Research and analysis

HPR volume 10 issue 34: news (7 October)

Updated 16 December 2016

1. HIV new diagnoses, treatment and care in the UK in 2015

A total of 6,095 people (4,551 males and 1,537 females) were diagnosed with HIV in the UK in 2015, according to newly released PHE data [1], including 65 children, 5,012 adults aged 15-49 years and 1,018 adults aged 50 years and over.

The overall level of new diagnoses in 2015 was similar to that reported in previous years. There was a slight decline in new diagnoses among gay, bisexual and other men who have sex with men (MSM). However the number remains high (3,320) in this group, reflecting both increased levels of HIV testing and ongoing transmission.

There were 2,360 new diagnoses in heterosexual men and women – about half the level of diagnoses being made a decade earlier in this group (4,340); this fall was largely due to changing migration patterns, leading to fewer people born in sub-Saharan Africa being diagnosed with HIV in the UK. Those newly diagnosed in 2015 who acquired their infection through injecting drug use remains low overall (2% of the total). However, the number of diagnoses reported in this group rose between 2014 and 2015, largely due to a localised outbreak among people who inject drugs in Glasgow.

In 2015, 39% of adults were diagnosed at a late stage of infection, defined as a CD4 count ˂350 cells per cubic millimetre (pcm) within three months of HIV diagnosis. This represents a continuation of the gradual decline seen across all major groups. This proportion was higher among heterosexuals, with 55% of men and 49% of women diagnosed late. Rates were lower in MSM at 30%.

In 2015, the number of people living with diagnosed HIV, and accessing care, was 73% higher than a decade earlier, reaching 88,769. The rise reflects effective treatment, with few HIV-related deaths. As a consequence, the average age of people accessing care is increasing (45 in 2015 compared to 39 in 2006) with one in three of those accessing HIV care now being aged 50 years or over, compared with one in seven in 2006.

There was an increase in the proportion of those seen for HIV care who received treatment with anti-retroviral therapy (ART) in 2015 (96%) compared with 2014 (90%), likely to reflect new treatment guidelines published in 2015 (recommending that all those living with HIV should be offered treatment to prevent onward transmission). Ninety four per cent of those treated achieved viral suppression, greatly reducing the risk of passing on their infection. Viral suppression was high for MSM (95%), heterosexual men (95%) and women (93%), and somewhat lower for people who inject drugs (90%) and those who acquired HIV through mother to child transmission (83%). PHE’s overview of the newly released data [1] notes that the high levels of viral suppression achieved demonstrate the very high standard of HIV care available in the UK.

1.1 Reference

1. PHE (October 2016). HIV official statistics overview: 2016.

2. New AMR local indicators launched

AMR local indicators are publically available data intended to raise awareness of antibiotic prescribing, AMR, healthcare-associated infections (HCAI), infection prevention and control (IPC) and antimicrobial stewardship (AMS). The data will also serve to facilitate the development of local action plans. The data published may be used by healthcare staff, commissioners, Directors of Public Health, academics and the public to compare the AMR situation in their local area to the national picture and to monitor their progress over time.

PHE launched new AMR local indicators on the PHE Fingertips portal [1] on 4 October; some of the data are relevant to the NHS England AMR CQUIN (Commissioning for Quality and Innovation) goals for 2016/17. The specific data items comprise the following:

For Acute Trusts

• total and broad-spectrum antibiotic prescribing by Defined Daily Dose (DDD) per 1000 admissions (2016/17 AMR CQUIN data)
• the proportion of antibiotic prescriptions that are reviewed within 72 hours (2016/17 AMR CQUIN data)
• hospital-onset E. coli bloodstream infection (BSI) rates per occupied bed-days

For Clinical Commissioning Groups (CCGs)

• rates of resistance to nitrofurantoin and trimethoprim among E. coli and coliforms isolated from community urinary tract infections (UTIs)
• ratio of trimethoprim to nitrofurantoin prescribing in community settings

Antibiotic prescribing and AMR are inextricably linked, as overuse and incorrect use of antibiotics are major drivers of resistance. A reduction in the occurrence of infections will reduce the need to prescribe antibiotics. Total and broad spectrum antibiotic prescribing rates in primary care are also openly accessible on the PHE Fingertips portal.

PHE Centre staff are requested to:

• be aware of the Trust and CCG AMR local indicator data for their area and associated caveats with the data
• engage with trusts with high rates of E. coli BSI to support the development of local action plans. These could include looking at urinary catheter insertion and care, central line catheter care, surveillance of BSI in ICUs, uptake of bladder scanners, surgical prophylaxis and hand hygiene (to reduce the incidence of UTIs which are a risk factor for BSI)
• work with NHS Improvement to support trusts that have NOT submitted data for 16/17 AMR CQUIN
• work with CCG prescribing advisors and Directors of Public Health to highlight PHE primary care prescribing guidance and resistance data

In addition, AMR leads in each PHE Centre are requested to familiarise themselves with AMR local indicators on Fingertips in readiness to discuss these data and respond to any queries. Full definitions for each indicator, including any data caveats, can be found on the AMR local indicators webpage [1].

It is requested that if local PHE teams need support in responding to queries, the centre AMR lead, lead microbiologist or FES should contact: [email protected]

2.1 Reference

1. PHE AMR local indicators (“Fingertips”) webpage.

3. Infection reports in this issue of HPR

In addition to the above, the following reports are published in this issue of HPR. The links below are to the relevant webpage collections.

3.1 HIV-STIs

• Post-immunisation monitoring of HPV vaccine-induced seroprevalence in England 2010-2013.

3.2 Respiratory infections

• Laboratory reports of respiratory infections in England and Wales.