Implementation of HIV PrEP in Scotland: first year report

A new report published on 26 February 2019, by NHS National Services Scotland (NSS), highlights the progress made during the initial year implementing the first national HIV PrEP programme in Scotland.

HIV Pre Exposure Prophylaxis (PrEP), a new and highly effective method of preventing HIV, was introduced free of charge in Scotland in July 2017 to those who are at the very highest risk of acquiring HIV. Almost 1900 people were prescribed PrEP during the course of the first year, exceeding initial expectations, with the vast majority (99%) being men who have sex with men (MSM).

PrEP is not a lifelong measure and is only needed by people when the risk of HIV is highest for them. It is combined with other support and sexual health advice to reduce the chance of becoming HIV positive.

PrEP is available within every health board with most patients accessing it through sexual health services.  About a fifth of those receiving PrEP had never been to a Scottish sexual health clinic before; this demonstrates that the provision of PrEP has increased the opportunities to engage with people who are at a high risk of exposure to HIV - who otherwise would not have engaged with such services.

It is too early to draw any conclusions about the impact of PrEP on the transmission of HIV and other Sexually Transmitted Infections such as gonorrhoea, because during the initial year nearly all of those prescribed PrEP had been on it for less than a year and many had only been on it for less than a few months.

The report was prepared collaboratively by the Scottish Health Protection Network (SHPN) HIV PrEP National Coordination Group which draws expertise from across the NHS in Scotland, academic research, the third sector and Scottish Government. The report is available from Health Protection Scotland (HPS).

Professor David Goldberg, Consultant Epidemiologist, Health Protection Scotland (HPS) and Chair of Scotland’s National HIV PrEP Coordinating Group, commented on the report:

“Sexual Health Service teams throughout the country should be congratulated for successfully implementing an exciting new measure which has the potential to be a game-changer in Scotland’s drive to eliminate HIV infection from its population.

“The programme has already entered its second year and the focus is now also on reaching other groups who could benefit from PrEP; these include some women and transgender people.”

Dr Rak Nandwani, Chair of the HIV Clinical Leads in Scotland said:

“A great deal of work has already been done to prevent HIV transmission in Scotland. This includes condom provision, routine antenatal testing, the provision of injecting equipment and a range of behavioural interventions. More recently, evidence has shown that HIV drugs are highly effective in reducing HIV transmission from people who are already living with HIV when the amount of virus present in blood becomes undetectable. PrEP is a further addition to the toolbox to help us stop people being infected with HIV”.

Prof Claudia Estcourt, Professor in Sexual Health & HIV Medicine from Glasgow Caledonian University commented:

“The availability of PrEP has encouraged people at high risk of HIV to engage with sexual health services, many of whom had not used services before. This is enabling people to take pro-active steps to a healthier sex life by taking advantage of the wide ranging screening and prevention services on offer.”

Nathan Sparling, Chief Executive of HIV Scotland said:

“Scotland was the first country in the UK to embrace the PrEP revolution with full and free access. This report shows it was a great first year, with more people at risk of HIV taking it than anyone anticipated.

“We know that people are accessing PrEP to prevent HIV, and we know from this report that more people are considering the importance of good sexual health than ever before. People are telling us that PrEP is working for them, and we should be proud of our collective achievement.”

 

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