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- 1. Tackling HIV and co-infections The UK experience AIDS conference Mexico City, 2008 Dr Valerie Delpech Centre for Infections Health Protection Agency
- 2. Acknowledgments The Public Health Agency of Canada (PHAC) CDC colleagues at HPA, Department of Health and The Terence Higgins Trust
- 7. HIV in the UK
- 8. New HIV diagnoses in the UK by exposure category: 1998 – 2007 Data reported to December 200795% confidence intervals provided for estimates
- 9. New HIV diagnoses in the UK by prevention group and probable world region of infection: 2006 Data reported to December 2007
- 10. Estimated late diagnosis 1 of HIV infection and AIDS at HIV diagnosis by prevention group, UK: 2006 1 CD4 cell count less than 200 cells/mm3 within 30 days of diagnosis among adults (aged >14 years) HIV/AIDS diagnoses and death reports, and surveillance of CD4 cell counts in HIV-infected persons TB is the most important cause of AIDS in migrant populations
- 11. Pattern of diagnosis and associated short-term mortality rate among BME adults Late diagnosis CD4 count <200 cells/mm 3 ; prompt diagnosis ≥200 cells/mm 3 . Short-term mortality rate: percent of patients known to have died within a year of diagnosis. Reports of HIV diagnosis, deaths and CD4 cell counts Number diagnosed Short-term mortality rate Diagnosed promptly Diagnosed late
- 12. STIs in the UK
- 13. STIs diagnosed in GUM clinics, UK
- 15. LGV in MSM, England
- 18. Proportion of infections among HIV+ MSM in 2006 Syphilis Gonorrhoea LGV 0% 100% MSM HIV+ MSM HIV+ MSM HIV+ 50% 99% HCV MSM - HIV+ 7.5% 33% 59% HIV+ 34% 75% 28% 99%
- 22. Linking Exercises TB HCV Pneumococcal
- 23. TB co-infections
- 24. Incidence of Invasive Pneumococcal Disease in HIV-diagnosed individuals England and Wales: 1996-2005 Source SOPHID & EPS incidence estimate of 141/100,000, 10 times higher than background adult population
- 28. Better integration of services Sexual Health & HIV Screens in GUM clinics, UK
- 30. Proportion of late diagnosed in London Percentage of patients diagnosed with CD4<200 by PCT of residence >45% (4) 40-45% (6) 35-40% (8) 30-35% (6) 25-30% (6) <25% (1)
- 31. Proportion of HIV-infected persons not on ARV by CD4 category: UK, 2006 CD4 cell count category 31% 19% 31% Proportion not on ARV Annual survey of HIV-infected persons accessing care n = 5,144 2,407 18% 30% 31% 11,595 4,983 29,165 9,894
- 33. THANK YOU Acknowledgments The Public Health Agency of Canada (PHAC) CDC colleagues at HPA, Department of Health and The Terence Higgins Trust
Notas do Editor
- Of the estimated 6,840 (95% confidence intervals 6,600-7,050) persons newly diagnosed with HIV in the UK in 2007, an estimated 56% (3,860 [3,700-4,000]) acquired their infection heterosexually and an estimated 38% (2,630 [2,500-2,750]) were men who have sex with men (MSM). In recent years there has been a decline of new HIV diagnoses in HIV-infected heterosexuals from sub-Saharan Africa who were probably infected in their country of origin. In contrast, there was no evidence of a fall in the current high rate of HIV transmission among MSM within the United Kingdom, which has remained at epidemic level.
- Among MSM newly diagnosed in 2006, 83% probably acquired their infection in the UK. Among white MSM this percentage was 84% compared to 74% among MSM of all other ethnic groups. There is evidence that MSM born abroad are also at risk of acquiring HIV infection within the UK. Among heterosexuals, 17% probably acquired their infection in the UK. A greater percentage of heterosexuals of white ethnicity probably acquired their infection in the UK (50%) compared to those of black African ethnicity (8%) and those among other ethnic groups (30%). Migration is a major cause of late diagnosed and reduce access to testing and treatment in many countries, including the UK Following earlier steep increases in UK, there is a levelling off in diagnoses among black-African individuals largely due to changes in immigration Small but important increases in number of heterosexually acquired infections acquired in the UK, particularly among black-African individuals HIV prevalence in UK amongst black-African populations greatly exceeds that amongst other ethnicity groups.
- There have been 2 major NHS reorganisations since the Sexual Strategy in England Shifting the Balance of Power (abolition of health authorities) And Changes in commissioning to Patient-led NHS (2006) Our health, our care, our say (2006) – deliver of care in partnership Changes in commissioning (2006) offer the opportunity to have more specialist care support for commissioning but consequent changes in personnel and population configuration may present challenges to local service development Practice based commissioning should facilitate patient pathways and closer working between acute and community based services. Our health, our care, our say (2006) – provides an opportunity for innovative methods for providing services to tackle hepatitis and HIV
- Since the National Strategy for Sexual Health (England) in 2001, we have seen increase testing of HIV offered to all GUM attendees as part of STI screen, o ver 700 000 screens in 2007 with a High uptake >80% Additionally there is since 1999 routine HIV testing in the antenatal setting with >85% uptake TB clinics- routine in most clinics across London Up to 20% co-infection rates among BA TB patients
- There were 35,242 individuals reported to SOPHID in 2004 with both a CD4 count and level of ARV reported (88% of a total 40,000 reported). 14% of these – almost 5,000 – had CD4 counts less than 200 *Click* Of those 5,000 individuals, 19% - almost 1000 (950) – were not receiving ARV.