On 17 April 2025, Jason Strelitz, Corporate Director for Adults, Health and Communities, approved the acceptance of £572,000 in grant funding from the Elton John AIDS Foundation (EJAF) on behalf of all North East London (NEL) Local Authorities. The funding will be used for the Expanding PrEP Access through Novel Delivery in North East London (ExPAND – NEL) pilot project, which aims to increase awareness and uptake of PrEP¹, particularly among under-represented groups at risk of acquiring HIV. Newham Shared Service will act as the lead authority, responsible for procuring services, managing the pilot, and coordinating efforts across NEL.

Expanding PrEP Access through Novel Delivery in North East London (ExPAND – NEL)

The Expanding PrEP Access through Novel Delivery in North East London (ExPAND – NEL) pilot project seeks to reduce HIV diagnoses and health inequities by increasing PrEP awareness and uptake, particularly within under-represented groups at risk of acquiring HIV. The programme aims to extend PrEP awareness-raising, initiation, and continuation beyond specialist sexual and reproductive health (SRH) clinics, making it accessible to residents with PrEP needs who do not currently access PrEP via specialist services but could access it via other physical or digital settings.

The ExPAND-NEL project has the following aims:

• Increase awareness through grassroots engagement and non-specialist health staff.
• Provide cost-effective PrEP via a digital platform integrated with STI testing.
• Facilitate PrEP initiation and continuation in non-specialist settings, including primary and secondary care, and community locations.
• Provide enhanced support for those with lower PrEP awareness and social barriers, and pathways for those with complex needs.
• Reach up to 3,100 people, increasing PrEP coverage by 60%.
• Establish a scalable model to influence PrEP delivery elsewhere.

The project will achieve these aims by:

• Engaging under-represented groups through targeted community outreach.
• Training non-specialist health staff to discuss and refer patients for PrEP.
• Establishing a direct-to-consumer online PrEP service (DPrEP).
• Delivering PrEP in non-specialist settings using existing infrastructure.
• Strengthening specialist SRH clinics to handle complex cases and interface with the DTC pathway.

Background

According to the Public reports pack 17th-Apr-2025 Officer Key Decision, North East London has a diverse population of 2 million people, including a high proportion of groups at risk for HIV. Although HIV incidence declined by about 60% between 2018 and 2021, it remains one of the highest in London and England. The rate of new diagnoses in North East London is 8.1 per 100,000, compared to the national average of 4.8 per 100,000. The number of new diagnoses increased sharply in the latest full year of data, rising from 164 in 2021 to 260 in 2022, and national data show a further substantial increase in 2023.

HIV incidence is higher among gay, bisexual, and other men who have sex with men (GBMSM), particularly young GBMSM (aged under 35), Black ethnic groups, those born abroad, and at-risk groups such as sex workers. High HIV prevalence in NEL is linked to the large and growing LGBTQ+ population, high migration levels, large Black African and Caribbean communities, groups engaging in high-risk sexual behaviours, and injecting drug use.

PrEP is currently available free of charge to eligible individuals through specialist Sexual and Reproductive Health (SRH) services, which are commissioned by local authorities and commonly provided by secondary care NHS Hospital Trusts. Increases in PrEP uptake in NEL, particularly among GBMSM, have led to a substantial reduction in HIV diagnosis. However, this has not been equitable across at-risk groups, and rates of new diagnoses among other at-risk groups have increased recently.

Council Policy and Priorities

The ExPAND-NEL pilot programme aligns with Newham’s Health and Wellbeing Strategy, 50 steps to a Healthier Newham (2024-27), which focuses on the drivers and determinants of health. The Council promises to increase PrEP uptake and HIV screening among priority groups (Step 14, p.40). The programme also aligns with strategic priorities within the ‘Fairer Newham’ Corporate Plan (2022-26), including:

• Priority 1: A healthier Newham and ageing well
• Priority 6: Supporting our young people

Alternative Options Considered

Commissioners considered the option of not accepting funds but rejected it due to the missed opportunity to reduce new HIV diagnoses, the continuation of inequity in PrEP access and uptake, and the programme's strategic alignment and policy influence.

Another option considered was for each NEL Local Authority to procure, manage, and coordinate the programme directly. This option was rejected because Newham hosts the NEL Sexual Health Shared Service Commissioning Service, which has established governance structures and experience in managing complex multi-stakeholder programmes, and can leverage existing procurement routes to ensure rapid contracting and implementation of the programme.

Implications

Financial Implications

The funding will be a specific grant, administered by Newham Council across NEL Local Authorities. All spending and grant income will be allocated to specific unique budget codes to ensure a thorough audit trail and evidence of spending and allocation to partner Local Authorities. All spending will be within the grant envelope, and any spending above that will be met from the existing cash budget of the service area. Any underspending will be reported back to the funding body, and the lead commissioner will ensure the funds are returned or carried forward for specific commitments, depending on the conditions of the funding.

Legal Implications

The Council has a statutory duty to take steps to improve the health of people in its area, including providing information, advice, and services for the prevention, diagnosis, or treatment of illness. The recommendations in this report align with this duty. The Council must ensure compliance with all obligations under the Elton John AIDS Foundation grant funding agreement, which Legal Services must review once the EJAF has finalised the grant conditions. Any agreement between the Council and third-party providers must require providers to meet the same obligations imposed on the Council under the EJAF grant funding terms and conditions. The decision to procure any third-party providers will be made subject to separate governance in accordance with the Council’s scheme of delegation.

Equalities Implications

HIV is an inherently inequitable illness, with higher prevalence among Black African residents and the LGBTQ+ community. Without specific action to address the transmission and late diagnosis of HIV, there is a risk of further exacerbating health inequalities. The ExPAND-NEL project aims to address health inequities by increasing PrEP awareness and uptake among underserved groups in North East London, including migrants from high-risk countries, Black African and Black Caribbean at-risk heterosexuals, sex workers, socially excluded GBMSM, and young GBMSM under 25.