Getting to Zero HIV

Getting to Zero HIV (and addressing other sexually transmitted infection epidemics)

Where did Getting to Zero HIV come from?
WHO / UNAIDS campaign since 2011 when it was beginning to be understood that effective treatment was a key tool for prevention

The latest UNAIDS 90:90:90 campaign aims to diagnose 90% of people with HIV, engage 90% into care to start HIV treatment and that 90% of patients become undetectable (i.e. uninfectious).  In a few countries this target has already been reached; however, find the remaining undiagnosed HIV positive individuals is an ongoing challenge

To achieve the first "90" - we need targeted testing and effective partner services to reduce the cost to make a diagnosis and ensure that we can get to zero HIV by 2030 with an emphasis on 'Fast-track cities'; however, each city has a limit to the resources that they can spend on this problem

When trying to work out the cost to diagnose a case of HIV a back of the envelope calculation is a useful exercise but it should be taken with a pinch of salt

The table below uses the following sources & assumptions:

• The background incidence rate is key to doing these calculations from low incidence countries where it is 9/100,000 (England, PHE)  & 12/100,000 (CDC Atlas, Massachusetts) to some sub-Saharan countries where it is 100x times higher e.g. Eswatini 862/100,000 (UNAIDS HIV estimates)
• The background rate will affect all the following estimates so I have focused on a country with low incidence
• Testing in sexual health clinics has a 3/1000 diagnostic rate (18 months data from inner London clinic)
• Outreach testing has three times the yield of 10/1000 (based on conversation with NAZ Latina)
• The BASHH / BHIVA audit in 2018 on HIV partner services found that 18% of partners were infected whilst in countries where less patients are undetectable this number has been as high as 35% (20% was chosen as a representative figure)

Testing strategy	HIV diagnostic rate (#/1000)	Diagnostic cost to diagnose one case of HIV ($20/test)	Difference
Screening blood donors	0.012	$166,666	Baseline
Targeted testing in specific venues	3	$6,667	x 25 less
Outreach & testing in ‘at risk’ communities	10	$2,000	x 83 less
Testing sex partners of patient diagnosed with HIV	200	$100	x  1666 less

Hitting the bullseye

A ‘Ground-Breaking’ Partner Notification Tool to Combat the Spread of HIV and all STIs in the UK

At SXT Health CIC, we are proud to announce the launch this month (December 2015) of our interactive digital Contact Slip – a new tool designed to help improve rates of Partner Notification and slow the spread of STIs in the UK. PHE’s Professor Kevin Fenton has called it one of 7 ‘ground-breaking initiatives’ to recently receive PHE funding. To find out more, please read on. You can also go to http://bit.ly/SXTfilms to see some 1 minute films of the tool in action, visit http://www.sxt.org.uk/pn/about for some key facts and figures, or contact enquiries@sxt.org.uk with specific enquiries.

The tool has been developed with the help of an HIV Prevention Innovation Fund from Public Health England and is being used across the London boroughs of Lambeth and Southwark. It is available to clinics throughout the UK.

Why we developed the tool - the Public Health challenge:

There were 440000 STIs diagnosed in the UK in 2014. The BASHH states that, for every patient diagnosed with an STI, a health care worker should verify that 0.6 partners have been seen at an STI testing centre within 1 month.

We know, from reviewing the clinical histories of index patients, that many have a number of partners, and all have at least one. The Key Performance Indicator (KPI) set by the BASHH, at 0.6 partners, is the best clinical practices have been able to achieve – many struggle to meet even this KPI, and STI rates are rising.

If we could improve levels of partner notification, we could significantly reduce the transmission of STIs in the UK.

The interactive digital Contact Slip on is designed to:

-Help health providers deliver PN effectively, and improve their PN rates

-Help the individual with the STI tell their partner(s)

-Help the partner(s) find a local testing service

-Give the health provider looking after the partner(s) the key information they need to deliver fast, high quality care

How it works:

Step 1 - Notify Partners at the Clinic

Step 2 - Notify Partners Away from the Clinic

Step 3 - Partners Receive Notification
Step 4 - Partners at the Clinic

There are some key reasons why it’s currently difficult to deliver PN:

-Embarrassment on the part of patients, wariness of stigma and fear rejection or violence

-For clinics, the logistics are often challenging – staff spend hours manually notifying partners, or trying to track down whether they have been tested by eg searching through databases or talking to other clinics

We have designed the idCS to address these issues - making it possible for patients to use it anonymously, and ensuring all personal details are deleted as soon as notification is sent. We have made it incredibly quick and easy for clinics to use, and ensured that it automatically records whether partners are seen at any STI treatment centre so that performance stats are readily available.

Tracking performance:

Each clinic has their own dashboard on the SXT website where they can see how many times the idCS has been used, how many partners have been notified, and how many have been tested at an STI treatment centre.

In summary, the idCS on offers some key advantages:

If you'd like help to improve your partner notification rates, or to find out more, contact enquiries@sxt.org.uk