Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what estimate has been made of the number of people with undiagnosed HIV, broken down by NUTS 1 region, in each year since 2013-14.

Estimates of undiagnosed HIV infection are not available by Nomenclature of Territorial Units for Statistics (NUTS) 1 region.

There may be some regional differences in treatment rates or drugs used based on variations in patient demographics or the available drug contracts.

Regional HIV networks determine prescribing guidelines which align with national commissioning policies for antiretroviral therapies. These guidelines are overseen by the HIV Clinical Reference Group – which includes strong patient representation - who provide clinical advice on HIV treatment issues and raise concerns from the community should there be perceived issue around equitable access.

Working closely with Public Health England (PHE), NHS England has produced a clinical dashboard that summarises clinical performance at the trust level. PHE prepares and analyses all the data that feeds into the Clinical Reference Group HIV dashboard. Two dashboard indicators measure anti-retroviral therapy coverage among all people accessing HIV care and among people with a low CD4 count (indicative of immunosuppression). Further information on the dashboard is available here:

https://www.england.nhs.uk/commissioning/spec-services/npc-crg/spec-dashboards/

Data are not available by NUTS for the proportion of people living with diagnosed HIV infection who are not receiving antiretroviral therapy treatment.

Antiretroviral therapy is now so effective that people receiving treatment can expect to have a near normal life expectancy. Consequently, the proportion of people receiving treatment continues to rise each year since death rates remain low. The higher antiretroviral therapy coverage rate observed in some regions is partially due to the longer history of the epidemic in these areas.

British HIV Association guidelines have progressively reduced the threshold at which patients may begin antiretroviral therapy. In 2018, NHS England announced routine commissioning of ‘Immediate Access to Antiretroviral Therapy’ from 1 April 2018.

https://www.england.nhs.uk/publication/clinical-commissioning-policy-immediate-antiretroviral-therapy-for-treatment-of-hiv-1-in-adults-and-adolescents/

This enables all patients to access treatment at the point of diagnosis or at the time the patient wishes to commence treatment. It has also clarified the position on the funding of antiretroviral therapy for immediate treatment among patients newly diagnosed with HIV.

NHS England and PHE keep under review data on the rates of uptake of antiretroviral treatment and will continue to do so to identify any unwarranted variation.