NICE, the body which produces guidelines for which treatments are available within the NHS, has published draft guidance that does not recommend the use of the first available long-acting injectable form of PrEP, Cabotegravir. PrEP is medication which can be taken to prevent a person from acquiring HIV. Currently, it is only available as a pill in the UK, however, some people who are at risk of acquiring HIV cannot take oral PrEP, or struggle with taking a daily pill.

For these people, a long-acting, injectable alternative could provide significant benefits. However, NICE in their draft guidance have not recommended Cabotegravir long-acting (CAB-LA), a form of injectable PrEP, which is administered every two months.

A wide range of HIV organisations have come together to express concerns over the draft guidance and highlight how important long-acting PrEP will be in the UK’s historic goal of ending new cases of HIV in the UK by 2030.

The HIV sector responds to NICE’s draft decision to reject Cabotegravir (CAB-LA)

As HIV charities, communities and health care professionals, we are deeply disappointed by NICE's draft decision not to recommend Cabotegravir long-acting (CAB-LA) as an HIV prevention option.

Alongside currently available prevention tools, CAB-LA is an innovative, effective and much-needed alternative for individuals who struggle with accessing or adhering to daily oral PrEP.

It is important that NICE has recognised injectable PrEP as a valuable option. We will be responding fully to the areas raised for the next round of the NICE consultation and will demonstrate the overwhelming value and merits of long-acting PrEP options in preventing HIV transmission. We will also be writing directly to ViiV to express our strong desire for a solution to be found for timely and affordable access to CAB-LA.

The HIV Action Plan and PrEP roadmap acknowledge the pivotal role PrEP must play in ending new HIV cases by 2030 and the significant differences in PrEP need and uptake among marginalised communities. Both highlight that availability of PrEP beyond sexual health clinics and different modes of PrEP delivery, particularly long-acting PrEP, will improve uptake, acceptability and adherence. For many, especially gay and bisexual men and other men who have sex with men, daily PrEP pills are highly acceptable, well-tolerated and cost-effective for the NHS to administer. There are however significant inequities to PrEP access and social inequalities which mean that for many groups, oral PrEP options have not been able to bridge these divides.

CAB-LA has the potential to significantly benefit other groups, including women, homeless people, the prison population, transgender and gender diverse individuals, and others currently underserved by existing prevention options. These communities are known to be more likely to acquire HIV and to face barriers to healthcare and oral PrEP. CAB-LA provides a discreet, long-acting alternative that could help address these unmet needs. The fact that other, longer-acting drugs are in the pipeline means that even more prevention options will be coming soon. But in the meantime, CAB-LA could help to bridge a significant gap for those who could benefit.

We are working with key stakeholders from the HIV community to discuss next steps and ensure as many voices as possible are heard in this vital conversation. We all remain committed to ending new HIV cases and tackling health inequalities and will continue to advocate for timely, affordable access for long-acting PrEP options for the communities that can benefit.

Terrence Higgins Trust

Actionplus Foundation

Africa Advocacy Foundation

BHA for Equality

⁠British Association for Sexual Health & HIV

The Brunswick Centre

The Eddystone Trust

⁠NAZ

⁠National AIDS Trust

Renaissance UK

⁠Sophia Forum

⁠UK Community Advisory Board (UK-CAB)

Manoel Filho, Community expert for NICE consultation on guidance for cabotegravir for preventing HIV-1