Expanding Access to HIV Prevention: PrEP Finds a Permanent Spot in Dutch Healthcare
A Significant Step in HIV Prevention
From August 2024, the Dutch public health service, GGD, will begin offering the HIV prevention pill PrEP to those wishing to protect themselves from the disease. This move, announced by the outgoing Minister of Health Ernst Kuipers in a letter to the House of Representatives, will see PrEP care funded under the ASG scheme, similar to the existing coverage for other STD care. This development promises to cement PrEP’s place in the healthcare landscape.
PrEP Pilot to Full-Blown Program
Currently, a pilot program is in operation at the GGDs where PrEP is made available to individuals at high risk of contracting HIV, particularly men who engage in casual sexual encounters with other men. For 7.5 euros per month, these individuals receive a supply of thirty PrEP pills, which provides protection for a month, along with associated tests. The National Institute for Public Health and the Environment (RIVM) is leveraging this pilot to study the effects of PrEP on not only HIV but also other STDs, which PrEP does not prevent.
PrEP’s Impact on HIV Reduction
PrEP has proven to be a game-changer in the fight against HIV. The GGD Amsterdam, which serves a region that has historically recorded the highest number of infections, reported a staggering 95% decrease in infections since 2010. This decrease, from two hundred infections to just nine in 2022, is partly attributed to the introduction and use of PrEP.
Cost-Effectiveness of PrEP
According to recent research by the RIVM, PrEP is cost-effective. The prevention of a single HIV infection can save society hundreds of thousands of euros, given that HIV medication is reimbursed for life. Importantly, the use of PrEP has not been linked to an increase in other STDs.
Overcoming Limitations in the PrEP Pilot Program
One major issue with the ongoing pilot program is the limited number of spots (8,500), with about 3,000 individuals currently on the waiting list. These individuals can also approach their GP for PrEP, but not all GPs are willing to provide this care. Furthermore, the cost of the pills and tests have to be borne by the individuals themselves. Depending on the pharmacy, the cost of these pills can range between 10 and 60 euros per thirty, while tests can cost hundreds of euros per year.
Expanding Access to PrEP
The Health Minister has now announced that the maximum number of spots at the GGD will be removed next year. This will make PrEP at the GGD accessible to people outside the risk groups, such as women who have sex with bisexual men or people from countries where HIV is common. However, PrEP users will still have to bear the cost of the pills at the GGD. The Minister anticipates that this will amount to 30 euros per thirty pills, enabling more people to receive PrEP care. The ministry has allocated 7.1 million euros per year towards this initiative.
Reaction from PrEP Advocacy Group
PrEPnu, an advocacy group that has been campaigning for accessible PrEP for ten years, has welcomed the Minister’s new initiative. Jorian van Schagen, a board member of PrEPnu, expressed optimism about the large-scale use of PrEP. However, he expressed a desire to see PrEP included in health insurance plans, acknowledging that this would be a more politically challenging move.
Ensuring PrEP Availability Through GPs
The advocacy group also emphasized the need for PrEP to remain available through GPs. While the ministry may refer non-vulnerable PrEP users to GP clinics, it does not mandate GPs to provide PrEP care, which is a point of concern for the advocacy group.
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