Across London, partnerships of NHS services, voluntary sector organisations and peer support teams are working together to find and support people living with HIV who have fallen out of care – and help them back.
People taking effective HIV treatment can live long, healthy lives and can’t pass HIV on to their sexual partners. But treatment is only possible if people stay connected to their care. The reasons people fall out of HIV care are complex and often overlapping. Mental health difficulties, housing instability, poverty, immigration challenges, experience of stigma and discrimination, drugs and alcohol, negative past experiences with services, or simply not feeling that HIV is the most pressing thing to deal with right now. All of these can lead someone to disengage from the care that keeps them well.
For many, healthcare drops to the bottom of a long list of things to manage.
Without treatment, HIV can damage the immune system, cause serious health problems and, in some cases, lead to preventable death. It can also be passed on to others. Re-engaging people with care isn’t just about clinical outcomes – it’s about supporting people to live well.
The scale of the challenge
UK Health Security Agency data estimates that between 1,500 and 5,500 people in London may currently be out of HIV care. Some have moved and not re-registered with a clinic. Some are managing complex and competing needs that make attending appointments difficult. Others have had negative experiences with services or carry stigma that keeps them away.
London accounts for a significant proportion of all people in England who are not engaged in HIV care. The challenge is greatest among communities already facing health inequalities – including people from racially minoritised backgrounds, people experiencing homelessness, those in contact with the criminal justice system and people dealing with substance use.
Finding these individuals, understanding their circumstances and supporting them back into care requires a coordinated effort that goes well beyond the clinic.
How the programme works
Fast-Track Cities London is supporting a programme that brings together NHS HIV services, voluntary and community sector organisations and peer support teams to deliver coordinated re-engagement across the city. The programme is designed to trace and contact people not in care, provide personalised support to help them reprioritise their health and HIV care, re-engage them with clinical services and improve their quality of life by addressing their unmet needs.
The work is being delivered through three partnerships, each covering different parts of London and bringing different strengths. All three are working alongside the UK Health Security Agency, the British HIV Association, NHS England, local authorities and GPs.
South London
The South London HIV Network leads the partnership that brings together the seven NHS HIV clinics across South London with Terrence Higgins Trust, Food Chain and Antidote.
South East London already has one of the most established re-engagement programmes in England, with over 330 re-engagement episodes recorded between 2022 and 2025. That learning is now being extended across the South London. The partnership includes peer support case workers, community nursing, dedicated chemsex support through Antidote, and an initiative working with Lambeth, Southwark and Lewisham Councils through primary care and GP HIV champion networks to reach people still visiting their GP but not engaged in HIV services.
North West London
The North West London partnership is led by Chelsea and Westminster Hospital NHS Foundation Trust, working with all HIV clinics within the area, Positively UK, Naz Project and Plushealth for peer support, and Antidote for substance use and chemsex support.
The model is built around taking care to the person rather than expecting them to come to the clinic – through community outreach, home visits, telehealth and rapid treatment re-start in the community. Peer support is embedded at every stage, including an online platform with self-referral for people who may find that a less intensive first step back towards services.
NHS Find and Treat
Working across the whole of London, NHS Find and Treat provides specialist peer and nurse led outreach for people from inclusion health groups – those experiencing homelessness, substance use, migration insecurity or contact with the criminal justice system.
Between 2020 and 2025, Find and Treat supported 99 referrals and successfully linked 58 people back into HIV care, including 43 who have remained in sustained treatment. The service also focuses on supporting people identified through emergency department opt-out HIV testing and those transitioning from prison back into the community.
More than a clinical pathway
What makes this programme distinctive is that it doesn’t treat re-engagement as a purely clinical problem. The reasons people fall out of care are rarely just about the virus or the medication. They are about stigma, mental health, poverty, housing, drug use, immigration status and past negative experiences with services. That is why the programme pairs clinical expertise with peer support workers who live well with HIV, and voluntary sector partners who provide counselling, immigration and housing advice, hardship support and community-based group work. The aim is not just to get people back through the clinic door. It is to help stabilise their wider circumstances so they can stay in care, stay on treatment and live well.
Learning, sharing and what comes next
All three partnerships will contribute to a shared understanding of what works and how services can improve. An external evaluation will assess effectiveness and generate evidence for future commissioning. This matters beyond London. The HIV Action Plan for England has set a national goal of zero new HIV transmissions by 2030, and re-engaging people who have fallen out of care is essential to achieving that.
London has made significant progress on HIV, but that progress cannot be sustained if people are falling out of the care that keeps them well. This programme reflects a commitment to reaching the people who need support the most – and working with them to find a way back.
Learn more
Funding opportunity: Re-engaging Londoners living with HIV back into care