PBAC approval of HIV drug a major step forward for at-risk populations

Paul Hayes

13/02/2018 3:07:44 PM

The recent Pharmaceutical Benefits Advisory Committee approval of a ground-breaking HIV drug will allow men who have sex with men to retain control over their own sexual health, GP and sexual health advocate Dr George Forgan-Smith told newsGP.

Once listed on the PBS, it is believed PrEP (pre-exposure prophylaxis) will be available for around $40 per prescription. Image: AP
Once listed on the PBS, it is believed PrEP (pre-exposure prophylaxis) will be available for around $40 per prescription. Image: AP

The HIV prevention pill PrEP (pre-exposure prophylaxis) was recommended for listing on the Pharmaceutical Benefits Scheme (PBS) at the December 2017 Pharmaceutical Benefits Advisory Committee (PBAC) meeting. The once-daily pill is said to be 99% effective in preventing HIV transmission.
While it was approved for use in Australia by the Therapeutic Goods Administration (TGA) in 2016, access to the drug has been difficult due to prohibitive costs of up to $1000 a month. Once listed on the PBS, PrEP will be available for around $40 per prescription.
The PBAC recommendation, which specifies the drug is effective for individuals at medium-risk and high-risk of HIV transmission – including gay and bisexual men, as well as Aboriginal and Torres Strait Islander people, migrant communities and some heterosexual populations – has been lauded in the healthcare community.
‘It’s great news, fantastic news,’ Dr Forgan-Smith, a gay inner-Melbourne GP with interests in male health, mental health and health promotion, told newsGP.
‘You have to think of it from the perspective of a gay man who has lived with 30 years of fear. Thirty years of fear of HIV, where we have been told – we have been lectured to – nothing but condoms is the only way to protect your health.
‘Condom usage still puts a lot of trust between the sexual partners. PrEP means that you are in control of your serostatus. If you know that you took the tablet in the morning, you will know that you are protected whether the condom goes on or not in the evening.
‘So that gives people a sense of control, which I think is fantastic.’
The fact PrEP offers a form of HIV prevention, rather than management after the fact, is also an important development in terms of the financial burden the virus places on Australia’s health system, according to the Australian Federation of AIDS Organisations.
‘Making PrEP available and affordable is not only a public health goal, it will also save millions of dollars,’ Darryl O’Donnell, Chief Executive of the Australian Federation of AIDS Organisations, said. ‘Access to PrEP makes enormous financial sense.’
Dr Forgan-Smith agrees that providing a treatment prior to infection is a significant step in the right direction.
‘Prevention for a portion of their life, when somebody is at high risk, is much, much better. Because people’s circumstances change, and sometimes they might be at a high risk of HIV and sometimes they are not at a high risk.
‘It enables people to have protection when they need it the most.’
While it has yet to be determined whether PrEP will be available as an s100 or s85 drug, Dr Forgan-Smith, who has been prescribing PrEP for the past four years, believes significant levels of education and upskilling will be required.
‘Most important is that all GPs know how to prescribe it,’ he said. ‘It’s not like a simple drug to prescribe because you have to be very clear and very understanding that the patient has to go through a consent process and understand the pros and cons of the drug. The drug has side effects – it can effect kidney functions, can effect bone metabolism.
‘The patient who goes onto PrEP needs to be carefully monitored and they need to be seen every 90 days for the process to be safe.
‘GPs are going to be asked about it; therefore, it is important that we enable GPs to be able to get the training that they require.’
Dr Forgan-Smith has created two resources designed to help GPs become more familiar with PrEP.
‘One is a video that is the ins and outs of PrEP and how to start somebody on PrEP,’ he said. ‘I have also got a document that people can access if they want to learn about PrEP.
‘I really want to work with GPs and ensure that PrEP is being prescribed in a safe and careful way.’

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Dr Jacob Rich   17/05/2019 5:43:33 AM

Age of eligibility for PrEP?