A drug that prevents HIV infection has been confirmed as highly effective in real-world prevention, according to a study.
The study, which focused on 24,000 individuals across England taking the drug, has been described as “reassuring”. Currently, thousands of people access PrEP through sexual health clinics.
HIV charity the Terrence Higgins Trust is advocating for easier access to PrEP, highlighting that many, including women, are unaware of its existence.
The PrEP Impact Trial, led by the UK Health Security Agency (UKHSA) and Chelsea and Westminster Hospital NHS Foundation Trust, represents the largest real-world study of its kind.
Funded by NHS England, the trial was conducted at 157 sexual health clinics from October 2017 to July 2020.
The study confirmed that PrEP (pre-exposure prophylaxis) reduced the risk of HIV infection by approximately 86% under real-world conditions, accounting for inconsistent or incorrect use—consistent with clinical trial findings indicating 99% effectiveness.
Dr. John Saunders, a consultant in sexual health and HIV involved in the study, emphasized its significance: “This trial further demonstrates PrEP’s effectiveness in preventing HIV transmission on a large scale through routine sexual health services in England.”
The Terrence Higgins Trust welcomed the study’s findings but stressed the need for greater access and awareness, particularly among marginalized groups.
Debbie Laycock, head of policy, noted, “We believe there are specific communities and individuals who could benefit from PrEP but are not currently accessing it. Many women simply do not know that PrEP exists.”
She urged for PrEP to be available in pharmacies and online to broaden access.
Dr. Saunders highlighted that beyond clinical efficacy, the study provided crucial insights into usage patterns:
“Previously, we lacked data on uptake and adherence. Now, we can identify who is being prescribed PrEP and work with clinics to encourage more widespread use.”
Harry Dodd, a participant in several PrEP trials, described the drug as “empowering,” freeing him from the fear of HIV infection: “I haven’t worried about HIV for nearly a decade, and that’s liberating.
I’ve had long-term partners with HIV since starting PrEP, which wasn’t even a consideration before. It’s given me the confidence to love without fear.”
While acknowledging some reluctance due to its association with sexuality, Dodd believes PrEP could help destigmatize HIV.
The UKSHA highlighted PrEP’s role in achieving the government’s goal of zero HIV transmissions by 2030 but stressed the need for increased uptake, noting that while gay and bisexual men are primary users, other groups like straight women could benefit.
PrEP, containing HIV treatment drugs tenofovir disoproxil and emtricitabine, prevents HIV from entering and replicating within the body. It can be taken daily or on an event-driven basis.
The decision to make PrEP widely available on the NHS in England in 2020 was informed by earlier research, including findings from this trial and previous clinical studies.
Published in Lancet HIV, the delayed release of this study’s results reflects its extensive sample size and rigorous peer review process.
John Stewart, National Director for Specialised Commissioning at NHS England, and co-Chair of the PrEP Impact Trial Oversight Board, celebrated the trial’s impact:
“Not only did it prevent numerous cases of HIV and normalize PrEP usage, it helped eliminate stigma and paved the way for a clinically and cost-effective PrEP service commissioned routinely.”
Stewart added, “We are delighted that PrEP has proven highly effective in reducing HIV risk, available at no cost through sexual health services.”
