GMI Partnership starring at HIV Prevention England conference

HIV Prevention England, Terrence Higgins Trust held its 2024 conference, Prioritising Equity and Impact’, at the County Hall, London with approximately 300 delegates.

Dr Renee West, Development Manager for GMI Partnership and Positive East presented on PrEP awareness, access and adherence. The study aimed to explore PrEP awareness, access and adherence among people from black African and Caribbean (BAC), Latin Gay, Bisexual and Men who have Sex with other Men (GBMSM) and trans and non-binary communities. Take-home points included that there needs to be an increase PrEP awareness and an expansion of access and receipt venues; barriers to PrEP adherence include side effects, potential drug interactions and busy lifestyles, and the importance of tailored community outreach models, informed by lived experience, in achieving and overcoming the previous points. Dr West stressed the point that all three populations suggested community outreach models including a mobile clinic and trans-friendly places, for information dissemination, and access and receipt of PrEP. The 2024 Roadmap to meeting the PrEP needs of those at significant risk to HIV is cognisant of the important role that the broader HIV voluntary and community sector plays in ensuring equitable and effective PrEP use. And as this study has demonstrated, the key groups want us to play a role in achieving this.

Later in the day Dr West also presented on the treatment journeys of 12 black African women living with HIV in London. When Persons Living with HIV, start their antiretroviral treatment, they may stop taking their medications, with most re-starting again. This ‘initial start-stop-re-start’ cycle continues until hopefully there is absolute adherence which is essential for effective HIV management. The study aimed to explore the factors, that influence the initial uptake and adherence among black African women living with HIV in London. The interviews provided valuable insights into their treatment journeys and highlighted the complex interplay of emotional, social, and structural factors influencing treatment initiation, and adherence. The role of support networks, including family, peers, and healthcare providers – as well as voluntary organisations – emerged as crucial in facilitating adherence, and addressing psychosocial needs. Challenges in adherence, such as side effects and stigma, highlight the importance of tailored interventions to support ongoing engagement with treatment. Dr West also advocated for global equitable access to HIV diagnosis, prevention, treatment, and ongoing support to be able to end HIV transmission by 2030.

Dee Wang, Research and Performance Manager, Spectra CIC/GMI Partnership and Deputy CEO of Spectra CIC, presented the results of an updated literature review on the factors to reduce disengagement from (DFC) and increase re-engagement into (RIC) care. Lessons learned show that DFC is strongly related to (a)individual factors, e.g. race, gender, sexuality, age, poor mental and physical health, and drug use; (b)social determinants of health, e.g. poverty, immigration, domestic violence and abuse, housing, education, and community networks/support; and (c)treatment, care and diagnosis factors, e.g. time from diagnosis and polypharmacy. The literature suggests that RIC factors include mostly (a)social and community factors, e.g. peer support and community testing; and (b)treatment, care and diagnosis, e.g. accident and emergency testing and patient monitoring tools. Some factors attributed to both DFC and RIC include stigma (self, societal, within health services) and joint working between the different components of a PLHIV’s care network. Community and structural interventions that can lead to re-engagement in care, and prevent disengagement from care were also discussed. These included interventions focussed on reducing HIV stigma and increasing HIV knowledge, psychological interventions to deal with mental health, measures to combat the impact of living in poverty, interventions around alcohol and drug use, interventions focusing on with people of colour, targeted interventions based on age, interventions focused on the social determinants related to disengagement from care, and increased healthcare co-ordination, collaboration and connectedness. It is important that interventions focused on retention in HIV care must be tailored to those intersectional populations and they must take a multi-disciplinary approach. The research suggests a shift from a binary understanding of patients as either engaged in, or disengaged from, care and that this nuanced understanding of an HIV care engagement continuum is important when planning interventions. The full review is available here.