Ensuring access to HIV care and treatment in London

With over 30,000 HIV positive patients receiving care in London, developing a plan to secure continued access to the best available treatment is critical.  There are over 25,000 HIV positive individuals on Antiretroviral Therapy (ARVs) in London, and up to 3,000 more starting each year. Antiretroviral therapy saves lives and is a cost effective treatment. London’s NHS spent over £170m on ARVs in 2009/10, and with more people going onto ARVs this spend will increase further.

By working together, the London HIV Consortium – which brings together clinicians, commissioners and patients – continues to get a good deal on HIV drugs. The ARV tender process this year means that considerable savings will be made to the bill for antiretrovirals, and these savings will be used to improve HIV services and pay for optimal treatment for all HIV infected individuals. 

With the clinical outcomes of a number of antiretroviral drugs now similar, HIV doctors and patients can ensure cost effectiveness of treatment without compromising the quality of care. HIV doctors will continue to ensure treatment is tailored to the needs of the individual patient and, where it is clinically appropriate to do so, will use the least expensive treatment option available. If the least expensive drugs are not clinically appropriate for a patient, then HIV doctors will select a different treatment that will keep the patient well and reduce their viral load to undetectable levels.

Building on existing treatment guidelines, London HIV doctors have produced some key messages for prescribers to ensure all patients in London continue to get the right treatment for them. All services will be working to these key messages to ensure equity of access to therapies across London. Led by clinicians, an audit to monitor the outcomes for patients will be undertaken.

Two HIV doctors - Professor Brian Gazzard and Professor Margaret Johnson – have led the clinical involvement in the process.  Professor Brian Gazzard, who chairs the London HIV Drugs & Treatment Sub Group said: “Good clinical care depends on the primacy of the consultation between doctor and patient. All doctors have a duty to give the best clinical care for the patient and this includes consideration of costs. Already HIV doctors work with patients to make sure treatment is effective and avoids unnecessary costs, such as avoiding wastage of drugs. All London clinics are working together to save money on the drugs bill to ensure services are improved and treatment is available for all in the future. Patients can be reassured that HIV doctors in London will continue to provide the best clinical care for all their patients and achieve excellent clinical outcomes”.

The plan to save money on antiretrovirals is part of a national drive to improve Quality, Innovation, Productivity and Prevention (QIPP) in NHS services. By bringing together clinicians, patients and commissioners, the London HIV Consortium aims to further develop its HIV QIPP programme to improve quality and productivity to secure access to care and therapy for all patients over the coming years.

To find out more about the prescribing messages for London, please see below.

To find out more from a community perspective, click here http://i-base.info/home/changes-to-hiv-drug-prescribing-in-london/