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Martin Fisher Foundation: 14 September 2015 www.i-Base.info
Remembering Martin Fisher
Simon Collins, HIV i-Base
Who should get tested?How and why
should I get tested?
Martin Fisher Foundation: 14 September 2015 www.i-Base.info
Remembering Martin Fisher
Martin Fisher Foundation: 14 September 2015 www.i-Base.info
Overview
• Background: gay men in the UK
• Who should test?
• How to test?
• Where to test?
• Conclusions
Martin Fisher Foundation: 14 September 2015 www.i-Base.info
Annual diagnoses in gay men
3000
2500
2000
1500
1000
500
0
2005 2006 2007 2008 2009 2010 2011 2012 2013
Year UK national data, 2014
~3000 gay men diagnosed every year for the last 10 years
Martin Fisher Foundation: 14 September 2015 www.i-Base.info
Annual diagnoses in gay men
3000
2500
2000
1500
1000
500
0
2005 2006 2007 2008 2009 2010 2011 2012 2013
Year UK national data, 2014
~2800 gay men infected every year for the last 10 years
~3000 gay men diagnosed every year for the last 10 years
Martin Fisher Foundation: 14 September 2015 www.i-Base.info
Country of HIV infection: gay men
PHE, HIV in the UK, 2014
Martin Fisher Foundation: 14 September 2015 www.i-Base.info
Context of ART
• Reduced risk when viral load <50 c/mL.
• Zero linked transmissions in PARTNER after 44,500 times without a condom. [1]
• Zero linked transmissions over 4 years in HPTN-052. [2]
1. Rodger A et al. CROI 2014. 2. Cohen M et al, IAS 2015.
Martin Fisher Foundation: 14 September 2015 www.i-Base.info
UK cascade is remarkable
20 HIV in the United Kingdom: 2014
Retention in care: proportion of adults retained in care in the following year: UK, 2013
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Men
Wom
en
15-2
4
25-3
9
40-4
9
50+
White
Bla
ck
Oth
er
Eth
nic
ity
Het m
en
Het w
om
en
MS
M
PW
ID
London
Outs
ide L
ondon
Tota
l
Sex Age group Ethnicity Exposure Region
Perc
en
tag
e o
f a
du
lts liv
ing
wit
h d
iag
no
sed
HIV
21 HIV in the United Kingdom: 2014
Treatment guidelines: proportion of adults with CD4<350 cells/mm3 receiving antiretroviral therapy: UK, 2013
Effectiveness of treatment: proportion of adults achieving viral suppression1: UK, 2013
22 HIV in the United Kingdom: 2014
• 95% in care, 90% on ART, 90% <50 c/mL. [1]
• Likely to increase with earlier ART. [2]
• START: 98% <50 c/mL - with efavirenz. [3]
1. UK PHE 2014; 2. BHIVA draft guidelines, June 2015; 3. Lundgren J et al, START study, NEJM 2015.
Martin Fisher Foundation: 14 September 2015 www.i-Base.info
Gay men: who to test?
• 8,000 gay men are not yet diagnosed: “This could be you”.
• Differences by age and experience – school, peer pressure, Grindr, drugs as a norm, perceived low risk, bad luck.
• Frequent vs within 1- 5 years vs never.
Martin Fisher Foundation: 14 September 2015 www.i-Base.info
Gay men: who to test in 2015?
• Frequent testers engaged in care - need option of PrEP - £30 per month.
• Infrequent testers (270,000) need testing to be easier: self sampling and testing?
• Never tested: denial? Needle-phobic?
Martin Fisher Foundation: 14 September 2015 www.i-Base.info
Gay men: how to test?• Routine part of sexual health. Opt-out?
• STI clinic vs community venues.
• Frequent testers need 4th gen; other can use 3rd or 4th gen: option by post.
• Rapid testing vs result?
• Pantheon study – NIHR funded study.
Martin Fisher Foundation: 14 September 2015 www.i-Base.info
Making testing easier• Clinics: easy access, no appointment.
• Clean, friendly, modern.
• Non-judgemental services.
• Free/cheap, rapid results.
• Rapid treatment and care – for HIV and STIs.
Martin Fisher Foundation: 14 September 2015 www.i-Base.info
Why test?• For personal and community reasons.
• No one expects to be HIV+.
• 30% gay men still test late (CD4 <350)
• ART is now universally available: better health and reduced risk to partners.
• Why not?
Martin Fisher Foundation: 14 September 2015 www.i-Base.info
2015 2020 2025 2030
35%
64%79%
base test rate ART at diagnosis
test rate +215,000 tests
test rate ++370,000 tests
Current testing at 110,000pa and ART at 350
Rapid impact on UK incidence from increased testing by gay men
Adapted from: Phillips AN et al. AIDS June 2015.
Martin Fisher Foundation: 14 September 2015 www.i-Base.info
2015 2020 2025 2030
35%
64%79%
base test rate ART at diagnosis
test rate +215,000 tests
test rate ++370,000 tests
Current testing at 110,000pa and ART at 350
Rapid impact on UK incidence from increased testing by gay men
Adapted from: Phillips AN et al. AIDS June 2015.
Martin Fisher Foundation: 14 September 2015 www.i-Base.info
Conclusions• New landscape – even with NHS problems.
• Earlier, better, wider use of ART.
• Prevention has ART, PrEP, better testing.
• Increased diagnoses reduces infection rate.
• Window of chance – depends on setting incidence targets: 3000 >2000 >1000 >0.
Martin Fisher Foundation: 14 September 2015 www.i-Base.info
Community testing
Evaluate outcome by new diagnoses not the number of tests.
Martin Fisher Foundation: 14 September 2015 www.i-Base.info
Community testing
… he does
not know!
Martin Fisher Foundation: 14 September 2015 www.i-Base.info
Community testing
“2016: YEAR of HIV TESTING” branded by all organisations: public and
community PHE, THT, GMFA etc
Martin Fisher Foundation: 14 September 2015 www.i-Base.info
Thanks
• Andrew Phillips• Valerie Delpeche• Robert James
And to Martin Fisher for so many years of support and encouragement.
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