Preparing for PrEP; the cost of delaying universal access in England.

OBJECTIVES: Pre-exposure prophylaxis (PrEP) is not commissioned within National Health Service (NHS) England. Individuals can access it privately online or by enrolment into a clinical trial. We established a list of individuals not enrolled in trials, awaiting PrEP. In response to the observation that patients awaiting PrEP trials were being referred with newly diagnosed HIV, we aimed to measure attendance, incident HIV, STI acquisition and missed opportunities for prevention. METHODS: The search was conducted for patients on the list from November 2017 to November 2019. We examined the electronic clinical records of those on the list and extracted demographic information, STI and HIV diagnoses. In addition, for those diagnosed with HIV, we reviewed risk factors including chemsex and prior postexposure prophylaxis. RESULTS: There were 1073 patients on list, and 520 (48.6%) were still awaiting recruitment in a PrEP trial. Eight (0.75%) had an enrolment appointment booked while 200 (18.64%) had been contacted and deemed ineligible according to PrEP trial criteria. 45 (32.15%) had not responded to contact. We identified 15 new HIV infections in patients awaiting PrEP. Of these, 9/15 (60.00%) did not meet eligibility criteria at point of contact, though had been eligible at first referral. CONCLUSION: It is unacceptable that 15 patients acquired HIV while waiting. The individual lifetime cost of treating HIV is estimated at £360 800(1). This equals £5 412 000 for these 15 infections notwithstanding the psychological and physical burden. We advocate the immediate role out of universal PrEP for those who need it on the NHS. While this decision is delayed, harm is coming to those waiting. Wider provision of PrEP may encourage increased attendance, but must consider additional resources to accommodate added visits. We are relieved that at the point of final submission (21 March 2020) NHS England have recently announced funding of PrEP for eligible patients from, further details are pending.

The infusion nurse's role in precertification.

Gibbs Regional Cancer Center, a comprehensive cancer center, is part of the Spartanburg Regional Medical Center located in Spartanburg, South Carolina. Palmetto Hematology Oncology PC, located within the Gibbs Regional Cancer Center, is a private practice infusion therapy center owned by six physicians serving upstate Carolina residents. The practice has been successful in using precertification to confront complex reimbursement issues, complicated treatment methods, and demanding practice measures to ensure quality cancer care for patients. In the past 18 months, Medicare reimbursement guidelines for medications offered to patients at nonhospital infusion outpatient centers have been cut, and the future reimbursement criteria are uncertain. These cutbacks have caused other infusion centers to close or change practice guidelines. Precertification at Palmetto Hematology Oncology PC has trimmed treatment losses, increasing the focus on patients. Precertification of patients is not a new idea, but a new approach involves nurses in the process to help keep physician-owned practices afloat in this insurance-driven market. This article shares the value of precertification in an outpatient infusion center and the role of nurses in this process.