There are imminent changes on the horizon for how Pre-Exposure Prophylaxis will be accessed in Western Australia.
A project for accessing PrEP is anticipated to commence in the second half of 2017 (subject to ethical approvals), whereby PrEP and associated support services will be available to people who may be at risk of contracting HIV.
Do you want to be kept up to date on all changes to PrEP access in WA? Make sure you sign up to the mailing list by completing the expression of interest form below!
Since the announcement of funding for a Pre-Exposure Prophylaxis (PrEP) study in Western Australia earlier this year, a significant amount of work has been done to assess how this might be delivered.
Getting a real sense of the interest in PrEP within the WA community is an important step in the process, and soon an Expression of Interest Form will be available on the WA AIDS Council website, which will be used to register your interest in receiving updates on accessing PrEP in Western Australia. We will publicise this Expression of Interest Form once it is ready for use.
If you need PrEP right now, we urge you to consider commencing immediately using the Personal Importation Scheme. Online purchasing of PrEP is now as low as $38 per month (as of 02/06/2017) and there is a list of PrEP prescribers on the M Clinic website. Current or previous PrEP use does not affect eligibility into a future trial.
Please keep in touch with our progress by accessing our websites, subscribing to our newsletterand through the Expression of Interest Form when it becomes available.
For more information on accessing PrEP in Western Australia:
The WA AIDS Council is thrilled that the Government has confirmed funding for a WA PrEP demonstration project for 2,000 Western Australians. We’ve pushed this for what seems like forever, and the result is better than we dared to dream. We’ll release more details very soon on our websites and social media. This demonstration project will help eliminate new HIV transmission as we aim for our 2020 goals. CEO Andrew Burry has today made the following statement:
Statement on the Establishment of the WA PrEP Demonstration Project
We are thrilled that funding for the PrEP Demonstration Project has been secured and announced. We have been working hard for this for a long time, although I concede that at times our work may not have been visible. In the end, the outcome was greater than we dared to dream, and with 2,000 places available and the project funded for at least two years, it is the country’s largest on a per capita basis.
Whilst the funding is secured, there is still some work remaining before enrolments can commence. This is a partnership between the WA AIDS Council, the Department of Health and the Kirby Institute. Whilst the partnership has had plenty of dialog leading up to the announcement, final agreements between the parties still need to be concluded. This will not take long.
A ‘Demonstration Project’ is a research study. As such, the program must be run within strict protocols, and Ethics Approval must be obtained for each of the participating clinical sites. Training for the WA Chief Investigator and Research Supervisor(s) is also necessary. There are several sites included to ensure the project is well resourced, including clinical services and support, peer support and so on. Obtaining Ethics Approval is relatively complex and detailed and does take some time. Consequently, we have stated our goal as commencement being early in the second half of 2017. To us, this means July 1st, however if we can be fully ready earlier we will commence earlier.
The Demonstration Project is a criteria-based access program. This means that eligibility for participation will be determined based on HIV risk criteria. The aim is to rapidly enrol eligible people and follow them for up to two years while they take PrEP.
To facilitate the smooth entry of eligible people into the project, we will shortly establish a pre-registration program. Pre-registration will involve providing some details of your personal and sexual histories. All information collected will be secure and confidential.
We will also ensure details of implementation progress will be on both the WA AIDS Council and M Clinic websites. People interested will also be able to subscribe to a special newsletter and questions can be directed to a specific email address (details below).
If you currently feel you need PrEP right now, please consider commencing immediately via the existing PrEP access programs using the personal importation process. Details on how to do this are also on the WA AIDS Council and M Clinic websites. Current or previous PrEP use does not affect eligibility into the project.
There are many people who worked together in making this outcome possible. The team at the Sexual Health and Blood-borne Virus Program of the Department of Health shouldered a huge workload in developing costings of various proposals. The Kirby Institute also provided incredible support in helping us to develop a model that best suits Western Australia and takes advantage of some of our special features.
We aren’t the first ‘cab off the rank’, and similar large demonstration projects are underway in NSW, Victoria and Queensland. Our colleagues at ACON, the Victorian AIDS Council, the Queensland AIDS Council, Australian Federation of AIDS Organisations, and the The National Association of People with HIV Australia have tirelessly supported our efforts and occasional disappointments as we worked this through.
I want to acknowledge also the great people in NSW Health who offered extraordinary advice, warned us of potential pitfalls and shared their own experiences so that we can start as efficiently as the NSW program has become. In particular, we acknowledge former NSW Health Minister Jillian Skinner, who shone a light of hope when wide scale PrEP access seemed beyond our reach.
Please keep in touch with our progress in the WA PrEP Demonstration Program by accessing our websites, subscribing to our newsletter and through pre-registration when it becomes available.
Chief Executive Officer
For Information on the WA PrEP Demonstration Project:
By Andrew Burry, CEO, WA AIDS Council
On Friday 19th August, the Pharmaceutical Benefits Advisory Committee (PBAC) made public its decision on an application by Gilead Sciences to have Truvada™ listed on the Pharmaceutical Benefits Scheme (PBS) for use as Pre-Exposure Prophylaxis (PrEP). Their decision was that it should not be listed.
The impact of this decision is that PrEP will not be subsidised meaning that those who are prescribed it, will have to meet the full cost of it. The cost will amount to more than $1,000 per month if purchased from an Australian pharmacy. The alternative is to privately import a generic version, which is still costly and complex.
It is important to note that there is NO suggestion by PBAC that Truvada™ is ineffective. Indeed, PBAC acknowledge the growing and solid scientific evidence of its ability to substantially remove the risk of acquiring HIV by those who take the medication in accordance with the recommendations.
In short, the grounds for PBAC’s decision was around economics. PBAC suggests that Gilead’s asking price of $1,200 per month was excessive and that their calculation of the extent of its prescription was not credible and thus a necessary requirement for costs and benefits was not established.
We have not seen the actual submission made by Gilead and can only rely on the published minutes of the PBAC meeting and surmise. It is hard not to question Gilead’s strategy for a drug that moves out of patent in mid 2018. They could re-submit in November (and we hope they do) in time for the next PBAC meeting in March 2017, but even if then successful, they would be left with at best 12 months of PrEP prescribing in advance of the local availability of generic equivalents.
The impact of this decision is not evenly spread across the country however. The Eastern States (QLD, NSW, Victoria and the ACT) have the advantage of their local governments making substantial investments in making PrEP available in significant numbers through the establishment of access projects or trials. Participation in these is restricted to those who live in the respective jurisdictions.
Other states, including WA, cannot participate and thus access to PrEP is more complex and costly. Nonetheless, PrEP is available in Perth and the WA AIDS Council is working to promote awareness and to help facilitate personal importation for those who decide it is the appropriate means of personal protection against HIV risk. This isn’t ideal. Already bottlenecks are appearing in obtaining a prescription, and in some cases, patients are subject to high co-payments above the Medicare rebates. M Clinic is currently supporting more than 50 patients already on PrEP and helping them to maintain knowledge of their sexual health including the presence of other STIs. The WA AIDS Council has made considerable effort to secure the services (for a fee) of doctors able to prescribe PrEP at M Clinic itself so that the journey for PrEP users involves a single location and that a high level of peer support and education is maintained. So far these efforts have been unsuccessful.
Given this latest setback in a comprehensive establishment of PrEP as an essential tool in achieving our collective target of substantially eliminating the sexual transmission of HIV in WA by 2020, new strategies must be contemplated. The ACT Government successfully negotiated with the NSW Department of Health for the inclusion of ACT residents at high risk of HIV acquisition to be able to participate in the NSW EPIC program. An opportunity exists for the WA Government to attempt the same.
PrEP Decision Hits Hard in WA
PrEP Decision a Setback in Eliminating HIV in WA
The WA AIDS Council is disappointed in the decision of the Pharmaceutical Advisory Committee (PBAC) not to recommend the funding of Truvada™ for use as Pre-Exposure Prophylaxis (PrEP) through the Pharmaceutical Benefits Scheme.
Truvada™ taken once a day has been proven extremely effective in preventing HIV transmission. It was approved for use by the Therapeutic Goods Administration in May 2016. Already, Queensland, New South Wales, the Australian Capital Territory and Victoria have announced and implemented large scale PrEP programs funded by their respective governments.
In Western Australia no such program exists, and hopes were resting on a positive PBAC decision to at least partially address the disadvantage that Western Australians vulnerable to HIV are experiencing relative to their East Coast peers.
WA AIDS Council Chairperson Sam Hastings said today that this decision was a significant setback in achieving the virtual elimination of HIV by 2020. “Both our State and Federal Governments are committed to this goal, and PrEP is the most effective development in prevention we’ve seen in many years. That’s why other state governments are investing so heavily in making sure that as many people who both need and want PrEP can get it – our Government must consider doing the same.” he said.
New diagnoses of HIV remain stubbornly high in Western Australia at more than 100 per year, and gay and bisexual men account for over two thirds of this total. PrEP is considered vital for Australians at very high risk of HIV infection.
Despite this setback, Mr. Hastings is keen to point out that it is possible to get PrEP prescribed locally, however the high cost is an insurmountable barrier for many. “Our Government led the country in establishing an operational directive that encourages doctors to prescribe PrEP to those most at risk, but the cost and complexities of private importation are challenging” He said. He went on to say that the WA AIDS Council is working hard to make PrEP more accessible, but without political leadership and resources, results are limited.
“Our Government must talk to its counterparts in the Eastern States and negotiate participation of Western Australians in established PrEP Access programs. The ACT Government did this, and we should be doing the same” he concluded.
For media comment, please contact:
Sam Hastings, Chairperson WA AIDS Council 0433 144 105
Andrew Burry, CEO WA AIDS Council 0433 547 640
For comment on the national implications of this decision, please contact:
Bridget Haire, President Australian Federation of AIDS Organisations 0439 074 526
by Andrew Burry, CEO WA AIDS Council
Millions (and millions) of dollars are being spent in the states of Queensland, New South Wales and Victoria, to provide free PreExposure Prophylaxis (PrEP) to 8,400 homosexually active men willing to be part of research projects. But for those of us living in other jurisdictions like Western Australia, we don’t have that option.
So let’s take stock of where we are.
WA remains the only jurisdiction where the Government has issued an Operational Directive regarding the prescribing of PrEP. This is more than symbolism. It means that doctors employed by the Government who are specialised in prescribing HIV medicine (S100) can and should prescribe PrEP to patients who meet the eligibility criteria. These criteria are the same as those used to qualify guys over East to access the various trials.
Already there are over 100 guys in WA who have accessed PrEP in this way, and those numbers increase week by week. And, by the way, the Kirby Institute calculates that there are between 1,100 and 1,200 of us in WA who should at least be considering it. But even if we achieved that target, obviously not all of us would be amongst those in the Kirby calculation, so the real target for PrEP users would have to be closer to 1,500 and 1,800 if we want to achieve the goal of substantially eliminating new infections by 2020. We will also have to achieve those numbers within the next two years.
There is much talk about how expensive PrEP is, and how that cost acts as a significant barrier to those needing it now. In reality, the personal importation scheme and prescribing channels in Perth that are promoted by the WA AIDS Council and M Clinic result in an annual cost to the user of around $700. That’s four quarterly payments of $175. It’s not nothing, sure, but I suspect there are many more of us who would prefer not to pay for it than there are who genuinely can’t afford it. Cost is a barrier for some though, and we must collaboratively develop ways of addressing this fairly and equitably.
The Therapeutic Goods Administration (TGA) have now approved the use of Truvada™ for PrEP. The Pharmaceutical Advisory Committee (PBAC) has decided not to recommend the funding of Truvada™ for use as Pre-Exposure Prophylaxis (PrEP) through the Pharmaceutical Benefits Scheme.
On the face of it, it seems that 8,400 guys over East are well ahead of us over here. This isn’t necessarily or completely true. Whilst we are worse off by $700 per year if we import it ourselves, our experience with PrEP will not be confined within a research project. This means less time and energy having to meet research requirements and more time (and energy) to enjoy the added security that this form of prevention offers.
So the bottom line is, it isn’t particularly difficult to get PrEP in WA and it isn’t particularly expensive. It doesn’t even require much effort beyond making an appointment with a prescriber. It will be fantastic news if the Feds list it on the PBS and make it effectively free, but we don’t need to wait for that.
There is a note of caution though. We believe the decision to use PrEP is and should be a personal decision of our own, but it really is important to do so with medical advice. Although rare, there are medical reasons why PrEP should not be used by some of us for reasons of bone density or kidney function for example. These need to be properly checked out first. Some of us may experience side effects of the drug, but again this is rare.
Nonetheless, if we think we need PrEP we can and should be doing something about it.
Find out more:
PrEP Access Now website
Most HIV transmissions occur among gay men and other men who have sex with men in Australia. Pre-exposure prophylaxis (PrEP) is expected to make a substantial difference to the epidemic and is another strategy that can be employed to reduce risk of HIV infection.
So what is PrEP and how effective is it?
PrEP (Pre-exposure prophylaxis) is a type of medication called Truvada that is already used in Australia to treat HIV. Truvada has been shown to be extremely effective as PrEP at reducing HIV transmission among men who have sex with men.
It is TGA approved?
Recently, the decision was made by the Pharmaceutical Advisory Committee (PBAC) to not recommend the funding of Truvada™ for use as Pre-Exposure Prophylaxis (PrEP) through the Pharmaceutical Benefits Scheme. Although this is disappointing news, there are still ways of accessing PrEP. Currently, people can access the medication through clinical trials (not currently available in WA) or by personally importing generic versions of the medication.
What’s an off-Label prescription?
In the absence of readily available Truvada for PrEP in WA, many guys are choosing to purchase it from overseas. This is easily done once you have a prescription provided by a doctor where they request the drug “off-label” i.e. for a use that the TGA doesn’t currently approve it for.
How do I get a PrEP prescription?
There are three places in Perth you can go to obtain a PrEP prescription:
How often do I take PrEP?
Adherence (how often you take your meds), is a massive factor in how effective the pill is. The current recommendation is to take PrEP daily – any less and you may not be protected.
Are there side-effects? I’ve heard there’s side effects!
Tenofovir, one of the drugs used in Truvada, has been linked to a number of common temporary side effects including vomiting and diarrhoea and in rare cases acute kidney damage. Getting a prescription from a doctor that is knowledgeable about PrEP is paramount in ensuring you are provided with the right precautions, maintain a steady supply of Truvada and undergo important monitoring for kidney dysfunction. If you are HIV positive without knowing, and were to commence PrEP assuming you were negative, you run the risk of developing resistance to drugs used in Truvada which could limit your HIV treatment options. This is why HIV testing prior to commencing PrEP is so important.
What about other STIs?
Condoms are still a big part of preventing HIV infection, as well as other STIs such as gonorrhoea and syphilis (which PrEP can’t protect you against). If you are having sex without condoms you must remember to have a sexual health screen every three to six months.
If you think PrEP would work for you, it’s easier to get than you think, and doesn’t cost as much as you would expect.
PrEP Access Now: https://www.prep.global/get-prep
PrEP'd For Change: Public facebook page
In view of the HIV “treatment revolution” and bold targets to "virtually eliminate" HIV transmissions in NSW, Australia by 2020, a study led by the Centre for Social Research in Health at UNSW Australia has addressed a major research gap by exploring the prevention needs and experiences among gay and heterosexual serodiscordant couples in a changing epidemic.
This qualitative study has produced new knowledge of the social, sexual, emotional and medical management of HIV among couples with mixed HIV status in metropolitan and regional NSW.
The study investigated the challenges and opportunities presented by serodiscordance in the new HIV prevention landscape, with specific focus on how couples perceived and managed "risk" and their use of biomedical technologies as risk-reduction strategies, including condoms, viral load testing, HIV testing, treatment-as-prevention (TasP), and pre-exposure prophylaxis (PrEP).
The study was funded by NSW Health and developed in partnership with other research centres and key community HIV organisations in NSW, whose expertise and collaboration remained central throughout the study.
The study findings provide insights into the intersections between HIV, sexuality, stigma, love and medicine, and the diverse and complex ways human beings both resist and make use of the increasing biomedicalisation of the epidemic. These findings can contribute to future health promotion programs and policy for serodiscordant couples, and thus promote and support the well-being of individuals infected and affected by HIV.
Click the image below to read the full document.
Will Nutland proposes that instead of the Hollywood style ‘end of AIDS moment’ fantasy, the end of AIDS will be a process with a number of emerging endpoints. In this eye-opening talk, Will introduces a number of emerging treatments and discusses their efficacy and levels of acceptability. He surmises that the end might happen without us even noticing.
The short answer is yes and no.
The announcement recently that the Victorian Government would fund places for 2,600 people to participate in a trial that would provide them with free Pre-Exposure Prophylaxis – or PrEP – came close on the heels of the decision late last year by the New South Wales Government that it would similarly fund 3,700 places in that jurisdiction. The Queensland Government is currently considering a scheme that would offer 1,000 places.
So, on the surface it would seem that if you are a gay or homosexually active man living on the East Coast and are at risk of acquiring HIV, you have a fairly good chance to access PrEP for free. There are, after all, 7,300 potential places in total. If you live in WA, not so much.
As for Western Australia, the Kirby Institute estimates that there are 1,200 homosexually active men that would meet the guidelines (i.e. the guidelines in place in New South Wales and Victoria). However, there has still been plenty of progress here. We remain the only jurisdiction where the Government has issued an Operational Directive that means that if a patient meets criteria indicating heightened risk of acquiring HIV, they should be prescribed it. But, this means paying the un-subsidised costs of Truvada™ which amount to more than $1,000 for one month’s supply. Alternatively, they can privately import a generic version at a cost of under $100 per month. Even this will be a barrier to some who need this bio-medical prevention that research is increasingly showing as both safe and highly effective if used correctly.
Following the first PrEP forum in November, facilitated by the WA AIDS Council, it is clear that our community needs much more information about the potential benefits and access options. A second forum is scheduled for February. Meanwhile, we continue to talk to the Government about any possibility of funding for a PrEP access trial. M Clinic provides information on a variety of social media and internet sites and gay men who want to think about whether PrEP is a suitable option for them can meet with trained peer educators to discuss it.
A small but growing number of gay men in WA are already privately importing the medication, but as the number of new HIV infections remains at historically high levels, it is clear that many more can benefit. We have a Government recommending its use when indicated and community resources offering expanded support. We’ve come a long way in twelve months and we have a way to go. We are behind in terms of cost, but less so in terms of access.