Ending HIV Transmission in Scotland by 2030: HIV Transmission Elimination Delivery Plan 2023-26

Introduction

HIV policy development background

On 1^st December (World AIDS Day) 2020, the Minister for Public Health set the goal of ending HIV transmission in Scotland by 2030. Scottish Government, drawing on the expertise of Scottish Health Protection Network (SHPN) Sexual Health and Blood Borne Virus (SHBBV) Strategic Leads, established a dedicated short-life HIV Transmission Elimination Oversight Group (HiTEOG). HiTEOG produced a comprehensive report[i] published on 1^st December 2022, outlining 22 recommendations for achieving the elimination target. The report also included epidemiological definitions, accountability and leadership, and suggested data and monitoring developments.

On 1^st December 2022 Scottish Government also announced funding to support the development of an ePrEP clinic pilot led by Glasgow Caledonian University[ii] and a national publicity campaign to address HIV stigma to be developed by a multi-agency partnership with Terrence Higgins Trust (THT) leading on commissioning.

These projects are being taken forward alongside a broader policy refresh contained within the Sexual Health and Blood Borne Virus (SHBBV) Action Plan 2023-26, which was published on 28^th November 2023[iii]. The broader SHBBV Action Plan clearly prioritises the need to review and strengthen governance and accountability across the SHBBV sector and describes the development of new structures and processes which will underpin its delivery alongside the recommendations set out in the HiTEOG report detailed below.

An HIV Transmission Elimination Proposal Scoping Group - Co-chaired by Professor Nicola Steedman, Deputy Chief Medical Officer, Scottish Government and Dr Dan Clutterbuck, Consultant in Genitourinary and HIV medicine and Co-Chair of the Scottish Health Protection Network SHBBV Strategic Leads Group - met between March and June 2023 to review the HiTEOG report, to prioritise the recommendations and to identify key actions to be taken forward in the short term. This Delivery Plan is based on the output from the scoping group and its actions will be taken forward by a HIV Transmission Elimination Delivery Plan Implementation Short-Life Working Group (HIV-TEDI). HIV-TEDI will provide oversight for the delivery of the plan by establishing workstreams and lines of accountability for implementation. HIV-TEDI will report to the Ministerial-led SHBBV Oversight Group which will be set up under the SHBBV Action Plan.

For conciseness, other than the definitions and recommendations, details from the HiTEOG report are not repeated within this document. This document should therefore be read in conjunction with the original report. This Delivery Plan refers to the recommendation numbering as per the HiTEOG report but has created a new numbering system for ease of reference going forward.

The Vision

Our vision is to end HIV transmission in Scotland. This means achieving the ambitious target of zero people contracting HIV within Scotland by 2030. This aligns with wider global strategic aims. UNAIDS have a global goal “to end the AIDS epidemic as a public health threat by 2030.”[iv] The HiTEOG report defines HIV transmission elimination as the point when there are zero individuals acquiring HIV within Scotland, regardless of age, sex, gender identity, sexual orientation, race, ethnicity, religion, deprivation or disability status.

High level goals for achieving the vision

1. To prevent people from acquiring HIV, regardless of age, sex, gender identity, sexual orientation, race, ethnicity, religion, deprivation or disability status.

2. To find people living with HIV in Scotland (some of whom are undiagnosed) and support entry or re-entry into equitable and accessible HIV care and treatment, thereby improving health and quality of life, as well as preventing onward transmission of HIV.

3. To reduce stigma that makes some people less likely to access HIV prevention, testing and treatment services and adversely affects quality of life.

Dynamic Approach

Due to the changing epidemiology of HIV in Scotland, a dynamic approach to HIV transmission elimination (HIVTE) is required. Broad approaches addressing the wider population are a valuable step in the initial stages, however as the number of new HIV diagnoses reduce further, local interventions focused on smaller groups of sub‑populations and individuals will be required. At very low levels of new transmissions, interventions focused on outbreak response and individual case investigation will become a key factor to achieving the ‘zero’ transmission goal. The response therefore needs to be agile and flex with local and national epidemiological treads.

A person-centred approach is required at all stages of the epidemic. We must also ensure that individuals’ needs, anonymity and data protection are given the highest priority, particularly as the number of new diagnoses becomes very few. At all stages it is important that we consider the needs of people living with HIV to ensure that they can live longer, healthy lives free from stigma and harm.

There are currently significant gaps in our data, intelligence and research to inform elimination planning, many of which will be addressed by actions already underway and those outlined in this plan. This plan aims to tailor primary, secondary and tertiary interventions to the phases of the epidemic. Data developments will be aligned to the surveillance and evaluation requirements of each phase in order to monitor progress and provide intelligence to adapt plans as required (see Figure 1).

As HIV incidence declines and interventions become more localised, it is important that we consider the potential barriers and enablers to be addressed at each stage including resources, workforce, training and skill maintenance.