̽��ֱ�� of Cambridge - Daniela De Angelis

Vice-Chancellor’s Awards highlight research impact and engagement across Cambridge

zs332 — Thu, 07 Oct 2021 14:44:34 +0000

Academics from across the ̽��ֱ�� have been recognised in this year’s Vice-Chancellor’s Research Impact and Engagement Awards for their research into improving management of maternity emergencies during COVID-19, helping rural communities in India become agriculturally more sustainable and aiding the Government’s real-time COVID-19 monitoring.

Fewer than one in 20 people living with HIV in England expected to be unaware of status by 2025

cjb250 — Fri, 24 Sep 2021 07:49:11 +0000

In 2014, UNAIDS set an ambitious target of 90-90-90 by 2020 – that is, 90% of all people living with HIV will know their HIV status; 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy; and 90% of all people receiving antiretroviral therapy will have viral suppression.

According to the Cambridge and PHE team, in 2019 there were an estimated 105,200 people living with HIV in the UK, of whom 94% were aware of their HIV status. In addition, 98% of those living with diagnosed HIV were on treatment, and 97% of these were virally suppressed. In other words, England had already reached the UNAIDS goals.

In a publication today in ̽��ֱ��Lancet Public Health, the researchers extended their analysis of evidence from multiple surveillance, demographic, and survey datasets relevant to HIV in England from estimating HIV prevalence in a single year to estimating the trends over time in HIV prevalence. Trends in the number of people living with HIV, the proportion of people unaware of their HIV infection, and the corresponding prevalence of undiagnosed HIV are reported.

According to their analysis, the estimated number of people in England living with HIV aged 15-74 years who were unaware of their infection halved from 11,600 in 2013 to 5,900 in 2019, with a corresponding fall in prevalence from 0.29 to 0.14 per 1,000 people.

At the same time, the increase in the number of people living with diagnosed HIV resulted in the total number of people living with HIV rising from 83,500 to 92,800 over the same period. ̽��ֱ��percentage of people living with HIV whose infection was diagnosed therefore steadily increased from 86% in 2013 to 94% in 2019, reaching the UNAIDS target in 2016 – and even earlier, in 2013, for Black African heterosexuals.

Professor Daniela De Angelis from the MRC Biostatistics Unit, the study’s senior author, said: “Overall, we see a positive picture for the HIV epidemic in England, with a dramatic fall in the number of people living with undiagnosed HIV. We estimate we are already several years ahead of the UNAIDS 2020 goals and are on target to reach 95% diagnosed by 2025 and to eliminate HIV infections by 2030.

Dr Anne Presanis from the MRC Biostatistics Unit added: “Examined more closely, the situation is not as positive for everyone. We estimate that areas of England outside London have not seen as steep a decrease in undiagnosed HIV prevalence as in London, and there is evidence of missed opportunities to diagnose HIV infections among some population subgroups.”

In England, gay, bisexual, and other men who have sex with men, and Black African heterosexuals remain disproportionately affected by HIV, with considerably higher undiagnosed HIV prevalence per population in 2019 than heterosexuals in other ethnic groups. However, undiagnosed HIV prevalence rates within these communities have seen dramatic falls: for gay, bisexual, and other men who have sex with men, prevalence fell from 13.9 to 5.4 per 1,000, and for Black African heterosexuals prevalence fell from 3.3 to 1.7 per 1,000 population.

London saw more dramatic falls in the prevalence of undiagnosed HIV during the study period than other regions of England, down from 0.74 to 0.31 per 1,000, compared to a decrease from 0.20 to 0.11 per 1,000 outside London.

Although sexual health clinics provide free and confidential HIV testing to all clinic attendees, the researchers estimated that among heterosexuals in an ethnic group other than Black African, undiagnosed prevalence in clinic attendees in 2019 was more than 30 times greater than in those who had not attended in the past year. This implies that sexual health clinics are missing opportunities for testing attendees. This is in line with findings from Public Health England that among individuals outside those subgroups at greatest risk of HIV infection, the proportion declining a HIV test had increased to more than one in four (27%) in 2016.

̽��ֱ��researchers say their estimates have important implications for efforts to eliminate HIV transmission in England and the UK.

Dr Valerie Delpech, head of the HIV Team at Public Health England said: “This research is good news and shows that combination prevention, and in particular HIV testing and early treatment, is working in England. ̽��ֱ��increasing use of pre-exposure prophylaxis among persons at higher risk of HIV has further amplified our response to end HIV transmission. Nevertheless, further reducing the number of people who remain undiagnosed with HIV infection will become very challenging in the coming years. This is particularly the case for heterosexuals who may not consider themselves at risk of HIV.

“ ̽��ֱ��priority must be to ensure that all sexual health clinic attendees are offered and encouraged to accept a HIV test, regardless of ethnicity, rather than the 73% that currently do test. If we can increase the number of clinic attendees unaware of their HIV status who get tested and diagnosed, as well as improve partner notification, the prospect of eliminating HIV transmission becomes increasingly likely.”

̽��ֱ��research was funded by the Medical Research Council and Public Health England.

Reference
Presanis AM, et al. Trends in undiagnosed HIV prevalence in England and implications for eliminating HIV transmission by 2030: an evidence synthesis model. Lancet Public Health; 23 Sept 2021; DOI: 10.1016/S2468-2667(21)0042-0

England is on track to have diagnosed 95% of people living with HIV by 2025, putting it in a strong position to eliminate HIV transmission by 2030, say researchers at the MRC Biostatistics Unit, ̽��ֱ�� of Cambridge, and Public Health England (PHE).

Overall, we see a positive picture for the HIV epidemic in England, with a dramatic fall in the number of people living with undiagnosed HIV

Daniela De Angelis

Andy McCarthy

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England on track to achieve elimination of HIV transmission by 2030 as model shows sharp decrease in HIV incidence

Anonymous — Thu, 10 Jun 2021 08:20:10 +0000

To manage the HIV epidemic among men who have sex with men (MSM) in England, enhanced testing and earlier treatment strategies were scaled-up between 2011 and 2015 and supplemented from 2015 by pre-exposure prophylaxis (PrEP). ̽��ֱ��researchers examined the effect of these interventions on the number of new infections and investigated whether the United Nations (UN) targets for HIV control and elimination of HIV transmission by 2030 might be within reach among MSM in England.

A complexity in this assessment is that HIV infections are not observed. Routine surveillance collects data on new HIV diagnoses, but trends in new diagnoses alone can be misleading as they can represent infections that occurred many years previously and depend on the testing behaviour of infected individuals.

To estimate new HIV infections among adult MSM (age 15 years and above) over a 10-year period between 2009 and 2018, the researchers used a novel statistical model that used data on HIV and AIDS diagnoses routinely collected via the national HIV and AIDS Reporting System in England, and knowledge on the progression of HIV. Estimated trends in new infections were then extrapolated to understand the likelihood of achieving the UN elimination target defined as less than one newly acquired infection per 10,000 MSM per year, by 2030.

̽��ֱ��peak in the number of new HIV infections in MSM in England is estimated to have occurred between 2012 and 2013, followed by a steep decrease from 2,770 new infections in 2013 to 1,740 in 2015, and a further steadier decrease from 2016, down to 854. ̽��ֱ��decline was consistent across all age groups but was particularly marked in MSM aged 25–34 years, and slowest in those aged 45 years or older. Importantly, this decrease began before the widespread roll-out of PrEP in 2016, indicating the success of testing and treatment as infection prevention measures among MSM in England.

Through extrapolation, the researchers calculated a 40% likelihood of England reaching the UN elimination target by 2030 and identified relevant age-specific targeting of further prevention efforts (i.e., to MSM aged ≥45 years) to increase this likelihood.

Senior author, Professor Daniela De Angelis, Deputy Director of the MRC Biostatistics Unit, ̽��ֱ�� of Cambridge, said: “This is very good news and suggests that prevention measures adopted in England from 2011 have been effective. With the rollout of PrEP, England looks on course to meet the goal of zero transmissions by 2030. Our study also shows the value of regular estimation of HIV incidence to recognise and respond appropriately to changes in the current downward trend. ̽��ֱ��challenge now is to achieve these reductions in all groups at risk for HIV acquisition.”

Valerie Delpech, Head of National HIV Surveillance at Public Health England, said: “We have made good progress towards ending HIV transmission by 2030 in England. Frequent HIV testing and the use of PrEP amongst people most at risk of HIV, together with prompt treatment among those diagnosed, are key to ending HIV transmission by 2030.

“You can benefit from life-saving HIV treatments if you are diagnosed with HIV and it also means you cannot pass the virus on.

“HIV and STI tests are still available through sexual health clinics during the COVID pandemic. Many clinics offer online testing throughout the year – people can order tests on clinic websites, take them in the privacy of their own home, return by post and receive results via text, phone call or post.”

This research is funded by the UK Medical Research Council, UK National Institute of Health Research Health Protection Unit in Behavioural Science and Evaluation, and Public Health England.

Reference
Brizzi, F et al. Tracking elimination of HIV transmission in men who have sex with men in England: a modelling study. Lancet HIV, 10 June 2021; DOI: 10.1016/ S2352-3018(21)00044-8

̽��ֱ��annual number of new HIV infections among men who have sex with men in England is likely to have fallen dramatically, from 2,770 in 2013 to 854 in 2018, showing elimination of HIV transmission by 2030 to be within reach – suggests work by researchers from the MRC Biostatistics Unit at the ̽��ֱ�� of Cambridge and Public Health England, published in ̽��ֱ��Lancet HIV.

This is very good news and suggests that prevention measures adopted in England from 2011 have been effective

Daniela De Angelis

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#FreedomTo Know my HIV Status

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Tackling COVID-19: Professor Daniela De Angelis

jg533 — Thu, 20 Aug 2020 07:00:00 +0000

This article is part of a series in which we speak to some of the many Cambridge researchers tackling COVID-19. For other articles about our latest COVID-19-related research, click here.

I work for the Medical Research Council (MRC) Biostatistics Unit (BSU), a department in the ̽��ֱ��’s School of Clinical Medicine. I am a Programme Leader and Deputy Director of the Unit. ̽��ֱ��Unit is physically based at the Cambridge Institute of Public Health on the Cambridge Biomedical Campus. However since lockdown, all members of the Unit - including myself - have been working from home.

My research focuses on developing and applying statistical methods to characterise epidemics, using information on different aspects of the disease. This includes estimating transmission, severity (eg. the proportion of infected individuals who die), and reconstructing and predicting epidemics’ evolution. ̽��ֱ��goal is to provide accurate and timely quantitative support to the implementation and evaluation of public health policies. Historically we have worked on HIV, hepatitis and influenza, but since January this year our expertise has been used to understand the COVID-19 pandemic.

One of the most critical aspects of our COVID-19 work is to provide regular ‘now-casts’ and ‘forecasts’. ‘Now-casts’ refer to estimates of the current level of key epidemiological quantities, in our case, estimates of ongoing transmission and the number of new infections. ‘Forecasts’ mean estimates of future levels, in this instance, of the future number of deaths. Our results feed directly to the Scientific Pandemic Influenza sub-group on Modelling (SPI-M), a SAGE sub-group, and to regional Public Health England (PHE) teams.

I build models that allow us to reconstruct the pandemic and predict its future course. Our work on nowcasting and forecasting uses a model of disease transmission, data on daily COVID-19 deaths of infected individuals (by NHS region and age group), published information on the risk of dying and the time from infection to death, and data on antibodies levels in the population. This allows us to reconstruct the number of new COVID-19 infections and estimate changes in transmission (the famous reproduction number R) over time; and predict the number of COVID-19 deaths in different NHS regions and age groups.

I think the biggest challenge in dealing with COVID-19 is to understand what drives transmission of infection, and how to best use this knowledge to keep the pandemic under control - including when to introduce social restrictions and when to lift them. It is also important to use communication effectively, to build public understanding and trust so that people can react responsibly to the advice and recommendations given by the government and the scientific community.

There has been an enormous effort from the whole scientific community to contribute to the understanding of this pandemic. However, often these efforts have not been well coordinated and there are still lots of aspects of the SARS-CoV-2 infection that are not understood. We need to develop a more collaborative approach to working, building multidisciplinary teams where expertise is shared for a faster advancement of science.

I would like to see the creation of infrastructures that enable effective sharing of sensitive data. So much time has been spent in this pandemic waiting for authorised access to information that in an emergency situation should be available to any group with relevant expertise. It’s an important lesson to have learned, and we need to be better prepared for similar challenges in the future.

This has been one of the most challenging and exciting times to be in scientific research. I am glad to be playing a role in understanding this pandemic and making a difference to public health. Tracking COVID-19 will continue to be a major priority for my team at the BSU. ̽��ֱ��many important questions that still remain will keep us busy for years.

When the pandemic is over I’m looking forward to a nice holiday, and going back to normal life to enjoy the company of family and friends!

Professor Daniela De Angelis is Deputy Director of the MRC Biostatistics Unit. Read more about the Unit’s Nowcasting and Forecasting of COVID-19 here.

How you can support Cambridge’s COVID-19 research

Since January this year, Daniela De Angelis and her team have been informing the UK Government’s response to the COVID-19 pandemic. Their real-time model of transmission of the virus is helping to track and predict its course as information accumulates over time.

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