National Antiviral Service Cymru (NAVS)
The National Antiviral Service Cymru (NAVS) is co-ordinating the supply of treatments for COVID‑19 for the most vulnerable individuals across Wales who have not been admitted to hospital.
Information for Healthcare Professionals
The following information and resources are aimed at healthcare professionals. Members of public can access information about the National Antiviral Service (NAVS) from this site.
National Antiviral Service Pathway
The NHS Wales National Antiviral Service Referral Pathway provides a consistent way of triaging and assessing individuals for either an oral antiviral preparation, or referral to the local health board within which they reside for an infusion of a neutralising monoclonal antibody (nMAB).
National Antiviral Service Treatment Options Evidence Review
The NHS Wales National Antiviral Service Clinical Group has undertaken an evidence review and issued recommendations on COVID-19 treatment options for use in the community in Wales, following the change in the World Health Organisation (WHO) guideline in September 2022.
A decision aid (only accessible from an NHS Wales networked computer) has been developed to help maximise Paxlovid▼® use.
The eligibility criteria are specified in the UK-wide Clinical Commissioning Policy and are available in this NAVS table.
Healthcare professionals should use the information in the UK-wide Clinical Commissioning Policy to decide whether a patient is likely to be eligible for treatment. Where a healthcare professional considers a patient may be eligible for treatment, they can refer them for review by NAVS via an online portal. Patients can self-refer via the Self-Referral Portal or can call NHS 111 Wales.
Patient Group Directions (PGDs)
The national COVID-19 treatment PGD templates are available below. The sotrovimab PGD template is for adaptation by local health boards.
The national COVID-19 treatment PGD for oral antivirals is being run centrally for the whole of Wales within Cardiff and Vale University Health Board by the National Antiviral Service (NAVS Cymru). Copies of the PGDs are provided for information.
UK-wide Clinical Commissioning Policy Documents
The latest clinical commissioning policy documents can be accessed via the All Wales Therapeutics and Toxicology Centre (AWTTC ) COVID-19 therapies – alerts and advice page; under the ‘Neutralising monoclonal antibodies or antivirals’ section
COVID-19 “Rebound” associated with Paxlovid▼® treatment
Cases of COVID-19 rebound following treatment with nirmatrelvir/ritonavir have been noted. The NAVS team have been involved in highlighting case reports, which you can read more about in this Journal of Infection letter.
- Coulson JM, Adams A, Gray LA, Evans A. COVID-19 “Rebound” associated with nirmatrelvir/ritonavir pre-hospital therapy. J Infect. 2022; S0163-4453(22)00363-2. Online ahead of print. doi: 10.1016/j.jinf.2022.06.011
This recorded webinar focuses on the NHS Wales community deployment of neutralising monoclonal antibodies (nMABs) or antivirals for non-hospitalised patients with COVID-19.
Other useful resources
- Summary of Product Characteristics (SmPC) – Xevudy®
- Summary of Product Characteristics (SmPC) – Paxlovid®
- Summary of Product Characteristics (SmPC) – Lagevrio®
- NHS Medicines A to Z
- University of Liverpool COVID-19 Drug Interactions Checker
- NHS Specialist Pharmacy Services (SPS): medicines interactions with nirmatrelvir and ritonavir (Paxlovid®)
- PANORAMIC trial website
26 Oct 22 Paxlovid PGD updated. Decision aid link added.
25 Oct 22 Paxlovid PGD updated. Treatment options evidence review added.
07 Sep 22 NAVS Referral Pathway added, eligibility criteria and PGDs updated.
11 Jul 22 Webinar link added.
01 Jul 22 Eligibility criteria and PGDs updated.
22 Jun 22 COVID-19 “Rebound” article added.
06 Apr 22 Published.