PrEP Implementation in Israel: Background and 2019 Status

Background:

Israel is a country of notably low HIV incidence compared to other high-income countries. However, incidence among men who have sex with men (MSM) increased by 15% since 2016. PrEP was proven in randomized control trials to be effective in preventing HIV when taken properly. In 2015, the WHO recommended offering PrEP as an additional preventative measure in populations at high-risk for contracting HIV.

Objectives:

This presentation analyzes the epidemiological and economic data and describes the steps taken by the Ministry of Health in order to include PrEP as a prophylactic measure in Israel, and its subsequent roll-out.

Methods:

The process performed at the Ministry of Health for validating the use of PrEP in Israel was analyzed from a health policy perspective, including data regarding epidemiological trends and cost-analysis..

Results:

From 2015-2017, the MoH led discussions with civil and professional organizations and other relevant partners to determine the mechanisms of PrEP care. Simultaneously, the MoH prepared the clinical and pharmaceutical guidelines. The Health Management Organizations (HMOs) offered subsidized PrEP to their members, requiring a 300 NIS copayment per month. The MoH and Maccabi HMO conducted an evaluation of the first ten months of PrEP provision among Maccabi members as part of a longer retrospective analysis. Additionally, MoH performed a cost-utility of PrEP in Israel. In the MoH/Maccabi study, 38.4% of PrEP users displayed high adherence throughout the study. Cost-utility analysis found that drug prices would have to fall 90.7% in order to be cost-effective. Results from both studies were presented to the National Advisory Committee for HIV to determine PrEP’s priority in the national prevention strategy.

Conclusions:

Based on recommendations from these results, the ‘Basket of Care’ Committee decided not to include PrEP as a fully-covered medication under National Health Insurance in January 2019.