Progress towards ending HIV transmission in England by 2030

Background: England is committed to ending HIV transmission by 2030. The HIV Action Plan (2021) set an interim ambition to reduce HIV transmission by 80% to 600 new diagnoses first made in England by 2025. Here we present the progress between 2019 (baseline) and 2021, interpreted in the context of the COVID-19 pandemic. Method(s): People newly diagnosed with HIV were reported to the HIV and AIDS Reporting Section (HARS). The annual number of people having an HIV test in all sexual health services (SHS) including online testing were reported using GUMCAD. HIV diagnoses among people previously diagnosed abroad were excluded (25%). Result(s): New HIV diagnoses first made in England fell by 32% from 2,986 in 2019 to 1,987 in 2020, but plateaued in 2021 (2,023). Among gay/bisexual men, HIV diagnoses plateaued in 2021 (721) after a fall of 45% between 2019 and 2020, from 1,262 to 699. After a fall in HIV testing in 2020 (from 156,631 in 2019 to 144,800 in 2020), the number of people tested in 2021 (178,466) exceeded pre-COVID-19 levels. This suggests a decline in HIV incidence supported by a CD4 back calculation model (80% probability of a decline for the period 2019-2021), but at a slowing rate. Among heterosexual adults, new HIV diagnoses first made in England in 2021 also plateaued (798) following a 31% decrease (from 1,109 in 2019 to 761 in 2020). However, HIV testing coverage has not recovered to pre- COVID-19 levels (628,607 in 2019, 441,017 in 2020 and 489,727 in 2021). This provides no evidence of a fall in incidence in this population. Conclusion(s): A reduction by 360 new diagnoses first made in England year on year from 2022 onwards is required to meet the HIV Action Plan ambition. Despite an estimated 4,500 people with undiagnosed HIV and extremely high levels of antiretroviral therapy and viral suppression, PrEP access remains unequal. HIV testing numbers, which were affected by COVID-19 pandemic, have recovered in gay/bisexual men, but not among heterosexual adults. While the interim ambition is within reach for gay/bisexual men, PrEP and testing levels must be scaled up in heterosexual adults.

Hospitalisation and mortality risk of SARS-COV-2 variant omicron sub-lineage BA.2 compared to BA.1 in England.

The Omicron variant of SARS-CoV-2 became the globally dominant variant in early 2022. A sub-lineage of the Omicron variant (BA.2) was identified in England in January 2022. Here, we investigated hospitalisation and mortality risks of COVID-19 cases with the Omicron sub-lineage BA.2 (n = 258,875) compared to BA.1 (n = 984,337) in a large cohort study in England. We estimated the risk of hospital attendance, hospital admission or death using multivariable stratified proportional hazards regression models. After adjustment for confounders, BA.2 cases had lower or similar risks of death (HR = 0.80, 95% CI 0.71-0.90), hospital admission (HR = 0.88, 95% CI 0.83-0.94) and any hospital attendance (HR = 0.98, 95% CI 0.95-1.01). These findings that the risk of severe outcomes following infection with BA.2 SARS-CoV-2 was slightly lower or equivalent to the BA.1 sub-lineage can inform public health strategies in countries where BA.2 is spreading.

QUANTIFYING THE EFFECT OF THE COVID-19 PANDEMIC AND ASSOCIATED INTERVENTIONS ON HIV TESTING AT SEXUAL HEALTH SERVICES

Introduction The first COVID-19 lockdown in the UK resulted in disrupted patterns in risk behaviour and access to sexual health services (SHS), and therefore in HIV/STI testing and diagnosis. Methods To understand how HIV testing was affected by changes in risk behaviour and SHS access, quantification of these two unobserved variables using proxies for each - including number of partners, measures of propensity to consult, number of SHS attendances, and number of HIV and STI tests offered - is necessary. The effects of lockdown on the resulting measures of risk behaviour and SHS access, and of these intermediate variables on the number of HIV tests accepted, can then be estimated. Results Preliminary results from quantifying SHS access using proxies from GUMCAD surveillance data, including numbers of attendances and HIV/STI tests offered, resulted in a measure of SHS access which corresponds to approximately a unit increase in tests offered and attendances (estimates in range 0.88-1.04). SHS access decreased by 638 units after the lockdown compared to before. The number of HIV tests accepted increased by 0.88 for each unit increase in SHS access. Discussion These initial findings support the hypothesis that disruption to HIV testing resulted from the lockdown via its effect on SHS access. In ongoing work, we are using data from Natsal-COVID (general population survey), RiiSHCOVID (MSM survey) and the BASHH Clinical Thermometer Survey (SHS staff) to improve our derived measures of risk behaviour and SHS access, and therefore quantify the lockdown effect on HIV/STI testing and diagnosis via each of these paths. (Figure Presented).