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Brighton & Sussex Medical School

HIV and sexual health

BSMS > Research > Global health and Infection > Infection > HIV and sexual health

HIV and sexual health

The Royal Sussex County Hospital in Brighton hosts the largest cohort of people living with HIV outside of London and supports a long-standing programme of clinical research on HIV and Sexual Health.

This work has been expanded by the development of HIV research at BSMS where work is undertaken on clinical aspects of HIV such as ageing and comorbidity and the impact of HIV on the brain. HIV prevention and stigma are also key areas of interest.  

We have developed a global dimension to this programme through partnerships in South Africa, Uganda and Zambia where some projects mirror those in the UK, while others focus on important regional challenges such as the impact of climate change on HIV drug resistance and HIV prevention in high-prevalence settings. 

Martin Fisher Foundation Pilot Digital HIV testing Vending Machine

HIV prevention and treatment

HIV prevention and stigma

Our team works with community partners from the Martin Fisher Foundation and Oasis to improve access to HIV testing for key populations such as men that have sex with men (MSM) and female sex workers. Along with partners from the Martin Fisher Foundation and the University of Brighton we developed and evaluated a bespoke digital vending machine to deliver HIV self-tests to MSM in Brighton that won a BMJ award for innovation in 2018. 

We are taking this work further by developing the next generation of vending machines that will improve access not only to HIV but other services. With the same team we are currently working on a digital campaign to reduce HIV stigma in the city of Brighton and Hove. Both initiatives had been funded by HIV innovation awards from Public Health England. 

We are collaborating with the Oasis project in a study evaluating the acceptability and feasibility of HIV self-testing kits for female online sex workers which we are hoping can increased access to HIV testing to female sex workers in Brighton. 

We are also collaborating with the WHO on the evaluation of dual HIV and Syphilis point of care tests, the Prospero study, that will have implications in terms of access to rapid test in the UK and beyond. We have a PhD student investigating the role that whole genome sequencing in HIV might have in improving partner notification strategies in collaboration with the University of Edinburgh.

Brighton-Lusaka HIV Research Link 

Based on the work we are conducting in the UK we are conducting two projects in Zambia in collaboration with the Centre for Infectious Diseases in Zambia (CIDRZ) evaluating the acceptability and feasibility of HIV self-testing using digital vending machine technology to improve HIV testing and the feasibility of using mobile health to improve engagement in care of young people with HIV in Zambia.  

Woman on an exercise machine

Ageing, comborbidities and models of care 

Brain and HIV

Introduction of combination antiretroviral therapy has led to a dramatic reduction in the rates of HIV dementia and opportunistic infections affecting the brain. Despite this, cognitive impairment continues to affect people with HIV on effective treatment. Our research aims to understand the role of HIV, anti-retroviral therapy (ART) medications and other factors in the development of cognitive impairment in people with HIV. Currently our team is undertaking two research studies using PET and MRI imaging to determine the role of AB amyloid deposition and blood brain barrier permeability on the pathogenesis of cognitive impairment in people with HIV. We are also investigating the anti-inflammatory effects of ART on astrocyte function in collaboration with the molecular pharmacology team from the University of Brighton.

We are also interested in developing models of care for the management of people living with HIV  who have cognitive impairment. In this context, we are currently evaluating the impact of a novel one stop service for the management cognitive impairment in people living with HIV in Sussex that we developed in collaboration with partners from the Sussex Centre for Dementia and the neuropsychology department from Brighton and Sussex University Hospitals NHS Trust.

Ageing, comorbidities and models of care

The success of HIV treatment means that many people living with HIV now have a normal lifespan and the number of older people living with HIV is rising. Increasing numbers of people living with HIV have additional chronic conditions (such as heart disease and depression), often at an earlier age than people who are HIV-negative. 

We are part of the POPPY (The Pharmacokinetic and Clinical Observations in People Over Fifty) study that aims to understand a bit better the impact of HIV, ART and aging has on older people with HIV. We are also conducting a multicentre study in Sussex evaluating the use of a medication optimisation review tool for people living with HIV to reduce medication-related problems. This study complements another community project aimed to support prescribers of non-HIV medications in the community by providing improved access to HIV specialist advice via mobile phone and email. 

We have developed a programme for the prevention and management of frailty in people with HIV, called the silver programme, that includes the development of a new model of care screening for frailty and interventions such as an exercise program focused in improving frailty, quality of life and mental wellbeing of older people with HIV in Sussex.

Presenter showing graphical data at the Africa Health Research Institute conference

Climate change, poverty and HIV drug resistance

The HIV Drug Resistance Elimination And Management (H-DREAM) network

The H-DREAM network brings together a multidisciplinary team of researchers comprising clinicians, epidemiologists, computer programmers, social scientists and public health scientists from South Africa, Uganda and the UK. The network aims to set up a sustainable interdisciplinary partnership that will underpin long-term research exchanges, strengthen research capacity in overseas partners and form the basis for large scale research projects that tackle HIV drug resistance. The network undertakes training of health care staff on proper monitoring of people living with HIV on antiretroviral therapy and prevention of HIV drug resistance as well as evaluation of the individual and health system factors that contribute to drug resistance.

Long-term clinical outcomes of HIV-positive individuals treated at high CD4 counts in rural South Africa

The ANRS HIV treatment as Prevention (TasP) trial was implemented between 2012 and 2016 to investigate the impact of home-based HIV testing and immediate offer of antiretroviral therapy on HIV incidence. HIV-positive individuals in this cohort were amongst the first in sub-Saharan Africa to be offered antiretroviral therapy regardless of CD4 counts. These individuals were transitioned back to the public ART programmes at the end of the trial. This study aims to investigate their long-term clinical outcomes, including engagement and retention in care, virological outcomes, drug resistance and mortality.

The ethics of Post-trial access in Interventional Research and potential for Moral Hazard: Arguments for different responsibilities

Legislation and guidelines on Post-trial Access (PTA) are inconsistent and not as forward moving as the rate at which interventional research is developing in Low and middle-income countries (LMIC). The increased globalisation of research poses PTA challenges to research, and sponsors alike with increased ambiguity on who has responsibility for what and to whom. This study explores the issues around PTA, using the recently concluded HIV Treatment as Prevention trial in rural KwaZulu-Natal as a case study.

Drought, Poverty and HIV Drug Resistance: threat to resilience in a vulnerable rural setting

The co-location of HIV and drought has made HIV and diarrhoeal diseases the two leading causes of death in the uMkhanyakude district of South Africa. The project tests the hypothesis that the added shock from drought contributes to HIV-positive individuals prioritising their means of livelihood over their health, resulting in poor engagement with care and greater HIV drug resistance in the district.