The RPS raised concerns over recently published guidance on the use of HIV drug PrEP that directed patients “unable or unwilling” to access it on the NHS to a website “not regulated by the General Pharmaceutical Council (GPhC)”.
The body highlighted that the website “gives the option of purchasing PreP via Bitcoin”.
Read more: HIV: Government ‘exploring’ making PrEP available in pharmacies
Published by the British Association for Sexual Health and HIV (BASHH) and British HIV Association (BHIVA) in September, the draft guidance was open for consultation until last week (November 26).
The guidelines currently recommend that clinicians “should signpost individuals” to this website not covered by the pharmacy regulator if they face barriers to accessing the drug at sexual health clinics.
They said that the site “offers support and advice and the ability to source the generic drug as safely as possible” and that “the discussion of self-sourcing PrEP online needs to be fully informed including risks and benefits”.
Read more: Green Party pledges to make PrEP available in pharmacies and online
But the guidance states that “generic manufacturers” who import into the UK “have their own quality control process [to] meet production standards that are considered satisfactory by the World Health Organization (WHO) and the US Food and Drug Administration (FDA)”.
And it added that “there is no evidence that PrEP bought online from the major suppliers into the UK is substandard” or that there is “counterfeit PrEP in circulation”.
Guidance must be “reviewed”
In its response published last week (November 26), the RPS stressed that “the prescribing doctors section states that there [have been] no updates to the website since 2019”.
“We are concerned for patient safety with this recommendation and would not want to set a precedent for patients buying POMs medication online,” it said.
The RPS also said that “the quality of online purchased medicines can be highly variable and the presence of carcinogens and active product cannot be assured.”
It called for the “purchasing PrEP” section of the guidance to be “reviewed”.
Read more: RPS: Make HIV drug PrEP available from community pharmacies
The RPS also highlighted that “there are recommendations for prophylactic treatment options [in the guidance] that are not yet licensed via the National Institute for Health and Care Excellence (NICE)”.
“There isn’t any highlight of the implications to the prescriber for prescribing off license or the practicalities of being able to acquire the medication”, it said, calling for these to “be included” too.
However, it added that it “generally” welcomes the expansion of PrEP eligibility and promotion and believes that the drug “should be available to collect from community pharmacies”.
“Welcome strong engagement”
BASHH said that its clinical guidelines are “developed by a thorough process including evidence and peer review and open consultation” and stressed that the PrEP guidance is “currently in draft form”.
“We welcome strong engagement with this process and all submissions to the consultation will be reviewed and considered carefully by the writing group, lead authors and editors prior to final publication,” it said.
And BHIVA chair Professor Yvonne Gilleece also stressed the “importance of public consultation” and said that “all feedback, positive and negative, is welcome”.
“It is important to recognise that patients will access PrEP through non-NHS routes, but as patient safety is paramount, NHS engagement will always be the preference,” she said.
Read more: Be PrEPared: How can pharmacists best support their LGBTQ+ patients?
Meanwhile, the Green party pledged to inject billions of pounds into primary care and “end new cases” of HIV by 2030 as part of its election manifesto earlier this year.
It said at the time that elected Green Party members would push for “access to the HIV prevention pill online, in pharmacies and from GP services” to “end new cases” of the disease”.
The promises came after the government announced plans to “explore opportunities” for making PReP “available in a variety of settings…including online, general practitioner services and pharmacies” in October last year.
