Martin Fisher Foundation: 14 September 2015 Remembering Martin Fisher Simon Collins, HIV i-Base Who should get tested? How and why should

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?


Remembering Martin Fisher


Overview

• Background: gay men in the UK

• Who should test?

• How to test?

• Where to test?

• Conclusions


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


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


Country of HIV infection: gay men

PHE, HIV in the UK, 2014


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.


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


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


• 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.


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.


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?


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.


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.


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?


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.


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.


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.


Community testing

Evaluate outcome by new diagnoses not the number of tests.


Community testing

… he does

not know!


Community testing

“2016: YEAR of HIV TESTING” branded by all organisations: public and

community PHE, THT, GMFA etc


Thanks

• Andrew Phillips• Valerie Delpeche• Robert James

And to Martin Fisher for so many years of support and encouragement.

Documents

Martin Fisher Foundation: 14 September 2015 Remembering Martin Fisher Simon Collins, HIV i-Base Who should get tested? How and why should