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Idea Exchange: How we’re cutting HIV diagnoses in London

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Paul Steinberg explains how the London HIV Prevention Programme, funded by London boroughs and led on their behalf by Lambeth LBC, is helping cut diagnoses in the capital

  • Project: London HIV Prevention Programme
  • Objectives: To prevent transmission in Greater London, by increasing HIV testing and promoting safer sexual behaviours
  • Timescale: 2015 to (at least) 2019
  • Cost to authority: Just over £1m per year total budget – average annual borough contribution £25k
  • Number of staff working on project: Two
  • Outcomes: A record 40% reduction in HIV diagnoses in five central London clinics in 2016 and a 32% overall reduction in new diagnoses in London between 2015 and 2016
  • Officer contact details: psteinberg@lambeth.gov.uk

For the very first time, London is seeing a remarkable downward trend in the number of people being diagnosed with HIV.

In 2016, there was a record 40% reduction in HIV diagnoses in five central London clinics, far outperforming the rest of the country. It is a trend that is expected to continue. In January 2018, London Councils became a leading co-signatory to the Fast-Track Cities initiative, a global partnership to cut HIV diagnoses and stigma in cities. The city has already exceeded the United Nations targets for HIV diagnosis and treatment.

One factor in these exciting developments is the not-so-quiet revolution that has been taking place in the way London commissions HIV prevention and testing services. On the back of the transfer of public health to local government, the London HIV Prevention Programme (LHPP), and its public-facing campaign have been playing an important role in the capital’s fight against HIV.

Funded and supported by London boroughs, hosted by Lambeth LBC and endorsed by the Association of Directors of Public Health London network, the LHPP is an excellent example of how local authorities can join forces to deliver services that have a real impact.

By collaborating on HIV prevention, London boroughs are achieving economies of scale. The programme has a budget of just over £1m per annum (compared to over £3m per annum under previous NHS commissioners).

But there are not just financial economies of scale. A key element of the programme is Do It London, a public-facing multi-channel communications campaign. Since its launch, it has achieved 55,500,000 digital display advert impressions on Londoners’ mobiles, tablets and laptops and has appeared on at least 13,000 ad panels inside London Underground tube trains, just over 13,000 ad panels inside London’s buses and nearly 17,000 street-side adverts.

There is also a free condom distribution scheme – 4,200,000 condoms and 4,100,000 lube packets were distributed to Londoners between 2014 and the end of 2017. And there are targeted outreach activities including providing rapid HIV testing and sexual health advice for people in venues such as bars, clubs and saunas. A fourth element is a focus on vulnerable groups such as black African communities and men who have sex with men (MSM) who are most at risk from HIV.

Boroughs benefit from the Do It London campaign’s messaging remaining consistent throughout the capital, amplifying the impact of the programme. This is also helpful as people travel in and around London on a regular basis.

The brand and tone of the Do It London campaign have been uniquely effective, thanks to the creative yet public health-focused development of the artwork and messaging. Posters encouraging Londoners to get tested for HIV by encouraging them to “Do It with one finger”, combine a sense of humour and appreciation of peoples’ lives with essential and informative prevention and testing messages.

The campaign also hasn’t sought to put up false divides between HIV prevention and wider STI prevention and testing. Instead it has sought to deliver strong messages about the importance of combination prevention in reducing and stopping the spread of HIV and STIs.

Independent evaluation of the campaign carried out in 2016 showed that over two thirds of respondents who’d seen the Do It London campaign (68%) said it had positively influenced their HIV testing behaviour, and two thirds of respondents who’d seen the campaign (66%) said it had positively influenced their sexual behaviour and attitude towards condom use.

The campaign has also reflected recent developments in HIV prevention, including evidence that sustained anti-retroviral therapy leading to an “undetectable” HIV status and the use of Pre-Exposure Prophylaxis (PrEP) are helpful prevention methods. It is the first official campaign in the UK to inform the public about PrEP and “undetectable” status.

The success of the London HIV Prevention Programme, supported by other local initiatives and local authority commissioning of sexual health clinical services, directly correlates with the fall in HIV diagnoses observed in London over the past two and a half years.

Epidemiological data, supported by market research and user feedback, reveals the extent to which Do It London has helped to improve awareness of HIV, drive up testing and increase condom usage, while also promoting PrEP and awareness that an HIV positive person with an undetectable viral load is not infectious to others.

These factors have been highlighted by Public Health England as contributing significantly to the 40% decrease in new HIV diagnoses seen in central London clinics, as well as the first downturn in a decade in sexually transmitted infections.

We therefore strongly feel the London HIV Prevention Programme is a huge success story, demonstrating how political leadership, public health expertise, strong and unified programme management and a city-wide approach can align to deliver powerful results that residents. The LHPP has also highlighted that London boroughs can effectively collaborate together to improve the health outcomes of Londoners, working across borough boundaries and party lines.

In December 2016, London boroughs committed to fund the LHPP for another two years at least until 2019, operating with a 10% budget reduction. This was a tough decision to make as borough public health budgets have been cut significantly, but given the success of the programme and the value it delivers to London boroughs and its residents, London borough leaders and directors of public health agreed it had to continue. The future seems bright, with the NHS England PrEP Impact Trial is now underway, supported by local authorities, offering the potential to reduce the number of people with HIV even further.

Paul Steinberg, lead commissioner, London HIV Prevention Programme (LHPP)

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