CHAIN Workshop, 14 March 2014 Simon Collins: www.i-Base.info Health service constraints on HIV care – the research agenda: a UK perspective CHAIN Workshop,

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Presentation transcript:

CHAIN Workshop, 14 March 2014 Simon Collins: Health service constraints on HIV care – the research agenda: a UK perspective CHAIN Workshop, Barcelona 14 March, 2014 Simon Collins HIV i-Base

CHAIN Workshop, 14 March 2014 Simon Collins: Introduction HIV in the UK Changes to HIV care in the NHS Community involvement research

CHAIN Workshop, 14 March 2014 Simon Collins: UK overview ~ 100,000 +ve, 25% undiagnosed High% on treatment and <50 c/mL Good surveillance data on STIs National & regional data (hpa.org.uk) Public funding for HIV research Close links to European and international studies

CHAIN Workshop, 14 March 2014 Simon Collins: HIV research Good surveillance data on incidence (SOPHID – by age, region, year, ethnicity, risk group, CD4 etc) Cohort data on natural history, treatment and safety (UK-CHIC, seroconverters, MHRA, children, pregnancy etc, RITA/STARHS avidity) Drug resistance collaboration (HIV DRD) European cohort research - COHERE, CASCADE, EUROSIDA, PENTA, DAD etc Global – Large, randomised strategy studies: SPARTAC, DART, ARROW, ERNEST, PopART etc

CHAIN Workshop, 14 March 2014 Simon Collins: Current examples Research less-affected - ASTRA, PROUD (PrEP), CURE (Cherub), HIVDRB; UK in PARTNER, START etc Cohort data and reduced monitoring - changed use of CD4 and viral load based on data Resistance collaboration - community-supported (1998), central database, greater numbers: community link = earlier advocacy for access and guidelines - understand epidemic dynamics – sub-clades, clusters, virulence - reducing risk of first-failure – critical when fewer drug options - current TDR from undiagnosed patients with historical mutations - stock-outs – 10% from NNRTI-based (Abs 593 CROI 2014)

CHAIN Workshop, 14 March 2014 Simon Collins: NHS changes Financial pressure on NHS Continual restructure & overhaul Move to primary care – for cost - benefits: ageing cohort, normalising HIV? - disadvantages: drug interactions, confidentiality (rural), experience, convenience, cost-based Privatising NHS services - loss of HIV expertise: clinical, diagnostic, pharmacy HIV prevention & treatment separated - makes PrEP difficult to prescribe or study

CHAIN Workshop, 14 March 2014 Simon Collins: Flat HIV budgets £20 billion savings - Nicholson ”challenge” - no inflation uplift, increasing patients Commercial ARV tenders by volume London saved £10m – challenge to pharma pricing Splitting FDCs & generics Supported by HIV positive people, 60-85% non-HIV NHS medsare generics, also ”home delivery” to save tax on medicines Evidence-based for clinical result BUT no shift to older ARVs, EFV 400 mg or boosted-PI mono, New-fill still funded

CHAIN Workshop, 14 March 2014 Simon Collins: Model for other settings Treatment response and drug safety Essential to collect data on efficacy& safety of ARVs in practice – use of technology advances for collecting quality data Reduce viral failure Early uptake of viral load and resistance tests – but limited availability in other settings – stock-outs and resistance Community engagement Benefits from community involvement and a good profile Improve quality of life Switching options, pipeline and formulation research, cost & access (no premium pricing for new drugs)

CHAIN Workshop, 14 March 2014 Simon Collins: Thanks:

CHAIN Workshop, 14 March 2014 Simon Collins: Imperial College, November, 2013 Simon Collins: Andrew, Andy B, Andy C, Chris M, Chris P, Richard, Chris W, Space, Nick, Dolly, Wesley, Colvin, Jimi, Kevin, Mike, Paul, Mark, Steve. CHAIN Workshop, 14 March 2014 Simon Collins: