RPS calls for review of online PrEP purchase recommendation in draft HIV guidance

It supports the expansion of HIV PrEP eligibility and agrees that “PrEP should be available to collect from community pharmacies”  

The Royal Pharmaceutical Society (RPS) has expressed concerns over draft HIV guidance recommending the purchase of generic pre-exposure prophylaxis (PrEP) from an “unregulated” website.

The draft guidance, published in September 2024 by the British Association for Sexual Health and HIV (BASHH) and the British HIV Association (BHIVA), was open for consultation until 26 November 2024.

In one section, the new guidance suggests: “Clinicians should signpost individuals to IWantPrEPnow, PrEPster or https://www.prep.global/get-prep if they are unable or unwilling to access PrEP on the NHS. These sites offer support and advice and the ability to source generic drug as safely as possible.”

In its consultation response, the RPS suggested that this section should be reviewed, noting that the website referenced is “not regulated by the General Pharmaceutical Council (GPhC), gives the option of purchasing PrEP via Bitcoin and the prescribing doctors section states that there are no updates to the website since 2019.”

“We are concerned for patient safety with this recommendation and would not want to set a precedent for patients buying POMs medication online.

In addition, it highlighted that the quality of online purchased medicines can be “highly variable and the presence of carcinogens and active product cannot be assured.”

The RPS welcomed the expansion of HIV PrEP eligibility and that the medication should be available to collect from community pharmacies.

The guideline recommends that PrEP should be offered to people, regardless of their gender or sexual orientation, who would benefit from a reduction in HIV risk.

Under the section ‘Recommendations for PrEP Equity’, it suggests: “With clear governance connections to specialist level 3 GUM services, PrEP provision should be expanded, with evaluation, to settings outside of specialist sexual health services including but not limited to, online services, in community pharmacies, drug and alcohol services, in primary care and in community settings likely to be accessed by people who would benefit from PrEP.”

However, the RPS does not support the recommendation that children aged under 18 years should be offered tenofovir alafenamide fumarate-emtricitabine (TAF/FTC).

“This is not a prophylactic option on the BNFc [British National Formulary for Children], which states to use TD-FTC [tenofovir disoproxil-emtricitabine]. The BNFc says that TAF-FTC is indicated for treatment not prophylaxis.”