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  • England may be on track to eliminate HIV as a public health concern by 2030.
  • New research looked at the likelihood of England reaching this goal among men who have sex with men (MSM).
  • The study authors highlight the need for better ways to reduce numbers of new HIV infections among men aged 45 and older.

In 2014, the United Nations developed a strategy for addressing the HIV epidemic, and this set out “90-90-90 targets.”

These targets aim for three things. The first is for 90% of people with HIV to be aware of their status. The second is for 90% of people who know their HIV status to be receiving antiretroviral therapy. The third target is for 90% of people taking antiretroviral therapy to have achieved “viral suppression,” which means having fewer than 200 copies of the virus per milliliter of blood.

England achieved these targets in 2017 and set an ambitious new goal of ending HIV transmission by 2030.

A recent study in cochrane review alendronate Peer reviewed journal”>The Lancet HIV looked at the likelihood of England reaching its goals and reducing HIV transmission among MSM so that it becomes exceedingly rare.

The researchers also analyzed data to determine the effects of several intervention strategies on the spread of HIV. With the help of historical data and novel computational modeling, the study authors have identified encouraging trends.

Their analysis suggests an overall likelihood of 40% that England will succeed by 2030. The authors also note the need to target specific age groups, in which the number of new HIV infections has not declined to the same extent as in other groups.

Drop in new cases

The team, led by researchers from the University of Cambridge, in the United Kingdom, used a novel mathematical model that allowed them to estimate the numbers of new HIV infections between 2009 and 2018.

Researchers use modeling because there is often a time lag between a person contracting HIV and receiving the diagnosis. The model allowed the scientists to estimate the incidence of new HIV infections, including those that go undiagnosed, among MSM aged 15 or older.

The researchers point to reasons for cautious optimism. They found an across-the-board decrease in HIV infections within the study population.

According to the model, new HIV infections fell from 2,770 in 2013 to 854 in 2018.

All age groups showed reductions in HIV infection rates, but in the group aged 45 and over, the rate decline was the slowest. The authors suggest a need for targeted policies to further slow the rate of new cases among this group.

Based on the data, the team predicts a 40% probability that England will achieve fewer than one new HIV infection per 10,000 people by 2030.

Winning strategies

In their study, the researchers were not able to link results with specific public health strategies implemented in the last decade. However, they do find support for these strategies in the data.

Starting in 2011, test-and-treat measures gained significant traction. Specific approaches that appear to have had a positive effect include enhanced testing, early treatment, and treatment-as-prevention, including preexposure prophylaxis (PrEP).

PrEP became widely available in 2016 and is “now considered the best strategy to prevent HIV transmission” among MSM, the authors explain.

“This is very good news and suggests that prevention measures adopted in England from 2011 have been effective. With the rollout of PrEP, England looks on course to meet the goal of zero transmissions by 2030,” senior study author Professor Daniela De Angelis comments.

“Our study also shows the value of regular estimation of HIV incidence to recognize and respond appropriately to changes in the current downward trend. The challenge now is to achieve these reductions in all groups at risk for HIV acquisition,” she continues.

The researchers point out several limitations of their study. One is that they were unable to account for people moving away, nationally or internationally.

Despite the limitations, the authors conclude that “With additional large-scale implementation of PrEP, elimination of HIV transmission is likely to be within reach by 2030. However, targeted combination prevention measures might be needed to maintain the trajectory toward elimination in groups such as MSM aged 45 years or older.”

Dr. Valerie Delpech, the head of national HIV surveillance at Public Health England, which partly funded the study, commented on its findings:

“We have made good progress toward ending HIV transmission by 2030 in England. Frequent HIV testing and the use of PrEP among people most at risk of HIV, together with prompt treatment among those diagnosed, are key to ending HIV transmission by 2030.”

“HIV and [sexually transmitted infection] tests are still available through sexual health clinics during the COVID pandemic. Many clinics offer online testing throughout the year — people can order tests on clinic websites, take them in the privacy of their own homes, return [them] by post, and receive results via text, phone call, or post.”

– Dr. Valerie Delpech

Takudzwa Mukiwa, the head of health programs at the Terrence Higgins Trust, a U.K.-based HIV and sexual health charity, told Medical News Today, “The reality is, we now have all the tools we need to end new HIV cases in the U.K. by 2030 — not just among gay and bisexual men, as discussed in this study, but across all groups impacted by HIV.”

“We have prevention pill PrEP that stops [people] from contracting HIV, a range of fast testing options, and effective treatment for people living with HIV that means the virus can’t be passed on.”

“But we mustn’t be complacent, and we will only get there by making a real step change to ensure that we see a fall in HIV cases across all groups, rather than just those traditionally most impacted,” Mr. Mukiwa emphasized.

He also commented on the need for the British government to implement a robust strategy to achieve the goal of zero new cases by 2030.

“The government has committed to ending domestic HIV transmissions by the end of the decade and is currently drafting its action plan for making it happen. We are holding [the] government to account on its promise and must see an ambitious, properly resourced plan published this summer,” Mr. Mukiwa said.

“It must include PrEP being made available outside sexual health clinics with access via [general practitioner] surgeries and in pharmacies. We also want to see free postal testing available throughout the year and more testing as standard across our [National Health Service].”

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