Trends in undiagnosed HIV prevalence in England and implications for eliminating HIV transmission by 2030: an evidence synthesis model

Anne M. Presanis*, Ross J. Harris, Peter D. Kirwan, Ada Miltz, Sara Croxford, Ellen Heinsbroek, Christopher H. Jackson, Hamish Mohammed, Alison E. Brown, Valerie C. Delpech, O. Noel Gill, Daniela De Angelis

*Corresponding author for this work

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Abstract

Background: A target to eliminate HIV transmission in England by 2030 was set in early 2019. This study aimed to estimate trends from 2013 to 2019 in HIV prevalence, particularly the number of people living with undiagnosed HIV, by exposure group, ethnicity, gender, age group, and region. These estimates are essential to monitor progress towards elimination. 

Methods: A Bayesian synthesis of evidence from multiple surveillance, demographic, and survey datasets relevant to HIV in England was used to estimate trends in the number of people living with HIV, the proportion of people unaware of their HIV infection, and the corresponding prevalence of undiagnosed HIV. All estimates were stratified by exposure group, ethnicity, gender, age group (15–34, 35–44, 45–59, or 60–74 years), region (London, or outside of London) and year (2013–19). 

Findings: The total number of people living with HIV aged 15–74 years in England increased from 83 500 (95% credible interval 80 200–89 600) in 2013 to 92 800 (91 000–95 600) in 2019. The proportion diagnosed steadily increased from 86% (80–90%) to 94% (91–95%) during the same time period, corresponding to a halving in the number of undiagnosed infections from 11 600 (8300–17 700) to 5900 (4400–8700) and in undiagnosed prevalence from 0·29 (0·21–0·44) to 0·14 (0·11–0·21) per 1000 population. Similar steep declines were estimated in all subgroups of gay, bisexual, and other men who have sex with men and in most subgroups of Black African heterosexuals. The pace of reduction was less pronounced for heterosexuals in other ethnic groups and people who inject drugs, particularly outside London; however, undiagnosed prevalence in these groups has remained very low. 

Interpretation: The UNAIDS target of diagnosing 90% of people living with HIV by 2020 was reached by 2016 in England, with the country on track to achieve the new target of 95% diagnosed by 2025. Reductions in transmission and undiagnosed prevalence have corresponded to large scale-up of testing in key populations and early diagnosis and treatment. Additional and intensified prevention measures are required to eliminate transmission of HIV among the communities that have experienced slower declines than other subgroups, despite having very low prevalences of HIV. 

Funding: UK Medical Research Council and Public Health England.

Original languageEnglish
Pages (from-to)e739-e751
JournalThe Lancet Public Health
Volume6
Issue number10
Early online date23 Sep 2021
DOIs
Publication statusPublished - Oct 2021

Bibliographical note

Funding Information: AMP, PDK, CHJ, and DDA were funded by the UK Medical Research Council (unit programme number MC_UU_00002/11). DDA was also funded by Public Health England (PHE). AM, SC, RJH, EH, HM, AEB, VD, and ONG were employed by PHE when this manuscript was submitted. We thank Dr Stefano Conti (National Health Service England), Louise Logan, Dr Stephanie Migchelsen, Katy Davison, Sophie Nash, Dr Zheng Yin, Dr Nicky Connor, and everyone in the Blood Safety, Hepatitis, Sexually Transmitted Infections and HIV Division at PHE; Prof Cath Mercer (University College London [UCL]), Dr Ford Hickson (London School of Hygiene & Tropical Medicine [LSHTM] and Sigma Research), and Prof Claire Thorne (UCL Great Ormond Street Institute of Child Health) for providing data and constructive discussion. We acknowledge all of the participants of a stakeholder engagement event, whose contributions to the discussions informed model developments aimed at making greater and more efficient use of available data. This event was held at LSHTM in 2016 and was coordinated by Dr Catherine Dodds (LSHTM and Sigma Research), Deborah Gold (UK National AIDS Trust), Dr Valerie Delpech (PHE), and Prof Daniela De Angelis (UK Medical Research Council Biostatistics Unit).

UK Medical Research Council and Public Health England.

Open Access: This is an Open Access article under the CC BY 4.0
license.

Publisher Copyright :Crown copyright © 2021. Published by Elsevier Ltd.

Citation: Anne M Presanis, Ross J Harris, Peter D Kirwan, Ada Miltz, Sara Croxford, Ellen Heinsbroek, Christopher H Jackson, Hamish Mohammed, Alison E Brown, Valerie C Delpech, O Noel Gill, Daniela De Angelis, Trends in undiagnosed HIV prevalence in England and implications for eliminating HIV transmission by 2030: an evidence synthesis model, The Lancet Public Health, Volume 6, Issue 10, 2021, Pages e739-e751, ISSN 2468-2667.

DOI: https://doi.org/10.1016/S2468-2667(21)00142-0.

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