What will the future bring?
What future for HIV Service Provision?
Prof Jim McManus,
Director of Public Health, Hertfordshire County Council
Future design of Hertfordshire HIV Services
• Range of Speakers
• 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,
– Diseases of ageing, complications of long term HART
Why are we here today?
• 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 HIV
• Rapid decline
• Substantial need
• Psychosocial need
• Opportunistic infections
• These look different but
are still around
• Diseases of ageing too
• Cognitive decline
• Long term effects of
• Stigma and social support
• long term condition
Scenarios of living with HIV
• Living longer, living
• Living longer, getting
more ill for longer
(long term conditions)
• Living longer, higher
• What kind of
• Social Care Need,
Health care need?
• More complex needs
• Stigma still causes
Scenarios – population segmentation
Increasing severity, increasing need, increasing cost
Need and Severity Curve – most long term
Curve - Increasing Severity
How long in time will people be
In each cohort?
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
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
• 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
Not 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 scorecard
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?