Dr Alison Brown. Public Health England. 15 th Annual Conference of the National HIV Nurses Association (NHIVNA)

Transcription

1 15 th Annual Conference of the National HIV Nurses Association (NHIVNA) Dr Alison Brown Public Health England June The International Convention Centre, Birmingham

2 The UK HIV Epidemic: where are we now? Dr Alison Brown Centre for Infectious Disease Surveillance and Control

3 Annual HIV and AIDS diagnoses and deaths: UK, The UK HIV epidemic where are we now?

4 HIV prevalence: UK, 2011 Concentrated epidemic 96,000 living with HIV 25% unaware of infection People living with HIV /1,000 population All 1.5 MSM 47 Black African 37 Highest number reported This is good and bad news 4 The UK HIV epidemic where are we now?

5 Good news: PEOPLE LIVING LONGER WITH HIV

6 Number living with diagnosed HIV infection by age group, UK, People promptly diagnosed with HIV infection can expect a near normal life expectancy Nakagawa AIDS : The UK HIV epidemic where are we now?

7 Good news: PROVISION OF HIV CARE IN THE UK IS EXCELLENT

8 Adults with diagnosed HIV by residential deprivation: England, 2011 HIV prevalence per 1,000 population London 0.00 Most 2nd most deprived deprived Index of multiple deprivation Rest of England 3rd most deprived 4th most deprived Least deprived 8 The UK HIV epidemic where are we now?

9 Quality of care indicators for HIV patients: UK, 2011 Indicators Aim Result Link to care CD4 cell count taken within three months of diagnosis Retention in care - all patients Adults seen for HIV care in 2010 and also seen in 2011 Viral load outcome Viral load <50 copies/ml within 12 months of starting ART ART coverage CD4 cell count <350 cells/mm 3 prescribed ART CD4 outcome CD4 cell count 350 cells/mm 3 after at least 12 months in HIV care 96% 96% 87% 88% 83% 9 The UK HIV epidemic where are we now?

10 Quality of care indicators: no difference between population groups Link to HIV care: Proportion* of adults with a CD4 count within one and three months of HIV diagnosis, UK, % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Men Women The UK HIV epidemic where are we now? White Black Sex Age group Ethnicity Exposure Region Other Ethnicity Heterosexual men Heterosexual women MSM PWID CD4 count within: 1 3 months of diagnosis London Outside London Total

11 11 The UK HIV epidemic where are we now? The UK Treatment Cascade

12 Bad news: HIV TRANSMISSION IS CONTINUING

13 New HIV diagnoses by exposure group: UK, The UK HIV epidemic where are we now?

14 14 The UK HIV epidemic where are we now?

15 HIV diagnoses by estimated proportion UK-acquired: The UK HIV epidemic where are we now?

16 New HIV diagnoses by exposure group: UK, The UK HIV epidemic where are we now?

17 Birrell et al Lancet Inf diseases The UK HIV epidemic where are we now?

18 Distribution of HIV-infected MSM with viral load >1500 copies/ml, UK 2010 Undiagnosed, 62% Viral load <1500, 65% Viral load >1500, 35% Treated 5% Untreated CD4 <350, 5% Untreated CD , 12% Untreated CD4 >500, 16% Brown AE et al. HIV medicine in press 18 The UK HIV epidemic where are we now?

19 Bad news: HALF OF HIV DIAGNOSES ARE LATE

20 120 Adult deaths within 12 months by CD4 at HIV diagnosis, UK <350 >350 Men Women White Black Other Ethnicity Heterosexual men Heterosexual MSM PWID London Outside London Total Mortality rate per He UK HIV epidemic: where are we now?

21 Late diagnosisof HIV infection by Proportion diagnosed late1 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% exposure group: UK, 2011 CD4 <350 CD4 <200 0% MSM Heterosexual men Heterosexual women People who inject drugs Overall 21 The UK HIV epidemic where are we now?

22 Diagnosed HIV prevalence (aged by residence, UK, 2011 Less than London >2 22 The UK HIV epidemic where are we now?

23 WHAT NEXT?

24 Patient experience and behaviour RITA Return results back to patients 17% recent infection at Dx Questionnaire on recent risks Positive voices Sampling frame Satisfaction Barriers Behaviour 24 The HIV HIV epidemic- where are we now?

25 HIV&AIDS Reporting System: HARS 1. Quarterly, disaggregate and attendance based dataset 2. All service providers of outpatient services in England 3. Improves efficiency and enhances surveillance of HIV Service provider HIV & STI Web Portal Public Health Surveillance Service provider XML Verification PHE Aggregate commissioning outputs Service provider Validation Deduplication Quality of care indicators Errors or inconsistent information for correction 25 Introduction to HARS and the HIV Clinical Dashboard

26 HARS outputs Commissioning of services through PbR Improved surveillance outputs Clinical dashboards at Trust level 26 The UK HIV epidemic where are we now?

27 Summary Good news Bad news What next? Near normal life expectancy Relatively few deaths Health care provision excellent Outcomes show no difference by ethnicity/sexual orientation HIV transmission continuing Widespread HIV treatment has not reduced transmission Half of new HIV diagnoses are late presentations Black African heterosexuals most likely to be late diagnosed Strengthen programmes to reduce late diagnoses Changes in commissioning arrangements HARS new dataset to enhance surveillance Clinical HIV dashboards 27 The UK HIV epidemic where are we now?

28 Acknowledgements We gratefully acknowledge the continuing collaboration of clinicians, nurses, microbiologists, immunologists, public health practitioners, occupational health specialists and other colleagues who contribute to the surveillance of HIV and STIs in the UK.