxil), as well as generic manufacturers to make proposals to participate.
"We are pleased that NHS England has acted quickly and chosen to fund the commissioning of this trial and rollout of PrEP. We now want to stand united with the NHS to defeat the spread of HIV," said Cllr Izzi Seccombe, chairman of the Local Government Association's Community Wellbeing Board.
"PrEP is a ground-breaking method of treatment that has the potential to save lives and councils want to work with the NHS to help roll out the trial…we firmly believe that PrEP could significantly reduce levels of HIV in the community."
Deborah Gold, chief executive of NAT (National AIDS Trust), said: "We are absolutely delighted that following our wins in Court, NHS England, working with Public Health England and local government will be now making PrEP available on a large scale, and quickly, to those who need it."
"We continue to seek reassurance that access to PrEP will not be unduly limited by geography, that routine commissioning will continue seamlessly at the end of the trial and that all those expected to be eligible through routine commissioning will be able to access PrEP via the trial."
NHS England also announced that it will routinely commission ten new specialised treatments as part of the annual prioritisation process for such therapies.
These are: pegvisomant for acromegaly as a third-line treatment for adults; auditory brainstem implants for congenital abnormalities of the auditory nerves or cochleae; haematopoietic stem cell transplant for Lymphoplasmacytic lymphoma Waldenstrom's Macroglobulinaemia (adults); everolimus for subependymal giant cell astrocytoma (SEGA) associated with tuberous sclerosis complex; rituximab for immunoglobulin-G4 related disease (IgG4-RD); microprocessor controlled prosthetic knees; tolvaptan for hyponatraemia secondary to the Syndrome of Inappropriate Antidiuretic Hormone (SIADH) for patients who require cancer chemotherapy; ivacaftor for children (2-5 years) with cystic fibrosis (named mutations); sodium oxybate for symptom control for narcolepsy with cataplexy (children); and asireotide for Cushing's Disease.
On the downside, those not funded as as part of this year's prioritisation are: eculizumab for treatment of recurrent C3 glomerulopathy post-kidney transplant; riociguat for pulmonary arterial hypertension; and second allogeneic haematopoietic stem cell transplant for relapsed disease (all ages)
"We're pleased to be able to announce funding not only for ten new specialised treatments but also a new ground breaking national programme for PrEP that will benefit at least 10,000 people," said Dr Jonathan Fielden, director of Specialised Commissioning and deputy national medical director, NHS England.
"This has, in part, been made possible by the willingness of many pharmaceutical and device companies to come forward with lower and more responsible prices. Continuing this constructive joint working will enable us to fund more new drugs and treatments in the future.
"We have however, had to make some tough decisions over what we are not able to fund at this point in time within the resources we have available. We will ensure those treatments have the opportunity to be considered as part of the next annual prioritisation round in spring 2017."