{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,21]],"date-time":"2026-06-21T14:40:07Z","timestamp":1782052807532,"version":"3.54.5"},"reference-count":9,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"accepted":{"date-parts":[[2020,4,14]]},"published-print":{"date-parts":[[2021,2]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>Pre-exposure prophylaxis (PrEP) is not commissioned within National Health Service (NHS) England. Individuals can access it privately online or by enrolment into a clinical trial. We established a list of individuals not enrolled in trials, awaiting PrEP. In response to the observation that patients awaiting PrEP trials were being referred with newly diagnosed HIV, we aimed to measure attendance, incident HIV, STI acquisition and missed opportunities for prevention.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The search was conducted for patients on the list from November 2017 to November 2019. We examined the electronic clinical records of those on the list and extracted demographic information, STI and HIV diagnoses. In addition, for those diagnosed with HIV, we reviewed risk factors including chemsex and prior postexposure prophylaxis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 1073 patients on list, and 520 (48.6%) were still awaiting recruitment in a PrEP trial. Eight (0.75%) had an enrolment appointment booked while 200 (18.64%) had been contacted and deemed ineligible according to PrEP trial criteria. 45 (32.15%) had not responded to contact. We identified 15 new HIV infections in patients awaiting PrEP. Of these, 9\/15 (60.00%) did not meet eligibility criteria at point of contact, though had been eligible at first referral.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>It is unacceptable that 15 patients acquired HIV while waiting. The individual lifetime cost of treating HIV is estimated at \u00a3360 800(1). This equals \u00a35 412 000 for these 15 infections notwithstanding the psychological and physical burden. We advocate the immediate role out of universal PrEP for those who need it on the NHS. While this decision is delayed, harm is coming to those waiting. Wider provision of PrEP may encourage increased attendance, but must consider additional resources to accommodate added visits. We are relieved that at the point of final submission (21 March 2020) NHS England have recently announced funding of PrEP for eligible patients from, further details are pending.<\/jats:p><\/jats:sec>","DOI":"10.1136\/sextrans-2019-054410","type":"journal-article","created":{"date-parts":[[2020,5,4]],"date-time":"2020-05-04T21:21:32Z","timestamp":1588627292000},"page":"5-7","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Preparing for PrEP; the cost of delaying universal access in England"],"prefix":"10.1136","volume":"97","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1396-8005","authenticated-orcid":false,"given":"Sally","family":"Jewsbury","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Garner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Redmond","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cara","family":"Saxon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siew Yan","family":"Teo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2395-8452","authenticated-orcid":false,"given":"Chris James","family":"Ward","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Orla","family":"McQuillan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,5,4]]},"reference":[{"key":"2024092304150906000_97.1.5.1","unstructured":"British HIV Association, British Association for Sexual Health and HIV . BHIVA\/ BASHH guidelines on the use of HIV pre-exposure prophylaxis (PreP), 2018. Available: https:\/\/www.bhiva.org\/file\/5b729cd592060\/2018-PrEP-Guidelines.pdf"},{"key":"2024092304150906000_97.1.5.2","unstructured":"Sullivan A . Prep impact trial: a pragmatic health technology assessment of PreP and implementation, 2019. Available: https:\/\/www.prepimpacttrial.org.uk\/protocol"},{"key":"2024092304150906000_97.1.5.3","unstructured":"Berger L , Williams P , Whitford P . House of commons health and social care Committee sexual health Fourteenth report of session 2017-19 report, together with formal minutes relating to the report, 2019. Available: https:\/\/publications.parliament.uk\/pa\/cm201719\/cmselect\/cmhealth\/1419\/1419.pdf"},{"key":"2024092304150906000_97.1.5.4","unstructured":"Collins S . Prep to be available free in France from January 2016. vol 16. London: HIV Treatment Bulletin. HIV i-Base publication, 2015: 24\u20135. http:\/\/search.ebscohost.com\/login.aspx?direct=true&AuthType=cookie,ip,shib&db=awn&AN=1104922-1&site=ehost-live"},{"key":"2024092304150906000_97.1.5.5","unstructured":"Ibase . Buying PreP in the UK including online, 2019. Available: http:\/\/i-base.info\/guides\/prep\/buying-prep-online"},{"key":"2024092304150906000_97.1.5.6","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0125018"},{"key":"2024092304150906000_97.1.5.7","unstructured":"NAM-Aidsmap . People getting PreP at their clinic have more STI and HIV tests than people who buy it online, 2018. Available: https:\/\/www.aidsmap.com\/news\/jun-2018\/nearly-quarter-people-who-want-prep-currently-cant-get-it-uk-survey-finds"},{"key":"2024092304150906000_97.1.5.8","unstructured":"NIHR . Good clinical practice (GCP). Available: https:\/\/www.nihr.ac.uk\/health-and-care-professionals\/learning-and-support\/good-clinical-practice.htm"},{"key":"2024092304150906000_97.1.5.9","unstructured":"NHS England . Update on the PreP impact trial, 2019. Available: https:\/\/www.england.nhs.uk\/2019\/01\/update-on-the-prep-impact-trial\/"}],"container-title":["Sexually Transmitted Infections"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/sextrans-2019-054410","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,23]],"date-time":"2024-09-23T11:15:23Z","timestamp":1727090123000},"score":1,"resource":{"primary":{"URL":"https:\/\/sti.bmj.com\/lookup\/doi\/10.1136\/sextrans-2019-054410"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,4]]},"references-count":9,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,1,15]]},"published-print":{"date-parts":[[2021,2]]}},"alternative-id":["10.1136\/sextrans-2019-054410"],"URL":"https:\/\/doi.org\/10.1136\/sextrans-2019-054410","relation":{},"ISSN":["1368-4973","1472-3263"],"issn-type":[{"value":"1368-4973","type":"print"},{"value":"1472-3263","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5,4]]}}}