Increased access to HIV combination prevention (including health prevention and promotion interventions, partner notification, frequent HIV testing, PrEP and PEP) will help maintain the HIV status of those who are HIV negative (Figure 6). Partner notification is a highly effective HIV prevention strategy which is not only an extremely efficient way to find people with an undiagnosed HIV infection, but also provides the opportunity to maintain the HIV status of those partners who test negative. PrEP prevents people who are HIV negative from acquiring HIV, where appropriate, and those who test negative should be offered and maintained on PrEP while indicated, thereby preventing transmission. Figure 6. Flowchart for theme 1: maintain people’s HIV status negative An accessible text version of this flowchart is also available. A summary of current and provisional indicators for theme 1 can be found in Table 4. Table 4. Provisional indicators for theme 1: maintain people’s negative HIV status
CodeDescription201920202021 PT1ANumber of people attending SHS due to partner notification1,558850820 PT1BProportion of people attending SHS due to partner notification among new HIV diagnosisProvisional indicatorProvisional indicatorProvisional indicator PT1CNumber of people attending though partner notification who tested1,397702620 PT1DRatio of partner notification contacts tested per diagnosis - a ratio of 1 suggests each HIV diagnosis results in at least one partner having a test1.010.850.76 PT1ENumber of people attending through partner notification who tested positive594228 PT1FProportion of all HIV negative individuals accessing specialist SHSs categorised as having a PrEP needNot applicableNot applicable7% PT1GProportion of all HIV negative individuals with estimated PrEP need who had this need identifiedNot applicableNot applicable79% PT1HProportion of all HIV negative individuals with estimated PrEP need who started or continued PrEP
Not applicableNot applicable70% PT1INumber of individuals accessing specialist SHSs who are receiving PrEP
Not applicableNot applicableProvisional indicator PT1JNumber of individuals accessing specialist SHSs stopping PrEP
Not applicableNot applicableProvisional indicator PT1K
HIV seroconversions among people receiving PrEP
Not applicableNot applicableProvisional indicator Partner notification (PT1A, PT1C, PT1D, PT1E) Between 2019 and 2021 the number of people attending SHSs due to HIV partner notification decreased from 1,558 to 820. The resulting ratio of new HIV diagnoses in SHS settings to attendees due to HIV partner notification was 1.01 in 2019 and 0.76 in 2021 nationally. This means for every 100 HIV diagnoses in 2021, 76 people attended SHS as a result of HIV partner notification. Overall, 3.8% (59 people) of those attending due to HIV partner notification tested positive for HIV in 2019 compared to 4.2% in 2020 (42 people) in 2020 and 2.6% (28 people) in 2021. This data indicates that when implemented, HIV partner notification is an effective strategy to find people with undiagnosed HIV. The declining number attending SHS due to HIV partner notification is likely due to the impact of the COVID-19 pandemic in terms of health-seeking behaviours, access to services and also a decrease in sexual mixing during the national lockdowns to control COVID-19 (10, 20 to 23). While most HIV partner notification attendees were GBMSM, the highest ratios of new HIV diagnoses to HIV partner notification attendees were observed in heterosexual adults across all 3 years (Figure 7). Figure 7: Number of people who attended SHSs due to HIV partner notification, and who had an HIV test or not, and ratio of new HIV diagnoses over number of HIV partner notification attendees, England, 2019 to 2021 Pre-exposure prophylaxis (PT1F, PT1G, PT1H) Between October 2017 and July 2020, the Impact Trial in England recruited 24,268 patients PrEP (24). Participants received PrEP in England during and after the trial period and until the rollout of a routine PrEP service in specialist SHSs in the autumn of 2020, as part of a combination approach to HIV prevention. The PrEP monitoring and evaluation framework (7) was published in March 2022 and consists of a series of indicators to inform service improvement in PrEP commissioning and delivery. In 2021, 7% (87,828 of 1,180,923) of HIV negative people accessing specialist SHSs in England (excluding people accessing reproductive health services only) were categorised as having PrEP need. This proportion represents people who were at substantial HIV risk and therefore could benefit from receiving PrEP (Figure 8). Among this group 79% (69,507 of 87,828) had their need identified during clinical consultation. Of those with a PrEP need identified, 70% (61,092 of 87,828) initiated or continued PrEP. However, there were differences between groups in relation to PrEP need, PrEP need identified and those initiating or continuing PrEP. GBMSM were the group most likely to be categorised as having PrEP need (65%; 70,076 of 108,605), compared to heterosexual men (1%; 3,119 of 229,926) and heterosexual women (0.5%; 3,009 of 624,856) respectively. While a smaller proportion of those aged under 35 years (6% (52,044 of 843,816)) were identified as having PrEP need in 2021 compared to those aged 35 years or older (11% (35,754 of 332,129)) a higher number of younger people were categorised as having PrEP need as they constitute 72% of the SHS population. PrEP need was categorised as highest among the following ethnic groups: White British (7%), Any other Asian (15%) and people of other ethnicity (12%) but lower among Black Africans (4%), Black Caribbeans (5%) and Black other groups (5%). A higher proportion of attendees were categorised as having PrEP need in London at 14% (42,774 of 301,764) compared to 5% (43,309 of 855,859) elsewhere in England. Among those accessing specialist SHS with PrEP need, the proportion who had their need identified was 81% (56,793 of 70,076) in GBMSM compared to 49% (1,542 of 3,119) among heterosexual men and 33% (994 of 3,009) in heterosexual women respectively. Among those aged under 35 years, 77% (40,175 of 52,044) had PrEP need identified compared to 82% (29,326 of 35,754) among those aged 35 years and over. The ethnic groups with highest proportion of PrEP need identified were Any other Asian (85%), White other (84%) and people of other ethnicity (80%), with lower levels of need identified observed among a Black Caribbean (70%), Black other (69%) and Black African (62%) groups. PrEP need was more likely to be identified in London 84% (35,940 of 42,774) compared to 74% (32,223 of 43,309) in areas out outside of London. The proportion of people accessing specialist SHSs with PrEP need identified who initiated or continued PrEP was 72% (50,152 of 70,076), 34% (1,068 of 3,119) and 23% (700 of 3,009) in GBMSM, heterosexual men and heterosexual women respectively. The proportion of people aged under 35 years with PrEP need identified who started or continued PrEP was 66% (34,557 of 52,044) compared to 74% (26,532 of 35,754) in those aged 35 years and over. The proportion of people accessing specialist SHSs who started or continued PrEP was 79% (33,944 of 42,774) in London residents, and ranged from 65% (6,410 of 9,856) among people residing in the South East to 47% (1,785 of 3,834) among people residing in the West Midlands. Figure 8. Proportion of HIV negative people accessing specialist SHSs with PrEP need who had their need identified, and who initiated or continued PrEP by demographics, England, 2021 Post-exposure prophylaxis In 2021, 8,115 people received PEP for HIV. This is a 13% increase in PEP activity relative to 2020, but a 33% decrease compared with 2019 (12,038). GBMSM constituted 57% (4,664 of 8,115) of all those receiving PEP, with heterosexual and bisexual women and heterosexual men representing 14% (1,137 of 8,115) and 11% (865 of 8,115), respectively. Among the 494 people receiving more than one course of PEP in 2021, 76% (373 of 494) were GBMSM.