The growing challenge: a strategic review of HIV social care, support and information services across the UK.

This report appears 10 years after the widespread introduction of anti-retroviral therapies. Availability of effective HIV treatment has transformed the UK epidemic, producing a dramatic reduction in mortality and, for many people living with HIV, an increase in health and well-being. Yet, in spite of medical advances, many services seem to continue to follow a historical pattern. Against this background we commissioned Sigma Research to review service commissioning in the HIV sector in order to inform members’ future grant making strategies. Results in the report indicate that commissioners and providers of services believe that people from ethnic minority backgrounds, migrants, children, carers and people from different age groups have unmet needs. Other findings in this research indicate that many more services have been commissioned recently for Africans, on the basis that Africans make up a significant part of the current UK epidemic. We believe this is a valid focus but are discouraged by the approach to these varied communities as one homogenous population. It seems timely to ask whether configuring services to follow broad epidemiological categories without any further refinement is sufficient. The report further suggests that commissioners and providers believe the needs of gay men are well met. This is a surprise and does not accord with the views and experiences of many gay men living with the virus. A significant minority of HIV positive people are neither gay men nor Africans. Even within these two groups the experience of living with HIV varies by age, geographical location and length of infection. HIV positive individuals may look at their needs from another starting point – for example, as a woman or an injecting drug user. The picture appears to be, increasingly, one of fragmentation and isolation. This poses the question: do we have the service models to meet the needs of HIV positive people in the third decade of the epidemic? The report further shows that many of the problems with access to services – including housing and welfare rights – are structural problems, present across health and social care, and are not unique to HIV. HIV support services are funded from budgets which must also contain the increasing costs of anti-retroviral drugs and other medical interventions, and which are therefore subject to continuous attrition and dissaggregation. Also highlighted is the lack of needs-based planning, the diminishing levels of knowledge and expertise among commissioners and the lack of a national strategic vision. In view of the fact that the Government has established a cross-departmental task force to address the epidemic in developing countries this lack of a national strategic vision is lamentable and has the effect of keeping the issue off the political agenda and almost invisible within local funding priorities. This is a concern both to us as funders and to agencies working within the HIV voluntary sector

The clinical effectiveness of individual behaviour change interventions to reduce risky sexual behaviour after a negative human immunodeficiency virus test in men who have sex with men: systematic and realist reviews and intervention development

Background: Men who have sex with men (MSM) experience significant inequalities in health and well-being. They are the group in the UK at the highest risk of acquiring a human immunodeficiency virus (HIV) infection. Guidance relating to both HIV infection prevention, in general, and individual-level behaviour change interventions, in particular, is very limited. Objectives: To conduct an evidence synthesis of the clinical effectiveness of behaviour change interventions to reduce risky sexual behaviour among MSM after a negative HIV infection test. To identify effective components within interventions in reducing HIV risk-related behaviours and develop a candidate intervention. To host expert events addressing the implementation and optimisation of a candidate intervention. Data sources: All major electronic databases (British Education Index, BioMed Central, Cumulative Index to Nursing and Allied Health Literature, EMBASE, Educational Resource Index and Abstracts, Health and Medical Complete, MEDLINE, PsycARTICLES, PsycINFO, PubMed and Social Science Citation Index) were searched between January 2000 and December 2014. Review methods: A systematic review of the clinical effectiveness of individual behaviour change interventions was conducted. Interventions were examined using the behaviour change technique (BCT) taxonomy, theory coding assessment, mode of delivery and proximity to HIV infection testing. Data were summarised in narrative review and, when appropriate, meta-analysis was carried out. Supplemental analyses for the development of the candidate intervention focused on post hoc realist review method, the assessment of the sequential delivery and content of intervention components, and the social and historical context of primary studies. Expert panels reviewed the candidate intervention for issues of implementation and optimisation. Results: Overall, trials included in this review (n = 10) demonstrated that individual-level behaviour change interventions are effective in reducing key HIV infection risk-related behaviours. However, there was considerable clinical and methodological heterogeneity among the trials. Exploratory meta-analysis showed a statistically significant reduction in behaviours associated with high risk of HIV transmission (risk ratio 0.75, 95% confidence interval 0.62 to 0.91). Additional stratified analyses suggested that effectiveness may be enhanced through face-to-face contact immediately after testing, and that theory-based content and BCTs drawn from ‘goals and planning’ and ‘identity’ groups are important. All evidence collated in the review was synthesised to develop a candidate intervention. Experts highlighted overall acceptability of the intervention and outlined key ways that the candidate intervention could be optimised to enhance UK implementation. Limitations: There was a limited number of primary studies. All were from outside the UK and were subject to considerable clinical, methodological and statistical heterogeneity. The findings of the meta-analysis must therefore be treated with caution. The lack of detailed intervention manuals limited the assessment of intervention content, delivery and fidelity. Conclusions: Evidence regarding the effectiveness of behaviour change interventions suggests that they are effective in changing behaviour associated with HIV transmission. Exploratory stratified meta-analyses suggested that interventions should be delivered face to face and immediately after testing. There are uncertainties around the generalisability of these findings to the UK setting. However, UK experts found the intervention acceptable and provided ways of optimising the candidate intervention. Future work: There is a need for well-designed, UK-based trials of individual behaviour change interventions that clearly articulate intervention content and demonstrate intervention fidelity

Annual Report 2013

The 2013 Annual Report includes a review of the year, research highlights and activities across the School's three Faculties, and key facts and figures. The financial review provides an overview of the School's finances and activities during 2012-13

GPs are from Mars, Administrators are from Venus: The Role of Misaligned Occupational Dispositions in Inhibiting Mandated Role Change

Research on mandated occupational role change focuses on jurisdictional conflict to explain change failure. Our study of the English National Health Service highlights the role of occupational dispositions in shaping how mandated role change is implemented by members of multiple occupational groups. We find that tension stemming from misaligned dispositions may emerge as members of different occupations interact during their role change implementation efforts. Depending on dispositional responses to tension, change may fail as members of the different occupations avoid interactions. This suggests that effective role change can be elusive even in the initial absence of conflicting occupational interests

Preschool growth and nutrition service - addressing common nutritional problems: a community based primary care led intervention

Childhood obesity has been prioritised by the World Health Organization in a recent report, which calls for a holistic multiagency approach to tackling and reducing future risks of obesity and its associated co-morbidities. This article examines a health service approach to improving recognition and management of pre-school nutritional problems as part of training health care professionals. It explores the practicalities of setting up a local pathway for managing cases in the community with appropriate specialist support. This model, developed for the management of weight faltering, has now been adapted to tackle childhood obesity

Injecting equipment schemes for injecting drug users : qualitative evidence review

This review of the qualitative literature about needle and syringe programmes (NSPs) for injecting drug users (IDUs) complements the review of effectiveness and cost-effectiveness. It aims to provide a more situated narrative perspective on the overall guidance questions

Anthropologists behaving badly? Impact and the politics of evaluation in an era of accountability

This paper discusses the move within UK social science funding to use non-academic ‘impact’ as a measure of quality and success for social research. It suggests that behind this move are a set of unspoken assumptions about what constitutes ‘good’ and ‘bad’ impact, and the paper seeks to problematize these. By way of provocation, it presents three classic cases of anthropological research, in which the impact of anthropologists on the societies in which they worked was at worst reprehensible, and at best controversial. These controversies – Darkness in El Dorado, the Human Terrain System and Fields of Wheat, Hills of Blood – are used to demonstrate the difficulty with which we can assess impacts as ‘good’ or ‘bad’, and the problems with attempting to do so

Making the Case and Getting Underway: A Funder Toolkit to Support Healthy People in Healthy Places

This toolkit was created as part of the Health Eating Active Living Convergence Partnership (www.convergencepartnership.org) to help funders create multi-field environmental change strategies to enhance healthy eating and active living

Witnessing history: a personal view of half a century in public health

Former Chief Medical Officer Sir Kenneth Calman recently celebrated 50 years in medicine. It was a period which saw the evolution of the public health agenda from communicable diseases to diseases of lifestyle, the change from a hospital-orientated health service to one dominated by community-based services, and the increasing recognition of inequalities as a major determinant of health. This paper documents selected highlights from his career including the Aberdeen typhoid outbreak, AIDS, bovine spongiform encephalopathy, foot and mouth disease, radioactive fallout, the invention of computerised tomography and magnetic resonance imaging, and draws parallels between the development of the modern understanding of public health and the theoretical background to the science 100 years earlier

The epidemiology of sexually transmitted infections in the United Kingdom: impact of behaviour, services and interventions

Sexually transmitted infections (STIs) are a major public health concern. The United Kingdom (UK) has some of the most advanced STI surveillance systems globally. This review uses national surveillance data to describe remarkable changes in STI epidemiology in the UK over the last century and explores behavioural and demographic shifts that may explain these trends. The past ten years have seen considerable improvements in STI service provision and the introduction of national public health interventions. However, sexual health inequalities persist and men who have sex with men, young adults and black ethnic minorities remain a priority for interventions. Technological advances in testing and a shift in sexual health service commissioning arrangements will present both opportunities and challenges in future