The Foundation, Lambeth Council, The National Lottery Community Fund, ViiV Healthcare, Comic Relief, and Big Issue have come together to implement the world’s first Social Impact Bond (SIB) focused on HIV treatment and care. The Zero HIV SIB is based in the South London boroughs of Lambeth, Southwark, and Lewisham (LSL) due to disproportionately high HIV prevalence, with an estimated 1,000 residents living with HIV that are unaware of their status in these boroughs. To reach patients in these boroughs, the Zero HIV SIB operates across three settings: in hospitals, in GP surgeries and in the community. In all settings, the SIB is focused on bringing individuals with HIV into care.
2019 was the first year of the SIB’s operation, which has resulted in more than 62,000 patients receiving HIV testing and more than 100 people newly diagnosed with HIV and engaged in care or re-engaged into HIV care. These 100 Londoners were not previously in HIV care and would not otherwise been reached. Hospitals, primary care, and community organisations all have conducted distinct activities through the SIB to find these patients and link them to care. The model places greater focus on patients themselves and utilises a bespoke approach to engage individuals in HIV services.
Hospitals in the programme have set up universal HIV testing in their A&E departments, so that all adults with blood drawn have the option to be tested for HIV. If a patient is HIV-positive, the clinic follows up with them and brings them in for specialist care. GP Federations are helping their practices implement a range of activities, including computerized notifications prompting screening patients for HIV, wide screening during universal HIV testing week, and targeted work with HIV-positive patients not in care. Community organisations go into public spaces, build trust and respect, test for HIV, and then provide supportive services to those who are diagnosed with HIV, which encourages those patients to seek specialist HIV treatment. This project has, in its first year of implementation, proved that diverse stakeholders can come together to develop varied but connected HIV activities across a complex health system.