The number of new HIV diagnoses in gay men attending five key London clinics fell substantially during 2015 and 2016, Valerie Delpech of Public Health England told the British HIV Association (BHIVA) conference in Liverpool yesterday.
Epidemiological analysis shows that the phenomenon is real. Diagnoses fell while testing rates dramatically increased, showing that the explanation cannot be reduced testing. The CD4 cell counts of newly diagnosed men increased, suggesting that fewer new diagnoses are indeed the reflection of fewer new infections. The time from diagnosis to starting HIV treatment has fallen.
Delpech said that the results were the result of combination prevention – testing and ‘treatment as prevention’. Pre-exposure prophylaxis (PrEP) is likely to have contributed to the fall, but to a lesser extent, she said. It could have more impact in the future.
Nneka Nwokolo of the 56 Dean Street clinic agreed: “Although I think we all accept that PrEP plays some part, actually the decrease started significantly before PrEP was being used in any widespread way,” she said. The clinic quickly identifies and engages the men with the very highest risk of acquiring HIV and encourages them to attend each month for sexual health check-ups. GeneXpert testing for sexually transmitted infections has reduced the time from test to treatment from ten to two days.
Perhaps most importantly, a quarter of newly diagnosed individuals now start HIV treatment within three days of diagnosis.
Valerie Delpech said that Public Health England had reliable data on new HIV diagnoses across England up to and including the third quarter of 2016 (July to September), whereas reports for the last quarter were still coming in. Nationally, there was a clear fall in diagnoses in gay men between October 2014 and September 2016, but not in other population groups.
Moreover, there are five clinics at which the falls in gay male diagnoses were concentrated. They are all in London: 56 Dean Street (which accounts for over a third of diagnoses), the Mortimer Market Centre, Burrell Street, Homerton Sexual Health and St Mary’s.