Ending HIV transmission in Scotland by 2030

HIV Transmission Elimination Oversight Group (HiTEOG)

The Scottish Health Protection Network (SHPN) is an obligate network co-ordinated by Public Health Scotland. The SHPN sexual health and blood borne virus (SHBBV) Strategic Leads established a dedicated short life HIV Transmission Elimination Oversight Group (HiTEOG) to produce this set of recommendations and to detail the thinking behind them, taking account of the wider factors influencing HIV in Scotland.

HiTEOG was chaired by Prof Rak Nandwani and administered by the Scottish Government SHBBV policy team. The Oversight Group drew upon lived experience and included people with individual expertise rather than representing specific populations or groups. HiTEOG brought together third sector and community organisations, public health, academia, primary care, and services including drug and alcohol/sexual health/HIV (see appendix for members and contributors). The approach was collaborative and included participants from outside Scotland to strengthen the evidence base and to broaden the perspective. There was no prior external commitment to new resources. A range of potential recommendations were explored; pragmatism was key in consolidating specific, realistic, time-based actions. At an early stage it was recognised that robust HIV surveillance data and epidemiological modelling were core to inform further actions as the wider system responded to COVID-19, monkeypox and other emerging challenges. It was envisaged that a comprehensive review and statement of progress would be required in 2025. At that point a gap analysis approach could be used to identify further interventions and adjustments to attain the 2030 vision.

Scotland has been a recognised leader in real-world implementation of HIV pre-exposure prophylaxis (PrEP) since the introduction of its NHS-delivered programme in 2017 [Ref 17]. However, the delivery model to date has primarily been through specialist sexual health services which has had the greatest impact in HIV reduction in UK-born, health-literate, white gay, bisexual, and men who have sex with men who already access existing services [Ref 18]. Recognising capacity challenges within sexual health services, the desire to explore alternative care pathways, and most importantly, to avoid exacerbating inequalities even further, HiTEOG convened a short-life PrEP delivery subgroup (jointly chaired by Prof Nicola Steedman and Prof Nandwani) to formulate advance recommendations whilst the wider proposal was in development. There was rapid recognition that the format and wording of currently used PrEP eligibility criteria may have been applied without sufficient flexibility, leading to exclusion of some individuals who would have benefited from being offered PrEP, whilst other individuals may not have realised that PrEP might reduce HIV acquisition risk in their own circumstances. It was therefore agreed to replace the existing Scottish PrEP eligibility criteria with broader prescribing guidance at the earliest opportunity, ahead of other recommendations.