HIQA Draft HTA of a PrEP programme Published on 23 Apr 2019

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The Health Information and Quality Authority (HIQA) has launched a public consultation on a draft health technology assessment (HTA) of a pre-exposure prophylaxis (PrEP) programme for populations at substantial risk of sexual acquisition of HIV.

From reviewing the evidence, HIQA has found that PrEP is safe and highly effective at preventing HIV in people at substantial risk. Additionally, implementing a PrEP programme would be considered cost saving compared with standard care. The effectiveness of PrEP is strongly linked with taking the medication correctly, and PrEP must not be taken by individuals with an unrecognised HIV infection as drug resistance mutations may develop. This means that it is important that people taking part in a PrEP programme should receive advice on taking the medication appropriately and undergo frequent HIV testing.

Background

In August 2018, the Health Information and Quality Authority (HIQA) commenced work on a health technology assessment (HTA) on a pre-exposure prophylaxis (PrEP) programme for populations at substantial risk of sexual acquisition of the human immunodeficiency virus (HIV). The HTA was requested by the Clinical Lead in Sexual Health at the Health Service Executive (HSE), with the endorsement of the Department of Health.


PrEP is a form of HIV prevention whereby oral anti-retrovirals (most commonly a combination of tenofovir and emtricitabine) are taken by individuals at substantial risk of HIV acquisition to prevent infection. There were 492 new HIV diagnoses notified in Ireland in 2017, giving rise to a notification rate of 10.3 per 100,000 population (based on Irish census data).(1) The National Sexual Health Strategy 2015–2020 has called for a comprehensive restructuring of its HIV prevention initiatives, with Priority Action 3 calling for "the appropriate use of antiretroviral therapy in HIV prevention".(2) It is envisaged that PrEP is made available as part of an overall HIV prevention package, with an overarching aim of reaching zero HIV transmissions.
 

There is increasing evidence that PrEP is safe and effective at preventing HIV in those at risk of infection. A number of countries (including France and Scotland) have introduced national PrEP programmes to combat the spread of HIV. Individuals taking PrEP must be monitored closely for side effects and require frequent testing for HIV (in addition to other sexually transmitted infections [STIs]). Individuals taking PrEP are also offered advice and support regarding safer sex practices and adherence to treatment is reinforced. PrEP refers to the antiretroviral medication itself, whereas a PrEP programme includes holistic assessment, preventive PrEP treatment, education and advice for individuals at substantial risk of infection.
The aim of this assessment is to examine the clinical and cost-effectiveness of introducing a PrEP programme in Ireland. Based on the available evidence, the HTA will inform decision making by the Department of Health and the HSE.
 

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