New HIV diagnoses in Brighton & Hove have fallen by half since 2013, according to a poster presented at the joint British HIV Association (BHIVA) and British Association for Sexual Health and HIV (BASHH) conference in Edinburgh last week.
Between January 2015 and September 2017, new diagnoses at the 56 Dean Street clinic in London fell by 80%, with similar trends seen at four other London clinics: the Mortimer Market Centre, Burrell Street, Homerton Sexual Health and St Mary’s. These falls have been attributed to more frequent testing in gay men at greater risk of infection (56 Dean Street has special arrangements for some patients to facilitate this), those men who are diagnosed beginning HIV treatment immediately (and therefore becoming uninfectious very quickly) and the clinics supporting men to use pre-exposure prophylaxis (PrEP).
The situation in Brighton appears to be a little different, although its HIV services might be assumed to serve a similar population to those attending the London clinics mentioned. Brighton & Hove is a city on the south coast of England with a large gay population and the highest UK prevalence of HIV outside London.
In Brighton & Hove, the numbers began falling two years before they did in London. At the beginning of 2013, there were around six diagnoses each month in the city, with the average steadily falling to a little over two a month in late 2017. The fall since 2015 (the period when diagnoses began falling in London) has not, in itself, been statistically significant.
Repeat HIV testing among gay men at higher risk of HIV infection has not increased as much in Brighton as in London. Instead, Brighton clinicians think that long-term work to improve HIV diagnoses outside of sexual health services may have paid off. Education and awareness events with GPs and hospital clinicians working in other areas of medicine have resulted in steady increases in diagnoses made in other healthcare settings.
This has happened against a backdrop of:
- Rapid initiation of treatment after diagnosis (92% start treatment within 90 days of diagnosis, compared with 76% nationally)
- Almost all diagnosed individuals taking treatment (98%) and having an undetectable viral load (98%)
- Less late diagnosis (34% diagnosed with a CD4 count below 350) than the national average (38%)
- Very few people dropping out of care or being lost to follow-up (0.5%, compared with 2.6% nationally)
- Around 370 gay men taking PrEP and seeking clinical support for it.
“In contrast to the steep fall in London clinics, the absence of a continued fall after 2015 in Brighton may in part be due to a relative lack of increase in repeat testing in high risk MSM,” say the authors. “If extra resources were available to tackle this, the decline could continue and investment is likely to be cost effective.”
Cavilla S et al. An earlier fall in new HIV diagnosis seen in a local centre prior to the 2017 PHE data for large fall clinics in London. Fourth Joint Conference of the British HIV Association (BHIVA) with the British Association for Sexual Health and HIV (BASHH), Edinburgh, April 2018, abstract P324.