The National AIDS Trust (NAT) is gearing up to fight in court a decision by NHS England to remove prophylactic HIV treatment PrEP from the official NHS commissioning process.

PrEP (pre-exposure prophylaxis) is a new way of using anti-retroviral drugs, which are normally used for treating people with diagnosed HIV, to stop those at very highest risk from contracting the virus. The charity says it is proven to be effective in stopping transmission of the virus in almost every case if taken properly.

But earlier this year NHS England said it would not take on commissioning of HIV prevention services and, after a subsequent challenge by the charity, it recently confirmed its position, effectively leaving the decision on whether to fund the treatment with local trusts or health authorities.

"NHS England is sitting on something that could be the beginning of the end for the HIV epidemic - if only it were made available. The refusal to commission it for all those at significant risk is astonishing," said Deborah Gold, NAT's chief executive.

A NAT spokesperson told PharmaTimes that the Trust is now in the midst of a crowd-funding process to gather the financial reserves needed to carry forward a legal challenge to NHS England's decision in the High Court, given that the organisation has not provided an alternative way of funding PrEP "that ensures fair access for all".

Test sites
NHS England is streaming more than £2 million into 'early implementer test sites' which it claims will help answer remaining questions around how PrEP could be commissioned in the most cost effective and integrated way, as well as provide protection to around 500 men at high risk of HIV infection.

However, NAT has questioned the necessity of the move, given that much of the work around potential commissioning arrangements has already been completed, and argues that under the plan only a narrow target group will get access to PrEP, leaving many people at risk from contracting the disease.

"We don't think it is possible for local authorities to individually purchase the medication itself, especially given their current financial circumstances and cuts to public health budgets within local authorities. The most cost-effective mechanism purchasing PrEP itself would be through the NHS, essentially in-bulk," the spokesperson stressed.

Around seventeen people are diagnosed with HIV every day, highlighting the need for more effective prevention strategies.