HIV has profoundly impacted public health. Currently, 36.7 million people live with HIV worldwide and over 100,000 in the UK. According to data from Public Health England (PHE), an estimated 6,000 people were newly diagnosed with HIV in the UK in 2015 and 13,500 people not yet diagnosed.
Increasing awareness, swift diagnosis and provision of antiretroviral therapy for people who are diagnosed is crucial to prevent onward transmission of HIV and end the HIV epidemic. These aims were highlighted in the United Nations Programme on HIV and AIDS (UNAIDS) 90-90-90 global target and the latest World Health Organization (WHO) recommendations on HIV treatment and prevention.
The UNAIDS 90-90-90 target states that by 2020:
- 90% of all people living with HIV should know their HIV status
- 90% of those with diagnosed HIV infection should receive antiretroviral therapy
- 90% of those who receive antiretroviral therapy should have viral suppression
The WHO recommendations published in 2015 stated that:
- Everyone living with HIV should be offered antiretroviral therapy, regardless of their CD4 cell count
- Daily oral pre-exposure prophylaxis (PrEP) is recommended for people with a substantial risk of HIV infection as part of combination prevention approaches
HIV Testing and Treatment in the UK
To reach the first UNAIDS 90% target, PHE expanded free and accessible HIV testing to a range of settings such as sexual health clinics, general practice surgeries, pharmacies and home-testing kits. PHE raised awareness of HIV testing through several education campaigns.
The UK is working towards the WHO recommendation of getting 90% of all people diagnosed with HIV on treatment. Before 2015, most people living with HIV started antiretroviral therapy when their CD4 cell count fell below 350 cells/mm3. The British HIV Association now recommends that anyone living with HIV start antiretroviral therapy as soon as possible, regardless of their CD4 cell count.
Actions to increase the HIV testing and adopt the early antiretroviral treatment programme have shown promising results – the UK achieved 87-96-94 compared to the 90-90-90 target in 2015. Although the UK has not hit the goal for the first target, steady progress has been seen – the proportion of people living with HIV knowing their status has climbed 5% since 2013.
Steps toward Preventing HIV in the UK
While there have been advances in diagnosis and treatment of people with a known infection, PrEP is not currently offered across the UK. This is despite the recent UK-based PROUD trial demonstrating that daily oral PrEP could reduce the risk of HIV infection by 86%. However, the UK is moving forward to align with the WHO recommendation for PrEP. NHS Scotland approved the provision of PrEP in April 2017. Encouragingly, after a year-long debate, NHS England also announced the launch of the large-scale PrEP Impact Trial in 2017 to understand how to sustainably implement PrEP for HIV prevention on a substantial scale in England. NHS England will partner with over 200 sexual health clinics across England, local authorities and PHE to implement the outcomes from the trial as part of a wider national rollout.
Aquarius Population Health research evaluates how to best support people living with HIV in the UK and Europe. We examined the optimal frequency of clinic visits for stable HIV patients and the impact on NHS England and estimated the impact of splitting fixed dose antiretrovirals. Our HIV experts endeavour to contribute to the combat against the HIV epidemic.
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