This Clinical Reference Group (CRG) covers human immunodeficiency virus (HIV) services. HIV is a virus that causes acquired immunodeficiency syndrome (AIDS), a condition in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive. An estimated 104,000 people were living with HIV in the UK at the end of 2014, of whom almost 20% were unaware of their infection.
Adult specialist services for patients infected with HIV include inpatient care for HIV related conditions in Adult Specialist HIV Treatment Centres and outpatient care provided by these Specialist Centres including outreach when delivered as part of a provider network. Specialist services for children and young people with HIV include services provided by Specialist Infectious Diseases Paediatric Centres.
Chair: Dr David Asboe
Recruitment to this CRG is in progress and the names of the members will be updated shortly.
Heading: Spotlight on HIV
The treatment of HIV infection has been one of the most outstanding medical achievements over the last 25 years. The Spotlight on HIV highlights the of achievements and key milestones in HIV care in the NHS over the past 40 years.
A key part of the CRG’s work is the delivery of the ‘products’ of commissioning. These are the tools used by the 10 Hub Commissioning Teams to contract services on an annual basis.
Service specifications are important in clearly defining the standards of care expected from organisations funded by NHS England to provide specialised care. The specifications have been developed by specialised clinicians, commissioners, expert patients and public health representatives to describe both core and developmental service standards. Core standards are those that all funded providers should be able to demonstrate, with developmental standards being those which may require further changes in practice over time to provide excellence in the field.
The following service specifications fall within the scope of this CRG:
- Specialised Human Immunodeficiency Virus (HIV) Services (Adult)
- Specialised Human Immunodeficiency Virus Services (Children)
A commissioning policy is a document that defines access to a service for a particular group of patients. A NICE Technology Appraisal Guideline on the same topic will replace, or be incorporated into, a commissioning policy as appropriate. These are important documents that are developed to ensure consistency in access to treatments nationwide.
The following policies fall within the scope of this CRG:
- Immediate antiretroviral therapy for treatment of HIV-1 in adults and adolescents
- Elvitegravir/cobicistat/emtricitabine/tenofovir for treatment of HIV in adults
- Use of cobicistat as a booster in treatment of HIV infection (all ages)
- Treatment as Prevention (TasP) in HIV infected adults
- Dolutegravir for treatment of HIV-1 infection (all ages) (updated January 2019)
- Tenofovir Alafenamide for treatment of HIV 1 in adults and adolescents
- Bictegravir-emtricitabine-tenofovir alafenamide for the treatment of HIV-1 in adults
PrEP trial updates
NHS England is funding a major extension to the national HIV prevention programme led by Public Health England with the aim of supporting those most at risk and reducing the incidence of HIV infection. The first phase of implementation will be the launch of a large scale trial of anti-retroviral drugs for the prevention of HIV, known as pre-exposure prophylaxis (PrEP).
The PrEP Programme Oversight Board provides governance to make sure the PrEP trial is as good as it can be and that it progresses as planned. Updates from the Board meetings can be found here.
- PrEP trial update – April 2019
- PrEP trial update – January 2019
- PrEP trial update – June 2018
- PrEP trial update – March 2018
- PrEP trial update – January 2018
- PrEP trial update – November 2017
- PrEP trial update – September 2017
- PrEP trial update – June 2017
- PrEP impact trial questions and answers