In the last two weeks, several countries have announced that they will soon launch pre-exposure prophylaxis (PrEP) programmes. On 19 May, Belgium announced that it would start rolling out PrEP provision and had set aside €1 million to pay for it. Aidsmap.com had learned this will be introduced gradually from 1 June. Two hundred Belgian men who have sex with men are already enrolled in a PrEP demonstration project, Be-PrEP-ared.
Belgium will use differential pricing, a scheme which has been dismissed as impossible elsewhere. While Truvada (tenofovir/emtricitabine) will be free to HIV-positive people who need it as treatment, PrEP users will pay a subsidised price of €11.90 for a 30-day supply (the full list price of Truvada there is €527.40 for 30 days).
On 24 May, Brazil announced that it had given itself a deadline of six months to start offering PrEP free of charge to those in need of it via its national Unified Health System.
At a video press conference during the World Health Assembly in Geneva, Brazilian Health Minister Ricardo Barros said that the Ministry of Health will invest $1.9 million to purchase 2.5 million tenofovir/emtricitabine tablets. According to Hornet’s news blog, this could provide daily PrEP for 6849 people, implying a price of €23 a month for generic drugs.
On 29 May, Portugal announced that it too was taking steps to roll out PrEP. It is considering waiving fees normally paid for consultations and examinations for people at high risk of HIV and allowing them direct access to HIV treatment centres without having to be referred through primary care – the same status already accorded to people with HIV.
Deputy Health Minister Fernando Araújo said he was giving the Ministry a deadline of one month to evaluate the cost of fee exemption for people eligible for PrEP and to devise arrangements for monitoring and evaluating a PrEP programme.
Meanwhile, on 26 May, Morocco announced an implementation trial of PrEP. Initially, PrEP will be provided to 300 people judged to be at high risk of HIV – 100 each in the three highest-prevalence cities, Agadir, Casablanca and Marrakech. PrEP will be financed by the Ministry of Health with the support of the Global Fund, which has negotiated a price for generic drugs of only $5 a month. Although this is only a small study initially, Morocco is the first country in the Middle East and North Africa region to authorise PrEP.
These announcements underline the fact that the introduction of PrEP will look very different in different countries, varying according to national resources and how health systems work. So far, Scotland and Norway have announced that PrEP will be free at point of demand; France provides PrEP with any fees charged upfront usually reimbursible, though in some situations co-payments may be required; in the US PrEP is dependent on the agreement of public or private insurers. In the lower-income world, PrEP in countries like South Africa and Kenya is initially being provided to specific high-risk populations; in Thailand, users have to buy PrEP, which is available for about $1 a day, but clinics provide monitoring and testing for free.