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Health service constraints on HIV care – the research agenda: a UK perspective

Health service constraints on HIV care – the research agenda: a UK perspective CHAIN Workshop, Barcelona 14 March, 2014 Simon Collins HIV i-Base. Introduction. • HIV in the UK • Changes to HIV care in the NHS • Community involvement research. UK overview.

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Health service constraints on HIV care – the research agenda: a UK perspective

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  1. Health service constraints on HIV care – the research agenda: a UK perspective CHAIN Workshop, Barcelona 14 March, 2014 Simon Collins HIV i-Base

  2. Introduction • HIV in the UK • Changes to HIV care in the NHS • Community involvement research

  3. UK overview • ~ 100,000 +ve, 25% undiagnosed • High% on treatment and <50 c/mL • Good surveillance data on STIs National & regional data (hpa.org.uk) • Public funding for HIV research • Close links to European and international studies

  4. HIV research • Good surveillance data on incidence (SOPHID – by age, region, year, ethnicity, risk group, CD4 etc) • Cohort data on natural history, treatment and safety (UK-CHIC, seroconverters, MHRA, children, pregnancy etc, RITA/STARHS avidity) • Drug resistance collaboration (HIV DRD) • European cohort research - COHERE, CASCADE, EUROSIDA, PENTA, DAD etc • Global – Large, randomised strategy studies: SPARTAC, DART, ARROW, ERNEST, PopART etc

  5. Current examples • Research less-affected - ASTRA, PROUD (PrEP), CURE (Cherub), HIVDRB; UK in PARTNER, START etc • Cohort data and reduced monitoring - changed use of CD4 and viral load based on data • Resistance collaboration - community-supported (1998), central database, greater numbers: community link = earlier advocacy for access and guidelines - understand epidemic dynamics – sub-clades, clusters, virulence - reducing risk of first-failure – critical when fewer drug options - current TDR from undiagnosed patients with historical mutations - stock-outs – 10% from NNRTI-based (Abs 593 CROI 2014)

  6. NHS changes • Financial pressure on NHS • Continual restructure & overhaul • Move to primary care – for cost - benefits: ageing cohort, normalising HIV? - disadvantages: drug interactions, confidentiality (rural), experience, convenience, cost-based • Privatising NHS services - loss of HIV expertise: clinical, diagnostic, pharmacy • HIV prevention & treatment separated - makes PrEP difficult to prescribe or study

  7. Flat HIV budgets • £20 billion savings - Nicholson ”challenge” - no inflation uplift, increasing patients • • Commercial ARV tenders by volume London saved £10m – challenge to pharma pricing • Splitting FDCs & generics Supported by HIV positive people, 60-85% non-HIV NHS medsare generics, also ”home delivery” to save tax on medicines • Evidence-based for clinical result BUT no shift to older ARVs, EFV 400 mg or boosted-PI mono, New-fill still funded

  8. Model for other settings • Treatment response and drug safety Essential to collect data on efficacy & safety of ARVs in practice – use of technology advances for collecting quality data • • Reduce viral failure • Early uptake of viral load and resistance tests – but limited availability in other settings – stock-outs and resistance • Community engagement Benefits from community involvement and a good profile • Improve quality of life Switching options, pipeline and formulation research, cost & access (no premium pricing for new drugs)

  9. Thanks:

  10. Andrew, Andy B, Andy C, Chris M, Chris P, Richard, Chris W, Space, Nick, Dolly, Wesley, Colvin, Jimi, Kevin, Mike, Paul, Mark, Steve. CHAIN Workshop, 14 March 2014 Simon Collins: www.i-Base.info

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