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Cost is biggest barrier to PrEP in Europe, ECDC declares
Gus Cairns, 2016-06-03 08:40:00
A meeting a month ago at the European Centre for Disease
Control (ECDC) in Stockholm found that cost was regarded as the biggest barrier
to the adoption of HIV pre-exposure prophylaxis (PrEP) by European countries. Many regarded
significant price reductions in the drugs used as a pre-condition for adopting
The ECDC held the meeting to discuss considerations for PrEP
implementation throughout Europe and invited clinicians, researchers, epidemiologists,
community advocates and, significantly, a high proportion of representatives
from various countries’ Ministries of Health – the people who would actually
make recommendations on PrEP to their governments.
The ECDC conducted a survey of 31 European countries as part
of the monitoring work it does on the implementation of the 2004 Dublin
Declaration on fighting HIV in Europe and Central Asia. It found that 17
countries ranging from Portugal to Azerbaijan had demonstration projects of
PrEP either in progress or planned.
It also asked: “What issues are limiting or preventing the
implementation of PrEP in your country?” By far the most common issue cited was
cost. Twenty-one out of the 31 countries considered the cost of PrEP drugs as a
highly important limiting factor and only two considered it of low importance;
the second most important limiting factor was the cost of service delivery,
which 11 countries considered as highly important and again only two of low
Compared with these, the medical or moral objections often
used against PrEP were less often cited. While lower condom use as a possible
consequence of PrEP was cited by 20 countries as of some importance only five
thought it was of high importance and increases in STIs were cited by seven
countries as a possibly highly-important consequence.
Other cost issues that the ECDC meeting highlighted as
important included the fact that only in the UK and the Netherlands have thorough
cost-effectiveness studies of PrEP been done and that even if models do show
PrEP to be cost-effective, PrEP programmes will require a considerable initial
spend before they start achieving significant-enough reductions in infections.
There was general consensus that the barriers to rolling out PrEP would be
considerably lower once drugs come off-patent and are available at generic
The meeting looked at a number of other issues that might
need to be addressed in order to make accessing PrEP easier in Europe.
One particularly important consideration is the sheer
difference in healthcare systems from one country to another. This makes a
standard European ‘template’ for adopting PrEP impossible, and requires each
country to come up with its own answers.
Who, for instance, will provide PrEP? STI clinics? Community
testing sites? Infectious disease physicians? Primary care physicians? Through
online order schemes? Different arrangements and even laws already exist in
different countries on who can conduct an HIV test and these are likely to
affect PrEP provision too.