APPENDIX 17
Memorandum by GlaxoSmithKline (SH 29)
INTRODUCTION
GlaxoSmithKline (GSK) believes that the publication
of the National Strategy for Sexual Health and HIV was very significant.
GSK welcomes this comprehensive document addressing serious public
health issues at a national level. However the company does have
some concerns with the strategy, and therefore welcomes the Committee's
inquiry.
The strategy itself is impressive in its breadth,
tackling a wide range of issues relating to the sexual health
of the nation. The concerns that the company has, relate specifically
to HIV care. The objective of this submission is to raise these
concerns. GSK's commitment to HIV care has been and continues
to be long term, and it is in this area that GSK feels the company
can really assist in the Committee's inquiry.
GSK's concerns fall into three areas:
— status of the strategy and funding;
— an insufficient focus on adherence;
and
— issues relating to HIV testing in
primary care.
THE STATUS
OF THE
NATIONAL STRATEGY
AND FUNDING
HIV is a serious communicable disease with rapidly
increasing numbers of new diagnoses. GSK is concerned that the
Sexual Health strategy does not have the status of a National
Service Framework, and therefore HIV care will not receive the
profile and investment it merits. GSK also has concerns regarding
the decision to mainstream the funding of HIV prevention, treatment
and care, and therefore the risk of monies being diverted to other
"priority" disease areas.
AN INSUFFICIENT
FOCUS ON
ADHERENCE
GSK is pleased to see that adherence is referred
to in the National Strategy as being important when treating HIV.
However we feel there is insufficient focus on this key area,
with no guidance on how the issue is to be addressed.
Adherence is complex and multi-factorial and
a key factor influencing the success of HIV treatment. HIV is
unique in that 95% adherence must be maintained continuously to
minimise the risk of developing drug resistant virus and subsequent
therapy failure.
Furthermore, once drug resistance has been established,
subsequent treatment may prove difficult with increased medical
costs as patients progress to more costly stages of HIV disease.
Poor adherence also poses a potential public health threat as
it may facilitate transmission of drug-resistant and cross-resistant
strains.
Building adherence support for patients via
multidisciplinary specialist teams is critical. It is important
to emphasise that this service requires specialist resource and
training. Tolerable regimens that fit with lifestyle, patient
education and patient involvement in treatment decisions are important
factors in achieving good adherence. The strategy should set a
recommendation at which service level this should sit.
The British HIV Association (BHIVA) is currently
developing guidelines on the establishment of core adherence support
services within clinical and community settings. GSK would like
to see this document link to the BMA Standards Document to provide
guidance on minimum standards for adherence support services.
ISSUES RELATING
TO HIV TESTING
IN PRIMARY
CARE
GSK supports the Sexual Health Strategy's aim
of increasing HIV testing uptake in communities at risk, by extending
testing to settings other than Genito-Urinary Medicine (GUM) centres.
However GSK believes that maintaining patient confidentiality
is critical. The company therefore believes this should not take
place in Primary Care due to concerns over patient confidentiality
in relation to the role of the GP in completing insurance company
questionnaires. In addition GSK believes the increase in workload
this may cause, and the amount of training that will be required
to provide pre and post-test counseling and adequate follow up
of those found to be HIV positive, would be a large burden on
primary care.
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