Case study:
South East London
The GPs in South East London ICB area are working on a project trialling a local service with proactive management in primary care for people living with HIV. This has been funded by Fast-Track Cities London.
The service will identify people living with HIV in a practice and ensure their care meets the standard of care set out by the British HIV Association (BHIVA).
GP Champions:
Dr Rebecca Hall
Dr Anita Belgaumkar
Dr Ruth Harris
Dr Grace Bottoni
They are working closely with GP champions commissioned by Southwark Council; Dr Chris Ward and Dr Mini Hata
Secondary Care HIV Consultant Lead:
Dr Elizabeth Hamlyn
Overview
South East London Integrated Care System covers 6 boroughs and a population of around 2 million. It has the UK’s highest HIV prevalence (8 per 1000 people aged 15-59). Four boroughs—Greenwich, Lambeth, Lewisham, and Southwark—report very high prevalence, with Lambeth peaking at 12.7 per 1,000, while Bexley and Bromley show high rates alongside the highest late diagnosis rates in London (55% and 51%). Newly diagnosed cases often involve females from Black or Latin American communities and white males, with a rising trend among older adults who may not perceive themselves at risk but regularly visit GPs. Primary care has a crucial role in achieving the Fast-Track Cities targets and national HIV Action Plan goals. Efforts began with primary care populations and extended through community collaborations, aiming to engage wider audiences and work toward ending HIV in south east London.
Pilot Aims
The team are working towards increasing HIV testing in primary care, HIV prevention, reducing stigma, reengagement of people into care and treatment, promoting HIV as a long term condition and connecting with the community.
Challenges
South east London suffered a widescale cyber-attack on their laboratory system resulting in no access to routine blood testing for 4 months (June-Sept 2024) and then a subsequently backlog.
Work completed so far:
1. Increasing HIV testing in primary care
- National HIV Testing Week 2024: we increased testing and found 3 new diagnoses across 3 boroughs.
- Offering HIV tests as part of NHS Health Checks (Lewisham).
- GP computer system pop up to alert to offer HIV test on anyone who is eligible (Lewisham, Southwark, Bromley, part of Lambeth).
- Implementing opt-out BBV testing to patients offered latent tuberculosis screening (Southwark).
- Development of a HIV dashboard to measure HIV testing within primary care.
2. HIV prevention
- Pilot PrEP clinic from within a GP surgery (Lewisham).
- PrEP GP information guide and signposting to southeast London wide sexual health and PrEP services (in process).
- Educate and streamline primary care teams about uses and access to PrEP.
3. Reducing stigma
- Educational sessions were delivered for primary care teams including GP practice administrative staff, practice nurses and healthcare assistants, social prescribers, psychologists working at Talking Therapies (IAPT), primary mental health community teams, GP trainees and GPs.
- The GPs supported the development of e-learning module for the HIV Confident charter.
4. Re-engagement into care
- Creation of one streamlined HIV referral pathway for GPs which includes support for those who are out of care.
- Ensuring out of care letters are sent from HIV clinics to GPs.
- South London HIV network strengthened primary and secondary care links and work is helping to understand challenges faced by people not engaging in care.
- Re-engagement networking event hosted by secondary care to try to tackle some of the challenges and learn from lessons in missed opportunities.
- Carrying out a lost to follow up audit of nearly 800 people living with HIV from marginalised backgrounds.
5. Establishing HIV as a long term condition
- Developing patient resources on statins specific for people living with HIV and support on how to access medications through primary care.
- Creation of HIV as a long term condition dashboard with specific metrics relating to recommended standards of care for people living with HIV such as immunisations, statin use, cervical screening and osteoporosis risk assessment for eligible population.
- Creation of a statin algorithm. We have created a standard operating protocol for statin initiation in people living with HIV over 40 years of age years of age, as well as patient information leaflets. This is soon to be published in the South East London Lipid Management guidance.
6. Connecting with the community
- Indo American Refugee Migrant Organisation community health and testing event, May 2024.
- Community Action Aplos Group (Lewisham PCN) teaching session on HIV, Hepatitis and PrEP access.
- World Aids Day event at Glades Shopping Centre, Bromley.
Impact
- Marked increase in HIV testing with 3 new people living with HIV found in the area.
- Over 100 HIV tests delivered in Penge in a three-month period.
- 80 people trained in HIV and mental health in Lewisham.
- Recognition of HIV as a manageable long-term condition
Testimonials
“HIV GP champions are helping raise awareness of HIV with primary care colleagues and connect with secondary to bring an end to HIV by 2030.”
“We recognise HIV as a long-term condition and just like any other condition with the right support and care management people can live life to the fullest.”
Evaluation and data
The GP champion programme is being evaluated by Kings College London, and we will be presenting the pilot data in the summer of 2025.
If you would like any further information, please contact the Fast-Track Cities London programme team at rf-tr.londonftci@nhs.net.
