Development process

The SHPN HIV Clinical Leads recognises the need to minimise the budget impact of prescribing and dispensing of HIV treatment, whilst simultaneously maintaining excellent clinical outcomes.

The British HIV Association (BHIVA) produces evidence-based guidelines on antiretroviral therapy (ART) for the treatment of adult HIV-1 infection¹. This document is aimed at experienced HIV prescribers who are familiar with the content of the BHIVA guidelines and the wider issues relating to HIV prescribing. The BHIVA guidelines note that ‘there are limited cost-effectiveness data in the UK comparing different antiretroviral drugs and for this reason we did not include cost-effectiveness as an outcome in ART comparisons’.

Therefore, whilst based on the considerations of drug regimen efficacy, tolerability and safety, this guidance also takes into account the current cost of various ART drugs to NHS Scotland. These may differ from other parts of the UK. It is also recognised that the budget impact of HIV care can be reduced in a number of ways, of which drug costs are a single factor. This guidance shares wider best practice on cost-sensitive prescribing from NHS Boards, in order to deliver consistency of approach and minimise duplication of effort.

The original version of this guidance was developed by SHPN HIV Clinical Leads, with input from HIV pharmacists, procurement colleagues from National Services Scotland (NSS), and representatives from the HIV third sector and implemented in June 2017. It was updated in 2018 and 2019 with patient and third sector input, which was maintained for update in 2025.