future of hiv services hertfordshire

www.hertsdirect.org

What will the future bring?What future for HIV Service Provision?

Prof Jim McManus,Director of Public Health, Hertfordshire County [email protected]

October 19th 2016Future design of Hertfordshire HIV Services Workshop

www.hertfordshire.gov.uk

Todays Workshop

• Range of Speakers• Scenario• Issues • Discussion• Agreement and Next Steps


Why are we here today?• Changing epidemiology• Organizations coming together • Personalising around people• Changing natural history?

– More people living longer– Late diagnosis down but still challenging– Cognitive decline– Malignancies, Cardiovascular Disease,– Co-infection– Diseases of ageing, complications of long term HART


Why are we here today?

• Prep• Prevention and effectiveness• Changing treatment patterns• Different patterns of living with HIV• Integrated Personal commissioning• UNAIDS 90-90-90

• Taking all these together we need to reflect on where the future of HIV services lies in our area

• The situation requires a refreshed and renewed approach


Then and now-still ongoing need with HIVThen (1980s/90s)• Rapid decline• Substantial need• Psychosocial need• Nutrition• Wasting• Opportunistic infections

Now• These look different but

are still around• Diseases of ageing too• Cognitive decline• Long term effects of HART• Malignancies• Stigma and social support• long term condition

among?


Scenarios of living with HIV

• Living longer, living better

• Living longer, getting more ill for longer (long term conditions)

• Living longer, higher cognitive decline

• What kind of psychosocial and other needs?

• Social Care Need, Health care need?

• More complex needs for some?

• Stigma still causes problems


Scenarios – population segmentation

Increasing severity, increasing need, increasing cost


Need and Severity Curve – most long term conditions? Discuss

Curve - Increasing Volume of spend

Blocks are numbers of people

Curve - Increasing Severity

How long in time will people beIn each cohort?

Thriving

Coping/Struggling Ongoing

complications

60% 80%??

20% 30%??

5% 10% ??


Implications for services - Discuss• What is social care need?• What is the psychosocial need?

– Then: lunch clubs. Now: ????• What is ongoing health need?• What is role of vol sector providers?• What role for self-management and peer support?• Services are still fragmented – how to overcome?• What are the training and development needs for our

workforce?


Rest of workshop

• Other presentations and notes from the workshop will be made available online

• Speakers and participants included local agencies and workers and people living with HIV

• Prof Jane Anderson, David Buck (Kings Fund), Dr Michael Brady (THT) and PHE spoke.


End of Workshop Conclusions

• Here at • Detailed notes of each group will be written up• Key outcomes from today on next slides• Some strengths and successes• More still to do• Some opportunities


Actions – Quick Wins

• User engagement will be a key priority• We will produce a new strategic plan for HIV• New balanced scorecard for this/dashboard• Multi-stakeholder group to take this forward,

linked to but distinct from sexual health strategy• Articulate what we need through design process• Articulate what is beyond 90-90-90


Beyond 90-90-90Not just UNAIDS 90-90-90 (3 x 90) but 6 x 90

– UNAIDS 90-90-90• 90% of people diagnosed• 90% on ART• 90% virological suppression

– OUR ADDED 90-90-90• 90% engaged in service design• 90% have optimal quality of life• 90% people aware about HIV and remove stigma


HIV Dashboard or balanced scorecardEpidemiological dashboard

How well are we reaching 90 90 90

User experience dashboard

How do people feel about services and how responsive are they

Service Performance dashboard

How are services doing

Education, Awareness, Attitudes?

future of hiv services hertfordshire

Health & Medicine