PHE resources to support Sexual Health evaluation

Public Health England talk us through their latest resources to support evaluation in Sexual Health, Reproductive Health and HIV.

Have you ever wondered if what you’re doing in your service actually achieves what you set out to do? How do you know? For example:

We’ve introduced HIV home sampling, what impact has it had?

We need to reduce our late HIV diagnoses, what can we do and how do we know we’ve achieved it?

Public Health England (PHE) is often asked about what works and what is the ‘best way’ to achieve a desired outcome in the area of sexual health, reproductive health and HIV (SH, RH and HIV). In order to understand what innovations work well there is a need to evaluate interventions and projects. Evaluation is essential to identify successful innovations which should be promoted and, equally important, those that are less successful or could be improved before being implemented elsewhere.

A vast amount of literature and tools to guide evaluation exist. However, no support tools or repository exist specifically for SH, RH and HIV. PHE therefore developed the following resources specifically aimed at supporting evaluations in this sector:

  1. Introductory guide to evaluating interventions
  2. Evaluation workbook
  3. Menu of output/outcome measures in SH, RH and HIV

The introductionary guide explains what evaluation is, why you should evaluate, and the different types of evaluations you can choose from. The guide explains how to undertake an evaluation using the concepts of ‘theory of change’ and a ‘logic model’:

The theory of change defines the long term goals of your intervention, and then maps backwards to identify necessary preconditions, i.e. the shorter terms and intermediate steps leading to the long term outcomes.

A logic model is a diagrammatic representation of your theory of change. It identifies the inputs, activities, outputs and outcomes, all part of the overall evaluation of your intervention. The guide contains illustrative examples, for example a logic model of a condom distribution scheme.

The evaluation workbook is a pragmatic and easy to follow tool consisting of 16 questions about your intervention or project. The answers you provide to these questions lead to the second part of this workbook: the development of a logic model.

This identifies the inputs (resources or materials needed to deliver your intervention), the activities (the interventions provided by the service or programme), the outputs (amount of activity provided) and the outcomes (factors which are expected to change as a result of the activities). The final part of the workbook contains a suggested template to write up the findings of your evaluation.

The third part of the resources provides an overview of the current standards and quality measures in SH, RH and HIV. It includes for example quality standards (July 2018) from BHIVA, NICE, and BASHH, among others. These standards can assist you to choose indicators to help measure the impact of your intervention or project.

PHE has also published resources for the evaluation of general health and wellbeing projects and programmes, helping professionals increase their knowledge, understanding and capabilities in evaluating health and wellbeing projects.

These resources consist of a general overview, guidance summaries (collation of 48 guides and frameworks on evaluation of different topics), and useful training resources including video clips on different types of evaluations, logic models, intervention mapping and case studies.

Get ready for National HIV Testing Week 2018

National HIV Testing Week starts on Saturday 17 November 2018. The purpose of the week is to promote regular testing among the most affected population groups and to reduce the rates of undiagnosed people and those diagnosed late.

In the UK, people are testing more, staying protected by using condoms and pre-exposure prophylaxis (PrEP), getting diagnosed and starting HIV treatment earlier. Thanks to this combination approach, the UK is witnessing a substantial decline in HIV diagnoses.

However, too many are still diagnosed late, especially among heterosexual men and women.

National HIV Testing Week puts a national spotlight on HIV testing

This year’s campaign slogan is ‘Give HIV the finger: a finger-prick test is all it takes’, a continuation of last year’s successful creative. While the slogan is focused on the ease of testing, the campaign is an opportunity for partners to promote three key messages:

  • Testing is necessary to diagnose HIV and prevent onward transmission.
  • Testing is easy and accessible in the UK.
  • People can rest assured that, if diagnosed with HIV, they can access free treatment and support.

For full details on how to take part, see the campaign briefings below.

Campaign briefing for Sexual Health Commissioners, Directors of Public Health and other local decision makers [PDF]

Campaign briefing for HIV, Sexual Health and other community-based organisations [PDF]

Campaign briefing for Clinicians [PDF]

Campaign briefing for Faith Leaders and Communities [PDF]

Coming soon

From 17 October 2018, you can order information resources for National HIV Testing Week.

Our social media pack will be available shortly with images and videos for Facebook, Twitter and Instagram.

New HIV diagnoses continue to decline in the UK

New HIV diagnoses have fallen for a second consecutive year, the latest data from Public Health England (PHE) shows.

In 2017 a total of 4,363 people were diagnosed with HIV in the UK, a 17% reduction from the 5,280 diagnosed in 2016 and a 28% reduction from the 6,043 diagnosed in 2015.

PHE have attributed the latest results primarily to improvements in the uptake of antiretroviral therapy in people living with HIV and the large increases in HIV testing. Particular attention has been paid to men who chose to repeat HIV testing.

While these results are published against the backdrop of the roll-out of pre-exposure prophylaxis (PrEP) through the IMPACT trial, and the increase in predominantly gay and bisexual men accessing generic PrEP privately online, PHE advises that it is too early to know the size of impact this is having on HIV transmission rates.

Gay and bisexual men

PHE has advised that the continuing downward trend in new diagnoses is largely due to a decline in new diagnoses among gay an bisexual men: the rate in this group has decreased more than any other group affected by HIV, with a 31% fall since 2015. This drop is even more significant in London where new diagnoses fell by 44%, compared to 30% outside the capital.

Black African and Black Caribbean men and women

Numbers of new diagnoses in black African and black Caribbean heterosexuals have been falling steadily for almost a decade and experienced an even more dramatic drop of almost 25% in the last year – from 1, 040 in 2016 to 800 in 2017.

Other heterosexuals

In previous years this group had reported approximately 1,000 diagnoses per year. However, in 2017 the new PHE data shows a 20% decline, the reasons for which are currently uncertain.

Trans people

For the first time PHE have supplied data on HIV diagnoses in trans people. In 2017, eight trans women were diagnosed with HIV, a slight fall from 10 in the previous year and 15 trans women in 2015.

Late diagnoses

While the fall in new HIV diagnoses is to be celebrated, there are still challenges facing the HIV sector. Late diagnoses rates have remained stubbornly high at around 40% for the past five years, and in 2017 43% of people were diagnosed late.

PHE has repeated its warning that people diagnosed late face a ten-fold increased risk of short-term mortality. People diagnosed late are more likely to experience an AIDS-defining illness at the time of their diagnosis: this was true of 230 people in 2017.

People receiving HIV care in 2017

The UK is making great strides, continuing to ensure people living with HIV remain in care and have access to treatment which benefits their health and reduces the chance of transmission to their sexual partners. In 2017 there were 93,385 people receiving HIV care in the UK, of which:

  • 98% were receiving antiretroviral treatment
  • 97% of people on treatment were virally suppressed

Overall, gay and bisexual men continue to be the most disproportionately affected by HIV, with 43,494 people seen for HIV care in 2017, followed by black African heterosexual men and women with 27,212 people seen for care. Trans people accounted for 123 individuals seen for care, the vast majority of which were trans women.

What this means for HIV prevention in England

It is clear that the combination prevention approach to drive down new HIV diagnoses across the country is working. However, to sustain this trend the hard work must continue.

The sector must tackle late diagnoses and ensure that all groups affected by HIV know how they can take responsibility of their own sexual health, by making use of the range of HIV prevention and sexual health tools available to them.

National HIV Testing Week presents the next opportunity for the sector to continue to increase HIV testing and reduce diagnoses rates and late diagnoses in all groups affected by HIV across England. The campaign starts Saturday 17 November 2018.

Stay informed with our plans for the campaign by signing up to our newsletter and following us on Twitter.

Official Statistics from PHE

Further information from HPE

Positive East’s Inaugural Faith Symposium

Positive East Faith Symposium, May 2018

Our Local Activation Partner Positive East reports on the success of their first ever Faith Symposium, held in May 2018 in London.

‘As faith leaders we work to create healthy and caring communities that support people living with and affected by HIV.’

These words spoken by Apostle Segun George, the Cherubim & Seraphim Church, Mount Zion (Jesus-Saves) are testament to the role that faith can play in the HIV response.

In London, HIV in black African people accounted for 51% of all heterosexually acquired cases in 2016. Of this group, 53% were diagnosed late and accounted for 21% of new HIV diagnoses. It is estimated that, in London, 600 black Africans are living with HIV without knowing it.

Positive East, recognising that religion can play a major role in the life of black African people, coordinates the East London Community Faith Forum. They work with faith leaders, who have the reach and influence to fight HIV-related stigma and promote HIV testing. With an aim to tackle stigma and discrimination and promote HIV testing, the Forum suggested Positive East host a symposium for faith leaders talking about HIV themes including ‘hope’, ‘love’ and ‘compassion’.

The inaugural symposium was held on Saturday 12 May 2018. It brought together faith leaders, individuals and drivers of change, those living with and passionate about the fight against HIV, as well as people of faith and representatives of HIV charities.

Highlights and outcomes

Representatives were delighted to hear from a range of powerful speakers. Most notably, Horcelie Sinda Wa Mbongo set a powerful tone to the day ahead by sharing her journey with HIV.

Her story inspired other people in attendance to share their personal experiences, some who had been living with the virus for over 25 years. The event aimed to break the silence around HIV-related issues and this occurred from the outset with testimonies shared of people living well, finding love and being able to have children born without HIV.

Positive East’s African communities’ coordinators had the opportunity to educate the symposium with the latest HIV innovations and up-to-date research, including Treatment as Prevention (TasP) and the global ‘U=U’ (‘undetectable equals untransmittable’) campaign as well as information about pre-exposure prophylaxis (PrEP).

The event gave an opportunity for faith leaders to reflect on their involvement in HIV advocacy. A poignant moment of the event came when one pastor requested forgiveness, on behalf of all faith leaders, for failing people living with HIV.

Next steps

The symposium recommended the implementation of workshops and training for both faith leaders and congregation members. Events were proposed with a focus around National HIV Testing Week and World AIDS Day.

Positive East is hopeful that the symposium will lead to an increased interest in African churches wishing to work in partnership with them in East London. They aim to continue to build upon the hard work the event generated and encourage more faith leaders to open their doors to the delivery of HIV awareness training and testing in their churches.

If you are a faith leader based in East London or are interested in getting your local faith community involved with Positive East’s work, please contact [email protected]

Download full symposium programme

HIV Prevention England GP Engagement Strategy

HIV Prevention England GP Engagement Strategy banner

In 2016, 42% of people were diagnosed with HIV late in the UK – and late diagnosis leads to a tenfold increase in mortality compared to those diagnosed promptly (Public Health England (PHE), 2016). People outside London, of black ethnicity and those over 50 are most likely to be diagnosed late (PHE, 2017).

A key priority of the national HIV prevention programme (HPE) is to reduce late diagnosis by increasing HIV prevention and testing among GPs and other primary care providers. To achieve this, we have launched a new GP Engagement Strategy [PDF] which outlines the activities and approaches which we will adopt.

The average adult visits their GP at least three times a year (The King’s Fund, 2016). In contrast, the last national survey of sexual attitudes and lifestyles (Natsal-3) found that (Tanton et al, 2018):

  • As few as 4.9% of sexually active adults attended a sexual health clinic (SHC) in the last year.
  • More than 80% of those who reported having condomless sex had not attended a SHC in the last year.
  • 65% of men and 77% of women who had never been to a SHC were more likely to seek treatment from their GP instead.

Despite the challenges associated with delivering HIV testing and prevention interventions in primary care, GP-based HIV testing and prevention is essential for many reasons, not least that the national guidelines strongly recommend increased GP testing in areas of high and very high prevalence of diagnosed HIV.

HPE will provide significant opportunities to support GPs and primary care practitioners, through National HIV Testing Week, providing free patient resources, information briefings for professionals, and providing sector development training events.

Download the briefing

HIV Prevention England GP Engagement Strategy [PDF]

Get involved

HPE provides resources and training. If you work in primary care:

  • Take advantage of our free patient resources.
  • Sign-up to our monthly newsletter to keep up-to-date with our latest news and events (complete the form opposite).

Forthcoming events

HPE will be attending the Royal College of General Practitioners (RCGP) Annual Primary Care Conference & Exhibition in October, we welcome delegates to visit our stand in the exhibition space to talk to us about our work.

In late October we will be hosting two events for GPs and people working in primary care on pre-exposure prophylaxis (PrEP) and HIV testing in both London and Manchester. Contact us if you would like to register your interest.

National HIV Testing Week starts Saturday 17 November 2018.