Research Area
Our doctors, nurses, pharmacists and health advisors work closely with psychologists, dieticians, community HIV nursing team and 3rd sector organisations (e.g. Terence Higgins’ Trust, Lunch Positive) to provide holistic care. As well as providing the latest in HIV treatments we run specialist clinics for PLWH alongside other experts e.g. memory, liver, ageing, women, cardiac, gastroenterology and renal. Both the HIV inpatient and outpatients are situated in the Royal Sussex County Hospital in a new purpose-built unit in the Louisa Martindale building. However, we offer Sexual Health & Contraception (SHAC) services provide prevention, treatment, and advice through many other clinics across the different sites of our Trust.
We are a regional training centre for genitourinary medicine (GUM) trainees and an active teaching centre for student nurses, medical students and other allied health professionals.
Our Research
Since1988(over 3 decades), our research has been embedded in the clinical service and we believe that every person who is eligible for research should have the opportunity to participate. Our research aims to improve health and knowledge, influence policy and guidelines and give patients the opportunity to have the newest of treatments/ strategies.
The unit has a reputation for providing high quality data and participation in a wide variety of collaborative studies with local, national and international commercial and academic partners. These include BSMS, the World Health Organisation, the National Institute for Health Research and Imperial College London.
As many different staff members are involved and all have specific research interests, we have a diverse portfolio including:
- HIV prevention and New HIV therapies e.g. new classes of drugs, injectables, new strategies
- Research on comorbidities such as hepatitis, ageing, bone health, renal issues
- Women and HIV and Sexual Health diagnostics
- New Sexual Health treatments e.g. for gonorrhoea, bacterial vaginosis, vaccinations
- Sexual Health prevention
- Special patient groups e.g. trans people, older people, & Digital innovation.
Key Outputs
Big data
We have been contributing data since 1994 to the EuroSIDA Study which now holds data from 23,000 patients living with HIV in Europe, contributing almost 200,000 person years of follow-up and has produced over 300 peer–reviewed journal articles. We have recently joined the Respond Outcomes consortium with participants across Europe and Australia, to address clinically relevant research questions such as the risk and outcomes of non-AIDS comorbidities and the possible relationship to long-term antiretroviral therapy (ART) exposure. We also collect data for the regular national Positive Voices survey which provide invaluable information on physical and mental health service access, important for assessing service design and provision to optimise care.
HIV treatment
The START study’s results in 2015 meant that for the first time, all global HIV treatment guidelines concurred – i.e. treatment was recommended no matter what a patient’s CD4 count was.
We have taken part in many HIV ART studies leading to the licensing of new antiretroviral drugs e.g. Biktarvy in naïve and treatment experienced patients; Doravirine in naïve and experienced patients; Dovato in naïve and switch studies; including implementation of the new HIV injectable treatment, ILANA and many more. Our team is also involved with writing national HIV treatment guidelines.
HIV prevention
This area has been revolutionised recently with the advent of Pre-Exposure Prophylaxis (PrEP); we were involved in early studies of PrEP (PROUD, Discover, IMPACT ) as well as Post exposure Prophylaxis (PEP) studies and digital innovations (EMERGE PREP) to support patient held PrEP related information. These PrEP studies have enabled PrEP rollout in the NHS which has been a factor in the dramatic decrease in new HIV diagnoses in England.
In addition, knowing that undetectable HIV = Untransmissible HIV, another contributor to the decrease in HIV diagnoses, is in part thanks to the PARTNER and PARTNER 2 studies.
Aging and HIV
Since 2013 we have partaken in the POPPY Study specifically looking at clinical outcomes of people living with HIV over the age of fifty in England and Ireland.
Hepatitis C
We were involved in one of the first studies showing the potential of curing Hepatitis C infection in PLWH with oral therapy only – Photon-2, which helped Brighton become a regional treatment hub for Hepatitis C.
Women and HIV
We contribute to increased awareness of women’s issues including comorbidities and integration of services for women. We have staff who are specialist in pregnancy and HIV and write the national HIV pregnancy guidelines.
Sexual health
The PID study, led by our team, showed that shorter course antibiotic was less effective than the standard 2-week course; the self-taken swabs study results changed guidelines for the way we screen for sexual infections in men who have sex with men, showing that patient taken swabs is just as effective as clinician taken swabs. Other themes on testing have included a WHO supported novel point of care test; we led on developing a digital vending machine to supply tests – which is now rolling out in UK, Japan & Uganda; and staff have led on highlighting novel infections such as mycoplasma genitalium and consequent national guideline writing (BASHH) . We are also increasing research in underserved populations such as gender diverse populations for which there is a paucity of studies.
Current Projects
The RIO study, funded by the Bill & Melinda Gates foundation, is looking at a novel treatment (Broadly Neutralising Antibody, bNAB) which may enable people to stop oral antiretroviral treatment and includes an optional sub study taking gut biopsies to assess the HIV viral reservoir.
The Mistral study (Microbiome-based stratification of individuals at risk of HIV-1 acquisition, chronic clinical complications, antimicrobial drug resistance, and unresponsiveness to therapeutic HIV-1 vaccination) which is funded by an EU Horizon 2020 grant is exploring the gut microbiota in relation to HIV-1, seeking microbiome biomarkers to support development of interventions that mitigate infection and enhance response to vaccines and therapies.
MK – 8591A 051 study: this is a switch study investigating a new class of HIV drug, Islatravir, a NRTTI along with a licensed drug Doravirine, as a single tablet dual therapy in people stable on treatment.
Refine-B study: looking at markers in Hepatitis B/HIV co infection to identify who may be able to safely stop HBV treatment whilst still maintaining HBV and HIV control.
PrEPaRe Study: Assessing use of PrEP amongst people newly diagnosed with HIV to understand the circumstances in which these diagnoses occurred and estimate the prevalence of HIV drug resistance.
LEAP: Exploring perceptions, barriers, facilitators and unmet need for injectable lenacapavir in the management of HIV
QTUG Frailty; Acceptability and feasibility of digital assessment of falls risk, frailty and mobility impairment using wearable sensors in people with HIV as part of HIV care
Prime EDQ: Evaluation of the psychometric properties of the short form Episodic Disability Questionnaire (EDQ) among women living with HIV in the United Kingdom
For more information on our programmes at BSMS: HIV and sexual health – BSMS
Soon to open studies:
Self -TI, self-taken smear tests in gender diverse populations
Artistry study, new class of HIV treatment – lenacapavir
Inside HIV, brain imaging in PLWH and depression
Key Contact Details
- Dr Amanda Clarke (Royal Sussex County and Princess Royal Hospitals), Consultant in GUM & Clinical Trials: [email protected] Prof Jaime Vera
- Dr Judith Zhou (Worthing and St Richards Hospitals), Consultant in Sexual Health: [email protected]
- Ms Lisa Barbour, Lead Research Nurse in Clinical Infection: [email protected] HIV SHAC Clinic website lin