Over a month on from the PrEP Impact trial starting to enroll its first participants, good progress is being made with over 1,900 people now enrolled on the trial and receiving PrEP.
Over 35 clinics including sites in London, Brighton, Cambridge, Norwich, Leicester, Nottingham, Sheffield, Leeds, Manchester, Liverpool and Durham are now open for trial recruitment. All participating clinics are expected to open by April 2018.
An up to date list of participating clinics can be found on the trial website where people can find out if their local clinic is open to recruitment.
Most sexual health clinics are expected to take part in the trial, so people will be able to enroll at a local clinic when it’s ready. In order to avoid people travelling long distances to access PrEP, we are currently working with clinics and community groups to ensure everyone has the latest information on the trial and is aware that clinics across the country will be opening soon.
The PrEP Oversight Board held its latest meeting on 15 November where it welcomed Florence Labwo, the third lay member to join the group following a recent recruitment process. Florence brings over 20 years’ experience as a health and well-being advocate, specialising in sexual and public health and has worked extensively in the field of HIV prevention and support in East London.
Issues raised and discussed at the Board included:
- An update from the trial Sponsor on progress so far with participant recruitment and site openings, along with future projections.
- An update on work to define the principles which will guide any future re-allocation of trial places, in the event of some clinics quickly filling their allotted places.
- An update from lay representatives which included a request for the website to include information on when a trial site has reached its full allocation of places for gay and bisexual men, but where there are still places available for other groups.
- An update from Local Authority commissioners who raised the importance of regular communication between the trial organisers and local sites to help address local issues or problems that might arise.
- The need for the Board to continue to receive frequent updates on trial progress given that recruitment was taking place very quickly. In future a dashboard will be produced showing progress against key objectives and to help actively manage the allocation of places between sites and different participant groups.
- The need for continued regular communication from the Board to stakeholders – it was agreed that going forward, stakeholder updates would be sent out within one week of Board meetings where possible.
- A request for a proposal to come to the next meeting on raising awareness of the trial in groups other than gay and bisexual men, to ensure that as diverse a range of participants can be recruited to the trial as possible.
- An update on the launch of Public Health England’s HIV Prevention Innovation Fund which includes a number of projects related to PrEP.
The Board will meet again on 19 December and a further update will follow after that date.
For further information on the trial please visit the trial trial website.
Since the last meeting, the multi-agency stakeholders involved in this trial have been working hard to put all the building blocks in place to enable the coordinated opening of the first trial sites across five major cities.
We had hoped everything would be in place for the trial to launch in early September. Unfortunately, it has not quite been possible to complete all the necessary steps to achieve this which we know will be disappointing for all those eager to participate in this important research. We are working hard with all partner organisations to put the remaining pieces of the jigsaw into place and whilst we hope the first clinics will open their doors in the next couple of weeks we are confident that the trial will be up and running by the end of October.
As the largest single study of its type in the world, the PrEP trial is complex, involving well in excess of 100 organisations ranging from sexual health clinics, local authority commissioners, research bodies, a drug manufacturer, as well as NHS England and Public Health England. The key building blocks to getting the trial off the ground are:
- Obtaining ethical approval of the clinical trial protocol (completed)
- Ensuring the drug supply is ready for distribution (completed)
- Completing trial site feasibility assessments (completed)
- Training of trial sites in trial protocol and associated activities (launched and ongoing)
- Individual trial sites securing local commissioner approval for participation in research (in progress)
- Individual trial sites securing local research governance assurance sign off (in progress)
Commissioners and researchers are agreed on the importance of having a good geographical spread of trial sites right from the start, particularly to manage potential demand in the early days. That is why the St Stephen’s Clinical Research (SSCR) trial team having been focusing efforts on making sure trial sites across London, Brighton, Manchester, Liverpool and Sheffield, coordinate to be amongst the first to open their doors to potential participants. The remaining clinics across the rest of the country will follow closely behind over the next few months.
The trial website will be continually updated with information on which clinics are involved and ready to enrol participants and we will continue to provide stakeholder updates to inform people of progress.
New lay members of the Board
The Board is delighted to welcome Roger Pebody and Rob Cookson as lay representatives, following the recruitment process led by NHS England and PHE.
Roger has been an Editor at NAM / aidsmap since 2008, producing patient information materials, as well as information for professionals on HIV prevention and the social impact of HIV. He is currently a member of UK-CAB, a network for community HIV treatment advocates in the UK, and co-chair of the community advisory group for the SELPHI study of self-testing. He was also a member of the community engagement group for the PROUD study of pre-exposure prophylaxis.
Rob Cookson has worked at LGBT Foundation for 10 years and was appointed Deputy Chief Executive in 2015. He has been involved in the GM Sexual Health Network and HIV Prevention England as a board member, and having worked within the voluntary and community sector for 18 years, he brings a wealth of experience in patient and public involvement.
The Board agreed that it will appoint a third lay member to represent participants from other community groups that are expected to enrol in the trial, including BME, women and transgender groups. For an application pack please email firstname.lastname@example.org.
We continue to make progress preparing for the pre-exposure prophylaxis (PrEP) Impact Trial. The work being undertaken now will provide a solid base to deliver a robust study. The PrEP Programme Oversight Board provides governance to make sure the PrEP trial is as good as it can be and that it progresses as planned.
The Board met on 5 May and 2 June 2017, and the following key points were discussed:
- To ensure the trial is robust, plans including the protocol, financial impact and measurement of results were shared with the National Institute for Health Research (NIHR) for their input. Their constructive feedback at the June meeting will be incorporated into the final plans.
The Programme Oversight Board subsequently approved the trial protocol and budget, subject to consideration and, where appropriate, inclusion of NIHR’s suggestions, and once finalised the protocol will be submitted to a Research Ethics Committee for approval.
NIHR will continue to attend future meetings as advisors to the Board.
- A timeline for next steps will be produced by the trial team, co-ordinated by St Stephen’s Clinical Research, part of St Stephen’s AIDS Trust, who are working with researchers to co-ordinate and lead the trial.
- NHS England emphasised that the PrEP trial is a top priority for the organisation and is leading the drug procurement for the trial. A pre-tender procurement supplier event was held in April, which was well attended by a number of manufacturers. Because of the value of the contract, EU procurement rules apply and as such the formal Prior Information Notice (PIN) was published in the Official Journal of the European Union on 30 May 2017. The PIN invites interested parties to submit applications to provide the drug for the trial. NHS England expects to be able to confirm the award of the final contract by 31 July 2017, meaning trial drugs could be available from early August, in readiness for the trial to begin once ethics approval is received and trial sites are prepared.
- Budget discussions focused on the maximum sum available (up to £10m) and the research and drugs costs.
- Public Health England reported that all specialised genitourinary medicine clinics (i.e. level 3 sexual health clinics) were written to with information on the trial and have received notification from only one clinic to opt out. All other respondents have demonstrated a willingness to be included as a trial site.
- The importance of including laypeople at all levels of governance and decision- making was discussed and agreed. A recruitment process is underway to ensure lay representation at future meetings of the PrEP Programme Oversight Board and any working groups. Paul Martin of the LGBT Foundation has agreed to be an interim lay member until appointments are made.
- The need to ensure regular communications with stakeholders was discussed and the Board committed to producing an update following each meeting. A frequently asked questions document to address some of the more detailed queries that have been received will be available shortly.
The PrEP Programme Oversight Board will meet again in July and an update will follow.