HIV in London: A Complexity Challenge Professor Jane Anderson (Homerton University Hospital) and Dr David Asboe (Chelsea and Westminster Hospital) NHS England Clinical Reference Group for HIV Representatives for London HIV clinical service 17/05/2018 London Clinical Senate Forum 1
Percentage Percentage of residents with diagnosed HIV and accessing care by age group, London, 2007 and 2016 70% 60% 2007 2016 59% 50% 40% 45% 39% 30% 20% 19% 14% 17% 10% 0% 2% 0% 3% 2% <15 15-24 25-34 35-49 50+ Age group Source: Public Health England, Public Health England, HIV & AIDS Reporting System (HARS). 2 Annual Epidemiological Spotlight on HIV in London: 2016 data
Prevention Testing Link to care HIV specific Treatment Long term Care HIV: The pathway of care 17/05/2018 London Clinical Senate Forum 3
Commissioning landscape for HIV services before the 2012 reforms Prevention Testing and entry into care Ongoing treatment and care NHS organizations ( PCTs and specialist commissioners) held the budgets and the responsibility for almost all the HIV and sexual health Pathways Prevention Use of ART NHS Organisation Home sampling and testing Sexual health clinic testing Primary care testing Testing in hospital STI treatment Drug and alcohol treatment HIV support services HIV treatment Social care and some support services commissioned by Local Authorities Local Authorities HIV treatment Antenatal screening Testing in prisons Clinical nurse specialists Comorbidities Primary care Treatment in prisons ART, antiretroviral therapy; STI, sexually transmitted infection 1. Health and Social Care Act, 2012, UK Parliament. Crown Copyright, 2012; 2. Baylis A et al. The future of HIV services in England, the King s Fund, April 2017. Available at: https://www.kingsfund.org.uk/publications/future-hiv-services-england [Accessed September 2017]. 17/05/2018 London Clinical Senate Forum 4
Ccommissioning landscape for HIV services: From 2013 Prevention Testing and entry into care Ongoing treatment and care Health Reforms of 2012 1 divided responsibilities across the pathway > NHS England > Specialist > Section 7A > Local authorities > Clinical commissioning groups (CCGs) Prevention Use of ART Local authorities Local authorities or CCGs CCGs NHS England specialised commissioning NHS England or CCGs NHS England screening commissioning NHS England justice health commissioning Home sampling and testing Sexual health clinic testing Primary care testing Testing in hospital HIV treatment Antenatal screening Treatment in prisons STI treatment Drug and alcohol treatment HIV support services HIV treatment Clinical nurse specialists Comorbidities Primary care Treatment in prisons ART, antiretroviral therapy; STI, sexually transmitted infection 1. Health and Social Care Act, 2012, UK Parliament. Crown Copyright, 2012; 2. Baylis A et al. The future of HIV services in England, the King s Fund, April 2017. Available at: https://www.kingsfund.org.uk/publications/future-hiv-services-england [Accessed September 2017]. 17/05/2018 London Clinical Senate Forum 5
Health and Social Care Act: reforms 17/05/2018 London Clinical Senate Forum 6
London: risks to future quality of care include A lack of coherent planning Financial pressures across the health economy 2012 reforms make coordinated change difficult. A whole city plan with effective leadership is crucial to make the system work and build on success Along the whole pathway of prevention, treatment and care Partnerships that including focus on quality of life, peer support and social care. National bodies have keys roles to play Setting strategic direction and accountability Support for change Tackling stigma Baylis A et al. The future of HIV services in England, the King s Fund, April 2017. Available at:https://www.kingsfund.org.uk/publications/future-hiv-services-england [Accessed September 2017].
Activity in London: a partial snapshot. Local Government NHS England Public Health England Greater London Authority Do - It London Campaign (all boroughs) London Sexual Health Transformation Programme (27 boroughs) Review of HIV Services in London ( 28 services, X providers) HIV Clinical Forum STP workshops Clinical Reference Group Guidance, Data, Monitoring, Evaluation Sexual health facilitators Mayor s Health Inequalities Strategy 17/05/2018 London Clinical Senate Forum 8
Combination prevention in action 17/05/2018 London Clinical Senate Forum 9
The FTCI Commitment The HIV - Fast Track Cities Initiative Brings together ALL the organisations and communities involved in HIV prevention, treatment and support of people living with and at risk of HIV in London, to work together to ensure an inclusive and transparent whole-city approach to the delivery of the strategic aims. Joining a global network of cities to share experiences with other cities January 2018: London joins the initiative
There is no one right way. It is for local teams to make collaborative commissioning for sexual health, reproductive health and HIV a local reality 11
Prevention Testing Link to care HIV specific Treatment Long term Care HIV: The pathway of care 17/05/2018 London Clinical Senate Forum 12
Challenges Pre-exposure prophylaxis (PrEP) Management of co-morbidities in ageing cohort Well-being; provision of mental health services
Thank you Professor Jane Anderson (Homerton University Hospital) janderson@nhs.net and Dr David Asboe (Chelsea and Westminster Hospital) David.asboe@chelwest.nhs.uk HIV clinical service NHS England Clinical Reference Group for HIV Representatives for London 17/05/2018 London Clinical Senate Forum 14