First UK NHS PrEP support service launched at 56 Dean Street, Soho
Simon Collins, HIV i-Base
In October 2015, the NHS sexual health clinic at 56 Dean Street in Soho London made important changes to the private PrEP clinic that was launched two months earlier. This is the first clinic in the UK to run a free PrEP support service. 
The clinic is an appointment only service that runs from 11 am to 3 pm on Saturdays.
The free service includes the monitoring tests that are essential for anyone using PrEP. This includes testing for HIV, hepatitis B, liver and kidney monitoring and the option to test for other STIs. The clinics also includes advice and information on how to take PrEP and follow up visits.
As NHS England has not yet agreed to pay for PrEP, medication is currently only available as a private prescription (at £400 for 30 tablets).
However, generic PrEP is already becoming widely used as it is easy and legal to buy generic tenofovir/FTC online at much lower prices (£40 to £80 for 30 tablets, depending on supplier).
Several community websites (including i-Base and the excellent IwantPrEPnow.co.uk) already provide good information about how to do this. [2, 3]
The Dean Street PrEP clinic also offer drug level tests as a private service at £230. This is a blood test that can confirm whether someone taking generic PrEP has active drug levels of tenofovir.
It is important to note that there is little need for everyone using generic PrEP to have a drug level test, once an internet supplier has been confirmed as genuine. The option for this service is nevertheless important.
As neither of the private services are needed, people will now be able to access appropriate care on the NHS.
This clinic was set up in response to the growing demand for PrEP services following the results from the UK PROUD study and the French/Canadian IPERGAY study a year ago. Both studies reported dramatic reductions in HIV transmission from PrEP in gay men and transgender women at high risk of HIV. Both studies were presented as late breaker oral abstracts at CROI 2015.The PROUD study was published in the Lancet last month. 
Two prices are currently listed depending on whether medication is included as part of the service. The initial consultation, plus HIV, hepatitis B, kidney and liver tests are provided free.
- 30-day TDF/FTC prescription – £400 flat fee.
- For patients sourcing TDF/FTC elsewhere who want a drug level test – £230 flat fee.
For further details please see the clinic website.
It is significant that 56 Dean Street have developed this service in response to the growing use of off-label use of generic PrEP, as it provides essential safety support in an NHS setting.
Although this shows the the urgency for the NHS to decide on criteria for free access to PrEP for people at high risk, the relatively low cost of generic PrEP is likely to encourage many people to source PrEP independently.
Raising awareness of this option might also limit use of PEP services as a source of PrEP.
- PrEP services at 56 Dean Street.
- i-Base Q&A. How do I safely use PrEP if I buy it online?
- Where to buy PrEP. IwantPrEPnow.co.uk. (20 October 2015).
- McCormack S et al. Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial. DOI: http://dx.doi.org/10.1016/S0140-6736(15)00056-2.