Fast-track the end of AI​​​DS in the EU - practical evidence-based interventions. Presentation by: Cary James, Terrence Higgins Trust In a two-day meeting under the auspices of the Maltese Presidency of the Council of the European Union (30-31 January 2017), HIV experts from across the European Union discussed how to reverse this trend and how to prepare Europe to achieve the set target of ending AIDS by 2030.

1. Fast-track the end of AIDS in the EU
Practical evidence-based interventions

2. Facilitating testing and linkage
to care – the UK experience
Cary James – Terrence Higgins Trust/ HIV Prevention England

3. Terrence Higgins Trust (THT) is the UK’s leading HIV
and sexual health charity providing a wide range of
services to more than 100,000 people a year.
The charity also campaigns and lobbies for greater
political and public understanding of the personal,
social and medical impact of HIV and sexual ill
health.
HIV Prevention England is the national HIV
prevention programme, funded by Public Health
England and coordinated by THT.
Terrence Higgins Trust

4. UK Treatment Cascade
86% 94%96%
Diagnosed On treatment Undetectable
HIV in the UK 2016: Public Health England

5. HIV in the UK 2016: Public Health England

6. 1. Testing and linkage to care in clinical
settings in London
2. National home-sampling service
3. Piloting free national self-testing service
Summary
HIV in the UK 2016: Public Health England

7. Dean Street diagnoses
1 in 9 of all HIV in the UK
1 in 5 of all MSM in the UK
1 in 4 of all HIV in London
1 in 2 of all MSM in London
Source: Public Health England
Clinical testing
HIV in the UK 2016: Public Health England

8. 40% decrease in diagnosis
Almost exclusively MSM
0 200 400 600 800
HIV diagnoses 2015
2016

9. HIV in the UK 2016: Public Health England

10.  In the past year, Dean Street has adopted the San
Francisco ‘RAPID’ model of offering immediate treatment
 All HIV positive results offered an appointment with an
HIV doctor within 48hrs
 Important as 50% of new diagnoses are RITA
positive/seroconverting so immediate treatment turns the
‘most infectious’ into ‘non infectious’
 In the last 6 months 76% of people decided to start
treatment at their first medical appointment.
 Median time to starting ART is now 7 days (Compared to
21 days in San Francisco).
 Median time to ‘undetectable’ was 58 days for people
starting in July 2016 (Compared to 87 days in San
Francisco).
Linkage to care model

11.  That linkage to care and early initiation
of treatment (along with PrEP) may have
a large effect on HIV transmission in
London – watch this space!
Possible lessons learned

12. Where home sampling can
make a difference
Don’t perceive
risk
Perceive risk
but services
inaccessible
Perceive risk
but services
unacceptable
Perceive risk,
services
accessible and
acceptable but
won’t go
Courtesy of Dr Claudia Escourt

13. • HIV POSTAL
SAMPLING
4th Gen, finger-prick
home sampling: first
pilot in Jan 2013.

14. Feasible
Over 50,000 kits ordered
Return rates of >50%
Acceptable
96% recommend to a friend
97% would use the service again
“I didn’t want to attend STI service” – 52.2%
“Clinic opening times are inconvenient” – 47.7%
“Nearest clinic is too far” – 20.8%
Effective
HIV positivity >1.5%
Cost Effective
Total cost per test < €15.00
(including the test, lab costs, postage and marketing
via social and digital media. )
THT home-sampling service
2013-2015

15. Socio-demographics
of home sampling users*
THT home
sampling
GUM clinics
Aged under 25 35% 23%
MSM aged over 35 27% 36%
Major urban 39% 78%
Rural 25% 5%
*PHE Home Sampling Evaluation (12,485 kits)
SJ Westrop, T Hartney, M Brady, A McOwan and A Nardone

16. Source: Public Health England
All
Number of kits ordered 55726
Number of kits returned 29258
Return rate 52.5%
Reactive rate 1.1% (311)
National Home sampling results
(Oct 15 - Dec 16)

17. Testing history (Nov 15 - Sep 16)
Source: Public Health England

18. “I did the home test and can
thoroughly recommend it. I’d
always been too scared to go to
get tested elsewhere, so for a first
timer like me it was much easier.
My result was negative and as I
was so relieved and happy I was
able to get over my fear and
actually go and get tested at the
clinic for everything else.”
Service user

19.  Home sampling can increase testing at scale
and at low cost
 It is highly acceptable to MSM and black
Africans in England
 Digital and social media are effective and cost
efficient channels to generate orders
 The service tests people who would not have
tested otherwise
Some lessons learned from
postal home sampling

20.  Terrence Higgins Trust (THT) and Biosure UK designed
and delivered a pilot of national HIV Home Testing which
ran from June – August 2016.
 5000 tests were made available to MSM and Black Africans
 Promotion via Facebook and dating applications
 Participants asked to report their results to THT
Self testing pilot

21.  Self-tests are acceptable and desired
 Most users would tell THT their result if asked
 Most of those who tested positive linked
themselves into care before they were
contacted
 Like home sampling, social and digital media
are powerful tools to generate orders and
deliver tests.
Some lessons learned from
self testing pilot

22. 56 Dean Street
Dr Alan McGowen
Public Health England
Luis Guerra
Anthony Nardone
Valerie Delpech
Terrence Higgins Trust
Dr Michael Brady
Dominic Edwardes
HIV Prevention England team
Thank you
cary.james@tht.org.uk
Acknowledgements