HIV pre-exposure prophylaxis (PrEP) available through the HSE from 4th November 2019
From 4th November, HIV pre-exposure prophylaxis (PrEP) will be available free of charge through the HSE to those who are at substantial risk of sexual acquisition of HIV in Ireland.
The HSE Sexual Health and Crisis Pregnancy Programme (SHCPP) and HIV PrEP Working Group, have developed national standards for the delivery and management of HIV PrEP in Ireland and clinical management guidance for individuals taking HIV PrEP within the context of a combination HIV (and STI) prevention approach.
PrEP is the pre-emptive use of oral antiretroviral therapy in HIV negative people to reduce the risk of HIV infection. PrEP is a combination tablet containing two drugs: tenofovir and emtricitabine. These medicines, which are widely used to treat HIV, have been licensed for use as PrEP in Europe since August 2016.
PrEP is an important addition to the suite of HIV prevention tools which includes access to: HIV testing; condoms; support around behavioural and risk modification; HIV post exposure prophylaxis; STI testing, treatment and management; and access to antiretroviral therapy for people living with HIV.
There is a large body of evidence demonstrating the efficacy of PrEP, specifically tenofovir / emtricitabine orally, in HIV prevention. Both the PROUD study (1) and the IPERGAY study (2) reported that PrEP reduced the risk of HIV infection by 86% in study participants. When taken correctly, PrEP has been found to be about 99% effective. The European AIDS Clinical Society recommends PrEP for those at substantial risk of acquiring HIV (3), in line with WHO recommendations (4).
A health technology assessment, conducted by the Health Information Quality Authority (HIQA) in 2019 (5), found that PrEP is safe and highly effective at preventing HIV in people at substantial risk and that the successful implementation of a national PrEP programme would be cost-saving over the medium to long term in Ireland. The HTA estimated that 173 HIV infections would be averted in the first 5 years of a national PrEP programme.
PrEP should be provided as part of a combination HIV (and STI) prevention approach within services that meet national standards. Clinical services that meet the national standards, can apply to HSE Sexual Health and Crisis Pregnancy Programme (SHCPP) for approval as a PrEP service and be authorised to prescribe free PrEP to those who meet the clinical eligibility criteria. For more information visit https://www.sexualwellbeing.ie/sexual-health/prep/
Clinical management guidance for individuals taking HIV PrEP within the context of a combination HIV (and STI) prevention approach in Ireland sets out the clinical eligibility criteria for free PrEP and guidelines on the assessment and monitoring of those on PrEP.
Prior to commencing PrEP, individuals must be assessed medically to ensure that they are suitable for PrEP, in particular that they are HIV negative. While on PrEP, individuals should be seen by their healthcare provider for assessment and monitoring at least every three months.
The clinical management guidance provides information on current PrEP availability in Ireland; who is eligible for free PrEP; determining suitability for PrEP; baseline assessment and testing; and monitoring individuals on PrEP.
PrEP will be dispensed through community pharmacies and PrEP users will need a drug payment scheme (DPS) card, medical card or long term illness card to access free PrEP through the HSE.
Information is available for people who are taking PrEP or who are considering taking PrEP on https://www.sexualwellbeing.ie/sexual-health/prep/ Printed patient information booklets are available within services and to order from https://www.healthpromotion.ie.