Are we PrEPared?

Natàlia Pascual , Executive Director of the Almirall Chair for Management of Pharmaceutical Policy Innovations at the NHS

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These days takes place the XII National Congress of GeSIDA , a key meeting to update research on HIV in our environment. Spain has practically achieved the treatment objective set by UNAIDS of 90-90-90 by 2020 (90% of those infected are diagnosed, 90% of those diagnosed receive treatment and 90% of those treated are free of detectable viral load). According to official data, Spain only fails in the first 90, with 87% of diagnoses among the 160,000 people infected with HIV.

The objective of reducing infections necessarily involves prevention. Among the most effective prevention strategies, the main one remains the use of condoms and the promotion of safer sexual practices. In this sense, one of the topics that will be discussed in the congress, and that arouse growing concern, is the recent evolution of chemsex (drug use in sexual contexts).

The most substantive recent advance in preventing HIV infection has been pre-exposure prophylaxis (PrEP). PrEP is an oral treatment, in pill format, that helps prevent HIV infection in at-risk populations. The success of oral PrEP is more than proven in numerous clinical studies of the last decade.

Lack of foresight with PrEP led to logistical problems and long waiting lists that led potential beneficiaries to resort to private purchasing through unapproved means

In 2018, the Spanish Ministry of Health showed its commitment to the implementation of PrEP, although it was not until the end of 2019 that its financing and access to zero cost to users. However, when the pill was incorporated into public funding, it was not complemented by increased investment in prevention tools such as sexually transmitted infection screening and control. The initial lack of foresight led to logistical problems and long waiting lists that led potential beneficiaries to resort to private purchasing through unapproved means.

At a global level, and more recently, in countries with low adherence rates (due to the fact that it is a treatment that requires compliance with a daily intake), long-acting PrEP injectables have been tested successfully. Although more studies are still needed, long-term PrEP offers a promising alternative, especially when it comes to protecting women in countries where they are one of the main population groups at risk.

The PrEP implementation agenda should be resumed now that there is data for a more complete first evaluation since its introduction

Although it is true that, as in other therapeutic areas, covid-19 pandemic has displaced public investment commitments already acquired, the agenda should be retaken implementation of PrEP now that data is available for a more comprehensive first evaluation since its introduction. PrEP is one more tool among the alternatives available in the preventive strategy against HIV-AIDS, and further evaluating its implementation is essential for the future of the necessary public investments and planning, beyond the pill.