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. 2018 Jun 20;13(6):e0197939.
doi: 10.1371/journal.pone.0197939. eCollection 2018.

HIV incidence among sexual health clinic attendees in England: First estimates for black African heterosexuals using a biomarker, 2009-2013

Adamma Aghaizu  1   2 , Jennifer Tosswill  1 , Daniela De Angelis  1   3 , Helen Ward  2 , Gwenda Hughes  1 , Gary Murphy  1 , Valerie Delpech  1
Affiliations

HIV incidence among sexual health clinic attendees in England: First estimates for black African heterosexuals using a biomarker, 2009-2013

Adamma Aghaizu et al. PLoS One. .

Abstract

Introduction: The HIV epidemic in England is largely concentrated among heterosexuals who are predominately black African and men who have sex with men (MSM). We present for the first time trends in annual HIV incidence for adults attending sexual health clinics, where 80% of all HIV diagnoses are made.

Methods: We identified newly diagnosed incident HIV using a recent infection testing algorithm (RITA) consisting of a biomarker (AxSYM assay, modified to determine antibody avidity), epidemiological and clinical information. We estimated HIV incidence using the WHO RITA formula for cross-sectional studies, with HIV testing data from sexual health clinics as the denominator.

Results: From 2009 to 2013, each year, between 9,700 and 26,000 black African heterosexuals (of between 161,000 and 231,000 heterosexuals overall) were included in analyses. For the same period, annually between 19,000 and 55,000 MSM were included. Estimates of HIV incidence among black Africans increased slightly (although non-significantly) from 0.15% (95% C.I.0.05%-0.26%) in 2009 to 0.19% (95% C.I.0.04%-0.34%) in 2013 and was 4-5-fold higher than among all heterosexuals among which it remained stable between 0.03% (95% C.I.0.02%-0.05%) and 0.05% (95% C.I.0.03%-0.07%) over the period. Among MSM incidence was highest and increased (non-significantly) from 1.24% (95%C.I 0.96-1.52%) to 1.46% (95% C.I 1.23%-1.70%) after a peak of 1.52% (95%C.I 1.30%-1.75%) in 2012.

Conclusion: These are the first nationwide estimates for trends in HIV incidence among black African and heterosexual populations in England which show black Africans, alongside MSM, remain disproportionately at risk of infection. Although people attending sexual health clinics may not be representative of the general population, nearly half of black Africans and MSM had attended in the previous 5 years. Timely and accurate incidence estimates will be critical in monitoring the impact of the reconfiguration of sexual health services in England, and any prevention programmes such as pre-exposure prophylaxis.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Trends in annual HIV incidence among heterosexual sexual health clinic attendees in England 2009–2013.
Fig 2
Fig 2. Trends in annual HIV incidence among heterosexual sexual health clinic attendees in London, 2009–2013.
Fig 3
Fig 3. Trends in annual HIV incidence among MSM sexual health clinic attendees by region 2009–2013.
Fig 4
Fig 4. Trends in annual HIV incidence among MSM sexual health clinic attendees by region and age 2009–2013.
See this image and copyright information in PMC

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