Watch it Live: National HIV Prevention England Conference

More than 350 people have registered to attend our biennial national conference which will be on Thursday 18 May in central London.

If you cannot attend this exciting event in person, do not worry because we will be livestreaming the main sessions.

Key highlights

  • Overview of the changes in new diagnoses rates in London and across England; and the part which combination prevention plays on HIV incidence.
  • Update on the state of the upcoming PrEP IMPACT trial set to start in summer 2017.
  • The effect of rapid initiation of treatment on HIV transmission (Treatment as Prevention).
  • The launch of a new report by National AIDS Trust on ‘Investment in HIV prevention and testing services in England’.

If you or your colleagues are interested, please register under the ‘Livestream’ ticket option on the Eventbrite page to get an alert when we go live.

Register for the livestream

View the programme [PDF]

Assisted HIV self-testing and self-sampling by community-based organisations in England

There has recently been a move towards online provision of HIV self-testing and self-sampling for people to test themselves. Our local activation partners, the GMI Partnership, comprised of Positive East, METRO and Spectra have been looking at how self-testing and self-sampling can be incorporated into current and future community-based HIV testing and outreach services.

There are questions about how community-based organisations can incorporate self-testing and self-sampling in their work, in order to increase access to testing for those who need it.

The GMI Partnership is a consortium of three community-based agencies (Positive East, METRO and Spectra) who provide sexual health promotion and HIV prevention services across London. In collaboration with Freedoms, the GMI Partnership deliver condom distribution and an outreach service for men who have sex with men (MSM) funded by the pan-London HIV prevention programme, as part of the Do It London campaign. Dee Wang, Research and Performance Manager at Spectra, tells us about how they are addressing self-testing and self-sampling.

‘Conducting extensive surveys via Grindr and through our face-to-face work in high-risk venues, we asked high-risk MSM about self-testing and self-sampling in a community-based setting,’ she said. ‘What we found was that community-based testing and outreach complements self-testing and self-sampling.’

Of the 2,889 MSM who undertook their survey over Grindr:

  • Only 22% understood the difference between self-testing and self-sampling.
  • Of those who did understand the difference, 30% still preferred to be tested by a professional.
  • Of the 2,889 men, 33% would prefer to be coached on how to self-test or self-sample before doing it themselves.

‘This data indicates that there is still work to be done around informing the community on the differences between self-testing and self-sampling (especially as this was a relatively HIV literate group, with 73% and 71% having heard of PEP and PrEP respectively),’ Dee said. ‘Secondly, it shows that there will always be a group of men who prefer to be tested by a professional.’

‘The finding which also stood out was that 33% of the MSM surveyed would prefer to be coached in the use of self-tests/ self-sampling tests before doing it themselves,’ said Dee. ‘These findings led us to develop the GMI community coaching model.’

GMI community coaching model

The GMI Partnership now provides community coaching with HIV testing. ‘We coach individuals on how to use both self-testing kits, and self-sampling kits. If desired, we then use the self-test kit as a point-of-care test (POCT),’ explains Norman Gillard, one of the GMI Partnership Outreach Coordinators from the METRO Charity.

Of the 159 men who GMI have so far provided with community coaching:

  • 96% agreed that they were able to better understand how self-testing for HIV works after being coached.
  • 80% felt more confident with the GMI worker supporting while doing a self-test.
  • 69% believed that they would be more comfortable to test themselves next time.

‘The GMI Partnership has always recognised that for many individuals, community-based services are the first step in a health care journey from an outreach venue into a clinic. The same may be true with self-testing and self-sampling. With the coaching model, 69% of individuals felt more comfortable with testing themselves in the future,’ Norman pointed out.

‘Still, we need to recognise that there will always be those who need to test but who would rather access services in their own community settings’.

National HPE Conference 2017

HPE Conference 2017 - Thursday 18 May 2017

The National HIV Prevention England Conference will be held on Thursday 18 May 2017 in central London.

It will bring together partners in HIV prevention including sexual health commissioners, health promoters, sexual health and HIV service providers, faith leaders working in England and other key figures and influencers in the field of HIV. The conference has the aim of facilitating the dissemination and development of best practice, alongside disseminating learning from the PHE Innovation Fund and other projects.

Download the programme [PDF]

Themes

  • Innovation in HIV prevention
  • Innovation in HIV testing
  • Community engagement/mobilisation and face-to-face interventions
  • Partnership working

Outcomes

  • Engagement with and cooperation across the HIV prevention sector
  • Increased understanding of the latest developments and current issues in HIV testing and prevention in England
  • Delegates can take away at least one new idea for local implementation

Response to past HPE conference (2014)

87 per cent of previous delegates agreed that they would ‘recommend the HPE conference to other people concerned with HIV prevention with at risk populations’.

Three quarters (74 per cent) of delegates agreed they had ‘increased their understanding of the latest developments and current issues in HIV prevention in England’, and 64 per cent agreed they had been ‘inspired to try at least one new idea in their local work practice’.

Register for the event

Sustained hepatitis A outbreak in England and Northern Ireland

There has been a sustained outbreak of hepatitis A virus in England and Northern Ireland, predominantly affecting men who have sex with men (MSM). Between July 2016 and January 2017, there have been 51 cases, 42 of which were in MSM.

Image from Beebeejaun et al (2017).

Investigations found that the outbreak was imported from Spain, with secondary sexual transmission within the MSM population in the UK. The two main regions affected are London (20 cases) and the East Midlands (12 cases).

The national response from Public Health England and local bodies, according to Beebeejaun et al (2017) has been to:

  • Enhance surveillance for MSM-associated cases through an adapted questionnaire
  • In conjunction with BASHH, alert health professionals about the outbreak
  • Recommend vaccination of at-risk MSM in outbreak areas according to national guidelines
  • Test cases for other STIs and partner notification
  • Increase public awareness of the issue and need for increased care
  • Give post-exposure prophylaxis to close contacts.

Professionals who work with clients likely to be exposed to the virus should encourage individuals to practice good personal hygiene, including washing hands after sex and changing condoms between any kind of sex to reduce the risk of transmission.

Particularly during outbreaks, clinicians should also offer hepatitis A vaccination to MSM who have multiple partners, and MSM in areas where the outbreak is concentrated.

Coming soon: hepatitis A resources

HIV Prevention England will be providing information leaflets and posters on hepatitis A to support prevention efforts. These will be available to order soon.

Learn more about the outbreak and hepatitis A

For more information on the outbreak and hepatitis A, see:
Beebeejaun et al (2017) Outbreak of hepatitis A associated with MSM, England, July 2016 to January 2017.
PHE (2013) Hepatitis A. Green Book Chapter 13.
NICE (2014). Scenario: Prevention of infection with hepatitis A.

Over 20,0000 Postal HIV test kits ordered around National HIV Testing Week 2016

The promotion of the national HIV home sampling service between 7 November 2016 and 8 January 2017 resulted in over 20,000 kits ordered, a substantially larger number compared to the same period in the previous year.

The national HIV home-sampling service

Since 2015, Public Health England (PHE) and Local Authorities have provided a national HIV home-sampling service for the most at-risk populations for HIV acquisition. For most parts of the year, the free test kits are available only in areas of England where local authorities choose to fund the service. However, during periods of national promotion, PHE fund the service across the whole of England.

The most notable period of national promotion is around National HIV Testing Week (NHTW), which occurs in November each year. HIV Prevention England (HPE) promote the home-sampling kits in the lead-up to, during, and after NHTW, encouraging people to order a kit online, take their own sample and return it by post to a laboratory for testing and results management. The test is highly accurate four weeks after infection, and almost 100 per cent accurate after eight weeks.

These kits differ from HIV self-testing kits, which do not need to be analysed in a lab: individuals get an immediate result that they can read themselves. The self-test is most accurate 12 weeks or more after infection.

Home-sampling kits ordered

The promotion in the period around NHTW 2016 resulted in 20,175 home-sampling kits ordered between November 7 2016 and 8 January 2017. This is 4,405 kits more compared to the same period in 2015-2016.

Table 1: home-sampling tests ordered during the full promotion period

Description Nov 2015 to Jan 2016 Nov 2016 to January 2017 Change
Number of kits ordered 15,770 20,175 up 4,405
Number of kits returned 7,985 10,421 up 2,436
Return rate 50.6% 51.7% up 1.1%

Table 2: home-sampling tests ordered during NHTW

Description 21 Nov to 29 Nov 2015 19 Nov to 27 Nov 2016 Change
Number of kits ordered 5,777 5,740 down 37
Number of kits returned 2,895 3,081 up 186
Return rate 50.1% 53.7% up 3.6%

Results management

Test results are managed by a community-based organisation partner who provides further support and guidance on next steps. Tests give ‘reactive’ or ‘non-reactive’ results. Reactive results are further classified into ‘high’ and ‘low’ reactives, based on a particular cut-off index. While high reactives are more likely to have an HIV infection confirmed, all reactive results are immediately referred to appropriate services for further testing and clinical confirmation.

The previous year, 1.1 per cent of analysed tests were reactive and of these, 0.7 per cent were high reactives. This information can be looked at alongside HIV positive test results in other testing settings, including specialist sexual health clinics and general practice settings:

Table 3: results comparison by setting (PHE, 2016)

Specialist sexual health clinics
Positivity rate for service users (2015 data)
0.3% (2,850/998,503)
Specialist sexual health clinics
Positivity rate for service users (2015 data)
0.3% (2,850/998,503)
National home-sampling service
High reactive rate for service users (Nov 2015 – Sept 2016 data)*
0.7% (128/18,270)

* high reactive test results likely to be confirmed as positive

Currently, 85 local authorities have committed to implementing the national scheme. Considering the increasing demand for the service, the relatively high reactivity rate and the reasonable cost of the service, there is scope for broader action on making postal tests available and promoting them to communities and individuals who may be at a higher risk for HIV acquisition.

More information

NICE/PHE guideline on increasing HIV testing uptake

The full report for 2015-2016 on the national home-sampling scheme will be available from Public Health England in March 2017.