I propose to take Questions Nos. 1302 and 1304 together.
Ireland established a national HIV PrEP programme in November 2019, following a HIQA HTA, which concluded that the introduction of HIV PrEP would be safe, effective and cost saving. The HTA also found that significant investment in public STI services was required to implement PrEP and €5.4 million was set aside in Budget 2020 to roll out a national HIV PrEP programme, managed by the HSE Sexual Health and Crisis Pregnancy Programme (SHCPP).
At present, there are 13 public PrEP clinics in Ireland, four of which are located in Dublin, and 16 private/GP providers who are approved to prescribe PrEP, 15 of which are located in Dublin. Dispensing PrEP is free of charge, as are appointments at the public clinics, however, the private providers are subject to consultation charges.
Since the PrEP programme commenced in November, 2019, significant progress has been made in PrEP rollout across Ireland. However, this occurred at a time of unprecedented challenges for the health service - the pressures of the Covid-19 pandemic on access to clinical services, coupled with the effects of necessary Covid-19 restrictions on people's social interactions. This made it difficult to assess whether capacity would meet demand under normal circumstances, between 2020 and early 2022.
Furthermore, in line with international trends, the eligibility criteria for PrEP have recently been revised to include anticipated risk of HIV infection. This is likely to increase the overall numbers of individuals meeting the criteria for inclusion in the PrEP programme.
The relaxation of most Covid-19 restrictions, following the successful national vaccination campaign, has, in 2022-2023, permitted assessments that additional resources may be required to meet additional demand, build capacity and invest in monitoring, evaluation and research to ensure that the PrEP programme in Ireland is reaching those in need, responsive to changing need and at the cutting edge of international PrEP programme delivery.
The HSE SHCPP have put a number of measures in place to support the PrEP Programme, including updating the clinical PrEP Guidelines and approval processes and providing an e-learning module to enable greater access to the PrEP programme through GPs, allowing stable patients to undertake routine STI testing through the new home STI testing service, and working with other areas of the HSE to enable efficient data collection and identify resources to improve capacity.
Both my Department and the HSE SHCPP have identified monitoring and evaluation of the PrEP programme as a priority area of work, building on that which has been undertaken to date. Allocation of additional resources to support expansion of PrEP next year is a matter for the Estimates process leading to Budget 2024.
Development of the new National Sexual Health Strategy 2023 – 2030 is currently underway; capacity for PrEP during this wider time period will be further examined as part of the policy development process leading to the new NSHS.
In relation to the numbers of patients currently enrolled in the programme, the number of new applicants and research to understand unmet levels of PrEP need, as these are service matters, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
