In 2019, the previous government committed to eliminating HIV transmission by 2030 [1]. An action plan was developed [2] and a funding commitment made for opt-out HIV testing in hospital A&Es. However, an analysis by UCL [3] found that we are unlikely to achieve the 2030 goal with the current prevention efforts, despite an estimated 77% decline in HIV incidence between 2014 and 2022.
PrEP (pre-exposure prophylaxis) refers to the use of antiretroviral drugs by HIV-negative people to prevent transmission. In 2016, the PROUD study, an extensive PrEP trial in GBMSM (gay, bisexual and other men who have sex with men) found that PrEP was effective at reducing HIV transmission rates [4]. Since then, PrEP has become available from NHS-run sexual health services (SHSs) to anyone of any gender at risk of HIV and the recent UCL model [3] found that PrEP has played a crucial role in reducing HIV transmission.
It is not clear how many additional people not currently using PrEP might benefit from its use. In the past couple of years, the UK Health Security Agency (UKHSA) have published data on the number of people using PrEP and with PrEP need among those attending SHSs (data collated as part of the GUMCAD surveillance system) [5]. What these data cannot tell us is the number of people with PrEP need who are not accessing such services.
Aquarius was asked to calculate the overall number of people with PrEP need in England and estimate the unmet need. Last month, our Managing Consultant, Dr Susie Huntington presented the preliminary findings of this work at the HIV Prevention Conference in London. The conference, commissioned by the Department of Health and Social Care and organised by the Terrence Higgins Trust (THT) was attended by many working in the field of HIV prevention including clinicians, advocacy groups, charities and researchers.
Our analysis shows a large unmet need for PrEP disproportionately affecting people in some population groups and ethnicities. The findings were well received with a number of panel members stating that the numbers were not a surprise. We intend to publish the full results in a peer-reviewed paper later this year and hope that this evidence can support future efforts to reduce the gap between PrEP need and PrEP use.
References
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- Department of Health and Social Care. Let’s pledge to do our part to end HIV. Jan 2019. Accessed August 2024 www.gov.uk/government/speeches
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- Department of Health and Social Care. Towards Zero: the HIV Action Plan for England – 2022 to 2025. December 2021 www.gov.uk/government/publications
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- Cambiano et al, Lancet HIV 2023; 10: e713–22. https://pubmed.ncbi.nlm.nih.gov/37923485/
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- McCormack et al, Lancet 2016; 387: 53–60 Online paper
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- UKHSA. HIV testing, PrEP, new HIV diagnoses and care outcomes for people accessing HIV services: 2023 report. Updated 6 October 2023. https://www.gov.uk/government/statistics