Improving Scotland’s health by reducing the impact of HIV and other blood borne viruses
Glasgow Caledonian University's dedicated research programme, Beyond BBV (blood borne viruses), seeks to support the Scottish Government in its ambitions to eliminate HIV transmission and Hepatitis C as a major public health concern in Scotland, with research relevance across the world.
This aim directly addresses the Scottish Government’s public health goals and its commitment to achieving the WHO and United Nation’s goals on communicable diseases. These goals directly align with SDG Target 3.3, Strategy 2030, the Research Enabling Strategy and the Scottish Government National Performance Framework.
We propose to capitalise on our world-leading research by bringing together high-level stakeholders across academia, public health, government, clinical practice, and the third sector in the GCU-hosted BBV strategic research programme, which is positioned to be the driving force behind the elimination of blood borne virus transmission and reduction in BBV-related poor health in Scotland.
Preventing new infections and reducing infection-related poor health will have a direct and lasting impact on people and systems, by reducing the significant health consequences of infection. This will improve health and wellbeing at an individual level and reduce the economic burden of infection at societal level.
Ground-breaking advances across medicine, policy and society have aligned to make the goal of zero new HIV infections achievable. Investment in this research initiative shows a real commitment from GCU to end HIV transmission in Scotland.
Professor Sharon Hutchinson
Research carried out at GCU has helped Scotland become one of the few countries that has made progress towards ending HIV and reducing Hepatitis C infection.
The Scottish ePrEP Clinic
Thanks to decades of activism and research, we are at the point where HIV transmission elimination is a realistic, attainable goal. However, we will only achieve this goal if we continue to invest in widening access to HIV prevention and address key structural barriers people experience when accessing care.
A key part of HIV transmission elimination strategies is the upscaling of oral HIV pre-exposure prophylaxis (PrEP) provision. PrEP is a pill that people take to prevent HIV acquisition. In Scotland, sexual health services are the primary providers of PrEP-related care.
Current guidance recommends PrEP users regularly test for HIV and other sexually transmitted infections, have their kidney function monitored, and discuss ongoing PrEP suitability with a healthcare professional. However, sexual health services are at capacity, making scaling up PrEP provision challenging. At this pivotal time, we must ensure that everyone who would benefit from PrEP can access it. Digital health technologies could offer a way of supporting PrEP users while reducing clinic burden. For this reason, we are developing an online PrEP clinical care pathway – the ePrEP clinic.
Key references
Ending HIV Transmission in Scotland by 2030. Scottish Government. 1 December 2022.
Health Protection Scotland & Information Services Division. Implementation of HIV PrEP in Scotland: First year report – Full report. Health Protection Scotland & Information Services Division 2019. 26 February 2019.
Estcourt, Claudia; Yeung, Alan; Nandwani, Rak; Goldberg, David; Cullen, Beth; Steedman, Nicola; Wallace, Lesley; Hutchinson, Sharon; Population-level effectiveness of a national HIV pre-exposure prophylaxis programme in MSM. AIDS: March 15, 2021 - Volume 35 - Issue 4 - p 665-673 doi: 10.1097/QAD.0000000000002790
Goldberg DJ, Hutchinson SJ, Innes HI, Dillon J. Scotland’s Hepatitis C Action Plan: Achievements of the First Decade and Proposals for a Scottish Government Strategy (2019) for the Elimination of both Infection and Disease. Taking Advantage of Outstanding New Therapies. Glasgow: Health Protection Scotland, July 2019. (https://hpspubsrepo.blob.core.windows.net/hps-website/nss/2840/documents/1_hcv-elimination-Scotland-v2.pdf ).
Hutchinson SJ, Valerio H, McDonald SA, Yeung A, Pollock K, Smith S, Barclay S, Dillon JF, Fox R, Bramley P, Fraser A, Kennedy N, Gunson R, Templeton K, Innes H, McLeod A, Weir A, Hayes PC, Goldberg D. Population impact of direct-acting antiviral treatment on new presentations of hepatitis C-related decompensated cirrhosis: a national record-linkage study. Gut. 2020 Dec; 69(12): 2223-2231. doi: 10.1136/gutjnl-2019-320007
Palmateer NE, McAuley A, Dillon JF, McDonald S, Yeung A, Smith S, Barclay S, Hayes P, Shepherd SJ, Gunson RN, Goldberg DJ, Hickman M, Hutchinson SJ. Reduction in the population prevalence of hepatitis C virus viraemia among people who inject drugs associated with scale-up of direct-acting anti-viral therapy in community drug services: real-world data. Addiction. 2021 Oct;116(10):2893-2907. doi: 10.1111/add.15459.
McAuley A, Palmateer N, Biggam C, Knox T, Shepherd S, Gunson R, Hutchinson S. The Needle Exchange Surveillance Initiative (NESI): Prevalence of blood-borne viruses and injecting risk behaviours among people who inject drugs attending injecting equipment provision services in Scotland, 2008 to 2020. Glasgow: Public Health Scotland, March 2022. (https://publichealthscotland.scot/media/12421/2022-04-01-nesi-19-20-report.pdf )
Public Health Scotland (PHS). Surveillance of hepatitis C in Scotland. Progress on elimination of hepatitis C as a major public health concern: 2022 update. PHS, October 2022. (www.publichealthscotland.scot/media/15549/surveillance-of-hepatitis-c-in-scotland-oct22.pdf)
Schröeder SE, Pedrana A, Scott N, et al. Innovative strategies for the elimination of viral hepatitis at a national level: A country case series. Liver Int. 2019 Oct; 39(10): 1818–1836.
Rodger, A. J., Cambiano, V., Bruun, T., Vernazza, P., Collins, S., Degen, O., … & Lundgren, J. (2019). Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-partner taking suppressive antiretroviral therapy (PARTNER): Final results of a multicentre, prospective, observational study. The Lancet, 393, 2428-2438. doi: 10.1016/S0140-6736(19)30418-0
Henderson L, Gibbs J, Quinn J, Ramasami S, Estcourt CS. Maintaining access to HIV Pre Exposure Prophylaxis in a pandemic: a service evaluation of a telephone-based model of PrEP provision. International Journal of STD & AIDS 10.1177/09564624211068766. 2022
Grimshaw, C., Boyd, L., Smith, M., Estcourt, C. S., Metcalfe, R. (2021). Evaluation of an inner city HIV pre-exposure prophylaxis service tailored to the needs of people who inject drugs. HIV Medicine, 22, 965-970. https://dx.doi.org/10.1111/hiv.13181
Saunders, J., Gill, O. N., Delpech, V., Estcourt, C., Five Nations (England, Scotland, Wales, Northern Ireland, Republic of Ireland) PrEP Minimum Dataset Working Group (2021). Minimum dataset for monitoring national human immunodeficiency virus pre-exposure prophylaxis (hiv prep) programmes: a five-nation consensus, 2019. Euro Surveillance: Bulletin Europeen sur les Maladies Transmissibles = European Communicable Disease Bulletin, 26, https://dx.doi.org/10.2807/1560-7917.ES.2021.26.23.2001595
Grimshaw C, Estcourt CS, Nandwani R, Yeung A, Henderson D, Saunders J. Characteristics of people with newly diagnosed HIV in Scotland have changed since the implementation of a national PrEP service: A retrospective cohort study. Sexually Transmitted Infections. https://sti.bmj.com/content/sextrans/early/2021/01/13/sextrans-2020-054732.full.pdf
Nakasone SE, Young I, Estcourt CS, Calliste J, Flowers P, Ridgway J, Shahmanesh M. Risk perception, safer sex practices and pre-exposure prophylaxis enthusiasm: barriers and facilitators to oral HIV pre-exposure prophylaxis in Black African and Black Caribbean women in the UK. Sexually Transmitted Infections. 2020 https://sti.bmj.com/content/sextrans/early/2020/06/12/sextrans-2020-054457.full.pdf
