Fifty new HIV diagnoses at Dean Street linked to caps on IMPACT study

Simon Collins, HIV i-Base

One of the most sobering posters at BHIVA 2019 was able to directly link recent HIV infections to the NHS block on access to PrEP.

This was a retrospective case notes review of all new HIV diagnoses during 2018 (n=177) at 56 Dean Street. Of these, 28% (50/177) had visited the clinic during the previous year.

These were almost exclusively gay men (one women, one MSW). Median age was 33 years (IQR: 27 to 37) with median of three partners in the previous three months (IQR: 2 to 11) and median of two HIV tests (IQR: 1 to 4) during the previous year.

Many of these men were engaged with healthcare and at high risk of HIV. They easily fulfilled criteria to access PrEP if it was available: one-third had previously used PEP, 38% disclosed chemsex with 10% injecting, 50% had had rectal gonorrhoea or chlamydia and 30% had early syphilis.

Only 12% had previously used PreP, but 56% had a documented PrEP discussion.

The poster noted that although PrEP was discussed with more than half of the people who later became HIV positive, there were no places on the IMPACT study for the majority of the study period.

comment

These cases – in a context when PrEP was clearly indicated, but also blocked given the limited places on the unnecessary PrEP IMPACT study – warrant a public interest legal case against the NHS, and questions in parliament, similar to the legal challenge many years ago that generated access to PEP.

THE UK PROUD study unquestionably proved PrEP efficacy in the UK in 2014 when the study was rapidly unblinded to offer immediate PrEP to all study participants in 2014 and with full results published in The Lancet in September 2015. [2, 3]

The IMPACT study itself – too little, too late – is controversial for limiting access to PrEP after clear data supporting efficacy and safety were established. This should have been an open access service based on demand, without caps on enrollment.

Even when expanded places were announced for the IMPACT study in January 2019, these have still not been made available to London clinics.

Reference

Woolham D et al. New HIV diagnoses in a London sexual health clinic: missed opportunities?  BHIVA 2019. Poster abstract 99.
https://www.bhiva.org/file/5ca73250e7009/P099.pdf (PDF)
UK PROUD study to provide PrEP to all participants earlier than expected: planned follow-up to continue to two years. HTB, December 2014.
https://i-base.info/htb/27593
McCormack S et al. Pre-exposure prophylaxis to prevent the acquisition of HIV-1 infection (PROUD): effectiveness results from the pilot phase of a pragmatic open-label randomised trial. The Lancet. Sept 9 2015. Open access.
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)00056-2/fulltext (full text)
NHS England doubles places on IMPACT PrEP study to 26,000. HTB: 21 January 2019.
https://i-base.info/htb/35568

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