Why did we undertake this project?
While HIV infection almost invariably progressed to AIDS and eventually death in the 1980s, nowadays treatment has improved significantly and, if diagnosed early, HIV has potentially no impact on life expectancy. As a result, more than 100,000 people in the UK are now living with HIV.
Treatment, support and prevention services for HIV have been going through a period of significant change and reorganisation following the Health and Social Care Act 2012. Now that the current service situation is becoming clearer, our project aims to identify key risks and opportunities that those involved in planning future HIV services nationally and locally should consider. We know that prevention services remain important, with significant variation around the UK in rates of new infection and how quickly infection is diagnosed. The distribution of HIV infection across the population, and patterns of new cases, are changing and so there is a need to review how treatment, support and prevention services may need to adapt.
In addition to being important in their own right, HIV services are also a potential case study of service development in the context of current health policy. In particular:
- Both concerns and opportunities have been raised, for example by the All-Party Parliamentary Group on Sexual and Reproductive Health in the UK, about the division of roles and responsibilities for HIV between clinical commissioning groups, local authorities, Public Health England and NHS England. This project will look across the HIV ‘pathway’ from prevention to treatment and ongoing support, and identify broader learning for policy-makers.
- The big policy picture, within which HIV services sit, is one of continuing efforts to integrate services, at the same time as managing and reducing costs. This project will consider how system-level policy developments, such as sustainability and transformation plans (STPs), apply to HIV services and draw out broader learning for policy-makers.
What did we do?
As part of this project, we:
- briefly reviewed how we arrived at the current landscape of responsibilities and service models for HIV services
- collected information about current services through: literature and data analysis; a number of case studies; and direct engagement with providers, commissioners, public health leaders and people using HIV services
- held workshops with key stakeholders, including people living with HIV, to consider what this information tells us about possible future scenarios.
The project’s advisory group, which includes service users, helped us finalise the project’s focus, which covered issues such as:
- how to build on the current distribution of responsibilities for service provision and commissioning
- how future HIV services will adapt to meet future developments in, for example, system-level policy developments, new technology, trends in funding
- how services may need to change to reflect changing needs of people living with or affected by HIV
- how people affected by HIV can be at the centre and forefront of service developments
- current leading-edge thinking about services for people living with HIV.
This project was funded by a grant from the M·A·C AIDS Fund, a charity established to support people living with HIV/AIDS worldwide. The King’s Fund was entirely responsible for independent research, analysis and reporting of the project.
Literature search and data analysis. Finalise project focus, identify case study locations and agree methods (including obtaining views of people living with or affected by HIV).
Scoping interviews with stakeholders and fieldwork in case study areas.