Pre-sex HIV drug 'no-brainer" for NHS

Gay menImage copyright Getty Images

A drug to dramatically cut the risk of HIV infection during sex would save the UK around £1bn over the next 80 years, say scientists.

The team at University College London says Prep, or pre-exposure prophylaxis, is a "no-brainer" for the NHS.

The study predicts that giving Prep to men who have sex with men would prevent one in four HIV cases.

NHS England is currently funding a trial of Prep in 10,000 patients, but does not offer the treatment routinely.

Prep is already available in Scotland[1].The health service in England fought against paying for Prep in the courts[2], but agreed to trialling it in selected clinics.

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Media captionHow taking pre-exposure drugs revolutionised one gay man's relationship with sex

Preventive pills

Prep disables HIV before it gets a stranglehold in the body and trials show it can cut the risk of being infected by up to 86%.[3]

The financial analysis, published in the Lancet Infectious Diseases[4], looked at the cost-effectiveness of a national roll-out of Prep, focusing on the highest risk group - men who have sex with men.

It showed offering Prep would cost the NHS money initially as it paid for both Prep and lifelong care for people already infected with HIV.

It could take up to 40 years to become cost-effective, when savings from the falling number of new HIV cases equal the cost of Prep.

Eventually, after 80 years, the pills would deliver a saving of £1bn, say the researchers.

Dr Alison Rodger, part of the UCL team, told the BBC:"Not only is it a highly effective treatment, it will save money.It's a no-brainer so it's a good thing to do."

Image copyright Getty Images

The researchers' mathematical model predicted:

  • In the first year Prep was available, 4,000 men would start taking it, rising to 40,000 within 15 years
  • Men would take Prep for 4.5 years on average
  • Men would take two pills before sex, followed by one-a-day until they had gone two days without condom-less sex
  • Men would average five pills a week

It is still cost-effective with a daily Prep pill, but it takes longer to become cost-effective.Both options are being investigated as part of the NHS England trial.

The other major unknown is the long-term cost of the drugs, which may fall as cheaper alternatives become available.

Dr Michael Brady, medical director at the Terrence Higgins Trust, said:"It is important that all who need Prep can access it, and evidence like this reinforces the need for Prep to be fully commissioned and given a long-term, sustainable home on the NHS in England."

Dr Paul Revill, from the centre of health economics at the University of York, said the NHS needed to be "far sighted [and] invest now and reap long-term gains".

He added:"With a combination of frequent HIV testing, immediate treatment, and Prep availability, there is now the prospect of bending the curve of new HIV infections downwards in a way that did not seem feasible just a few years ago."

A spokesperson for NHS England said:"The Lancet study makes an important contribution to the growing evidence for cost effectiveness of PrEP, highlighting the factors which will determine this, such as price and duration on PrEP."

Follow James on Twitter.[5]...

References

  1. ^ available in Scotland (www.bbc.co.uk)
  2. ^ fought against paying for Prep in the courts (www.bbc.co.uk)
  3. ^ by up to 86%. (www.nice.org.uk)
  4. ^ published in the Lancet Infectious Diseases (www.thelancet.com)
  5. ^ on Twitter. (twitter.com)

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Check NHS cancer, A&E and operations targets in your area

The NHS is under unprecedented pressure.Rising numbers of patients need hospital care - whether in an accident and emergency department, for cancer treatment or for planned operations and care, such as knee and hip replacements.

For each there are strict targets local services are expected to meet across the UK.But what are the chances of being seen in time where you live?Use our interactive tracker to find out.

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Figures are assessed against targets before rounding

When was the target last hit?

When was the target last hit?

When was the target last hit?

If you can't see the tracker, click or tap here.[1]

How the NHS tracker works

This guide uses the latest published data on performance against three key NHS waiting-time measures:

  • A&E treatment
  • cancer care
  • planned operations and care, such as knee and hip replacements

This data is currently published either monthly or quarterly depending on where you live in the UK, and there are differences between how the targets are measured in each part of the UK.

The A&E target

The way the A&E target is measured is almost identical.In each case services across the UK are given four hours in which to treat and discharge or admit or transfer a patient.

They are all expected to do that in 95% of cases, although ultimately Scotland wants it services to get to 98% once 95% is achieved.There are also slight differences in the way the start time is measured.

The cancer target

There are similarities in the way cancer care is measured.Each expects patients to be treated within 62 days of an urgent referral.

In Scotland this can be following a GP or A&E referral or following a screening test.

Elsewhere it is broken down individually by referral route.So for the rest of the UK the BBC has chosen GP referral as the area to focus on as this is the most common route.Again the thresholds services are expected to achieve vary.

The planned operations and care target

The one that varies the most is for planned hospital care, which is also known as non-emergency treatment.

In England, Wales and Scotland the target measures the point at which you get a referral from your GP to the point when your treatment starts - in effect the whole patient journey.

In Scotland and England services have 18 weeks, in Wales it is 26 weeks.

Meanwhile, in Northern Ireland there are a range of targets for different parts of the patient journey.The BBC has chosen the last part, from when the decision is taken to admit the patient for treatment to when that treatment starts.It therefore does not include the tests and appointments that follow a GP referral, which can take weeks or even months.Services in Northern Ireland have 13 weeks to achieve this target.

The thresholds vary too.None is expected to achieve these goals 100% of the time.In Northern Ireland services have to achieve the target in 55% of cases, whereas in Wales it is 95%, in England 92%, and in Scotland 90%.

How local is defined

In England data is provided down to individual hospital trust level, some of these run more than one hospital.The BBC has excluded specialist trusts for cancer, children's care, women's services and orthopaedic treatment and instead focused on the 135 general hospital trusts - what most people would consider their local service.

Elsewhere performance is broken down to health board level, known as health and care trusts in Northern Ireland.They are in charge of services for a region or large city and often run more than one hospital.

We have chosen these boards because while some data is provided down to individual hospital level it is not done across all three targets.

How far back performance is tracked

The BBC has tracked back performance to the point at which the latest target was set or to when the records allow.

When a target has been missed for five years, we have just labelled it as that.

When targets have been hit more recently, we have provided the month they were last hit.

There are only two targets where it has not been possible to go back five years:

  • in Scotland for A&E as the target threshold was reduced from 98% to 95% in October 2014
  • in Northern Ireland for planned operations and care because its 13-week target threshold of 55% was set only in April 2016

The full list of dates from which the performance of local services is available are:

For England:

  • A&E:June 2010
  • Cancer:January 2009
  • Planned operations:April 2012

For Northern Ireland:

  • A&E:April 2008
  • Cancer:April 2009
  • Planned operations:April-June 2016

For Scotland:

  • A&E:October 2014
  • Cancer:January 2012
  • Planned operations:January 2011

For Wales:

  • A&E:October 2009
  • Cancer:October-December 2009
  • Planned operations:September 2011

Research by the BBC data team, Ransome Mpini, John Walton, Christine Jeavans and Nick Triggle.Design by Sumi Senthinathan.Development by Chris Ashton, Evisa Terziu, Becky Rush and Alvin Ourrad....

References

  1. ^ click or tap here (bbc.in)

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NHS surgery waits run into years in Northern Ireland

Megan's mum, Karen Image caption Megan's mum Karen says she is considering paying privately for her daughter's operation

Patients in Northern Ireland are waiting three years to see a consultant about having surgery following a GP referral.

The BBC has obtained exclusive figures showing long waiting times before a decision to operate.

In Northern Ireland, targets say most patients should be seen within 9 weeks and none should wait over 15 weeks.

Yet some patients are waiting 155 weeks or more to see a specialist for spinal conditions.

A spokesman for the Health and Social Care board said it was 'unacceptable' that waiting lists had grown so long.

Longer and longer waits

The health service has not met the targets for several years.

Figures obtained by Freedom of Information requests in April this year and seen by the BBC show that in one of Northern Ireland's five healthcare trusts, the minimum waiting time for an appointment with an orthopaedic consultant specialising in spinal conditions was 155 weeks.

For upper limb conditions, the minimum wait was 127 weeks.

By June, waits for spinal appointments at the same trust had risen to 159 weeks.

Megan's story

Megan Fleming, who is 14 years old, needs an urgent operation to correct a curvature, or scoliosis, of her spine.

Image caption Megan Fleming needs surgery to help straighten her spine

Her health is deteriorating fast, and she has trouble breathing.Despite her condition, the teenager from Carrickfergus continues to go to dance classes, but says her future is on hold until her operation, which surgeons have told her will be a year away.

Her mother Karen said:"Megan loves dancing.It's just her life at the minute.She just wants to dance.

"But at the minute she needs the surgery to help her.You could see the consultant was absolutely gutted and you could see it was hurting to say a year, but it's out of his control.

"I've paid taxes, I've paid national insurance.So why can't I get the surgery that she deserves?"

Megan and Karen are now trying to raise the £50,000 that her surgery will cost privately, fearing that the long wait will put Megan's long-term health at risk.

Image copyright Megan Fleming Image caption Megan has a condition called scoliosis which means her spine is curved

Dr Ursula Brennan, a GP in Belfast, said that seeking private healthcare was a decision more and more patients were having to make in the current climate.

"You're going to have to wait, and it may be several months.It may be into 52 weeks, or 80 weeks, or beyond.

"It's very difficult to turn this conversation to - and these are our elderly folk - that you may have to use your life savings to actually improve your quality of life."

When asked about the long waits, which are far higher than in other parts of the UK, the deputy chief executive of the Health and Social Care Board, Michael Bloomfield, said:"That is absolutely unacceptable, and that's why we need to clearly illustrate the need for reform.

"There are about 35,000 more surgical procedures required than the health service currently has capacity for.

"Without the additional funding to see those patients or have them treated in different ways, it is regrettably inevitable that waiting times will increase to the position that they are now in."

Political vacuum

The political commentator Deirdre Heenan is working on a report with the Nuffield Trust into the emerging healthcare crisis in Northern Ireland.

She said:"In the last nine months we've had no government in Northern Ireland.We're in a political vacuum.

"This system reverts to keeping the show on the road, and any ideas about transformation or change are simply mothballed."

In a blog[1], she writes:"There is a difficult backdrop:austerity, increasing demand, rising expectations, and political uncertainty.

"It is not clear that the public are in a position to call for change.They may not have good information about how well the service meets their needs, and have not necessarily been made part of the long conversations about change, which as a result can sound like it brings bad news.

"But the impact on patients of the current impasse in implementing necessary changes is stark.In June this year, for example, one in six of the entire Northern Ireland population was currently on an outpatient or inpatient waiting list.In England the figure is one in 14.

"And over 64,000 people had been waiting over a year for their first outpatient appointment - a quarter of all those on the waiting list.In England, by contrast, around 1,500 people were still waiting over a year - just 2 per cent of the number in Northern Ireland for a population over 30 times larger."

On Wednesday, the BBC will be publishing its NHS tracker, which allows users to look at how their local hospitals are performing on waiting times for A&E, cancer and planned operations....

References

  1. ^ In a blog (www.nuffieldtrust.org.uk)

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Drug therapy 'restores breathing' after spinal injury

Spinal cord damageImage copyright Science Photo Library

A drug-based therapy appears to restore breathing in rats paralysed from the neck down by a spinal injury, according to scientists.

They hope their "exciting but early" findings could ultimately help free patients from ventilators.

The pioneering work, in Cell Reports[1], suggests the brain may not be needed for respiration if a nerve pathway in the spine can be awakened.

More studies are now needed to better understand and exploit this system.

'No brain' breathing

Normally, messages to and from the brain control breathing.

If the spinal cord is damaged high up in the neck, these messages can't get through and a person will need mechanical assistance or a ventilator to breathe.

Image copyright Getty Images

Experts have been looking at ways to repair spinal cord damage to reconnect with the brain, but the latest therapeutic approach, being explored at Case Western Reserve University, is entirely different.

Dr Jerry Silver and colleagues believe they have found an alternative nerve pathway for breathing in the spinal cord itself.

The researchers used a drug and a light therapy known as optogenetics to dial up this spinal system.

It appeared to control the body's main muscle of respiration - the diaphragm, a dome-shaped sheet of muscle that sits underneath the lungs, separating the chest from the abdomen.

The live adult rats that they studied had severed spinal cords, meaning the brain could not be the source of the diaphragm movement or breathing that the researchers saw after they administered the therapy.

They believe the treatment works by stopping other nerve signals that would normally silence the spinal system that they found.

Dr Silver said:"This is a primitive response that has been kept in the spinal cord for emergencies, like gasping and screaming in response to danger."

Although the researchers say the movements they saw resembled breathing, it's not clear yet if it would be enough to sustain life.They plan more animal studies to check.

Dr Silver said:"Ultimately, the goal of this research would be to free people with these neck injuries from having to use mechanical ventilators.

"Infections and other complications from mechanical ventilators are a leading cause of death after spinal cord injuries."

Dr Thomas Becker, an expert in neuroregeneration at Edinburgh Medical School, said:"This is an important discovery on the fundamental working of the spinal cord.

"Understanding the spinal network is the first step toward future therapies.

"This knowledge could be used for future therapies to restore breathing in patients who lost nerve connections from the brain as a consequence of spinal cord injury."...

References

  1. ^ Cell Reports (www.cell.com)

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