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Clinical effectiveness of pre-exposure prophylaxis (PrEP) for preventing HIV acquisition in men who have sex with men (MSM) at high HIV risk is established. A static decision analytical model was constructed to inform policy prioritisation in England around cost-effectiveness and budgetary impact of a PrEP programme covering 5,000 MSM during an initial high-risk period. National genitourinary medicine clinic surveillance data informed key HIV risk assumptions. Pragmatic large-scale implementation scenarios were explored. At 86% effectiveness, PrEP given to 5,000 MSM at 3.3 per 100 person-years annual HIV incidence, assuming risk compensation (20% HIV incidence increase), averted 118 HIV infections over remaining lifetimes and was cost saving. Lower effectiveness (64%) gave an incremental cost-effectiveness ratio of + GBP 23,500 (EUR 32,000) per quality-adjusted life year (QALY) gained. Investment of GBP 26.9 million (EUR 36.6 million) in year-1 breaks even anywhere from year-23 (86% effectiveness) to year-33 (64% effectiveness). PrEP cost-effectiveness was highly sensitive to year-1 HIV incidence, PrEP adherence/effectiveness, and antiretroviral drug costs. There is much uncertainty around HIV incidence in those given PrEP and adherence/effectiveness, especially under programme scale-up. Substantially reduced PrEP drug costs are needed to give the necessary assurance of cost-effectiveness, and for an affordable public health programme of sufficient size.

BACKGROUND: Pre-exposure prophylaxis (PrEP) has proven biological efficacy to reduce the sexual acquisition of the human immunodeficiency virus (HIV). The PROUD study found that PrEP conferred higher protection than in placebo-controlled trials, reducing HIV incidence by 86 % in a population with seven-fold higher HIV incidence than expected. We present the baseline characteristics of the PROUD study population and place the findings in the context of national sexual health clinic data. METHODS: The PROUD study was designed to explore the real-world effectiveness of PrEP (tenofovir-emtricitabine) by randomising HIV-negative gay and other men who have sex with men (GMSM) to receive open-label PrEP immediately or after a deferral period of 12 months. At enrolment, participants self-completed two baseline questionnaires collecting information on demographics, sexual behaviour and lifestyle in the last 30 and 90 days. These data were compared to data from HIV-negative GMSM attending sexual health clinics in 2013, collated by Public Health England using the genitourinary medicine clinic activity database (GUMCAD). RESULTS: The median age of participants was 35 (IQR: 29-43). Typically participants were white (81 %), educated at a university level (61 %) and in full-time employment (72 %). Of all participants, 217 (40 %) were born outside the UK. A sexually transmitted infection (STI) was reported to have been diagnosed in the previous 12 months in 330/515 (64 %) and 473/544 (87 %) participants reported ever having being diagnosed with an STI. At enrolment, 47/280 (17 %) participants were diagnosed with an STI. Participants reported a median (IQR) of 10 (5-20) partners in the last 90 days, a median (IQR) of 2 (1-5) were condomless sex acts where the participant was receptive and 2 (1-6) were condomless where the participant was insertive. Post-exposure prophylaxis had been prescribed to 184 (34 %) participants in the past 12 months. The number of STI diagnoses was high compared to those reported in GUMCAD attendees. CONCLUSIONS: The PROUD study population are at substantially higher risk of acquiring HIV infection sexually than the overall population of GMSM attending sexual health clinics in England. These findings contribute to explaining the extraordinary HIV incidence rate during follow-up and demonstrate that, despite broad eligibility criteria, the population interested in PrEP was highly selective. TRIAL REGISTRATION: Current Controlled Trials ISRCTN94465371 . Date of registration: 28 February 2013.

Baseline Sexual Behaviour Questionnaire. (DOC 155 kb)

Adherence and Sexual Behaviour Questionnaire. (DOC 95 kb)

When the utility regulators were established in the UK their primary duties and roles were focused on economic regulation – setting price controls for monopolies and promoting competition where possible. The increasing emphasis in government policy on sustainable development has led to pressures on the regulators to pay greater attention to social and environmental concerns alongside economic ones. Ofwat and Ofgem now have duties to contribute to the achievement of sustainable development. Why and how did this change come about, what impact will it have on how the regulators deal with sustainable development and on the nature of regulation?

The vision of Electric Vehicles (EVs) providing energy back into the grid is one that has captivated people since the re-emergence of EVs and the rise of the Smart Grid. In this vision, EV owners, electricity network operators and society more generally share the benefits of smoothing the peaks and troughs of electricity demand and improving EV battery utilization. Whilst technical obstacles remain, the greatest limitations are those presented by electricity market rules. Within existing frameworks, charging can be managed according to network needs for widespread benefit. And more immediately, vehicles can supply emergency back-up power or act as local storage for renewable energy through interactions that take place behind the electricity meter. Successful deployment of these scenarios will serve as a stepping stone towards the future vision of EVs as grid storage.

This paper examines energy conservation and energy efficiency policies and programmes, mainly in the UK but also in Denmark and the Netherlands. It explores the theoretical and practical differences between conservation and energy efficiency and shows how, particularly in the household sector, energy demand continued to increase despite a range of policies to improve energy efficiency. Energy efficiency's ability to deliver energy and CO2 savings may be significantly counter-balanced in the short term by trends towards, greater use of appliances and increasing comfort standards. Over the medium and longer term energy efficiency should prove much more beneficial as saturation is reached for many energy services. However without action to raise energy prices (e.g. through taxation) the potentially beneficial effects of energy efficiency programmes may be limited.

At Barnardo’s we recognise that children affected by the imprisonment of a family member are a highly vulnerable group. They face significant pressures during the period of imprisonment and are at risk of poorer outcomes afterwards. Having a parent or other family member in prison, can impact on a child’s sense of identity and how they interact with their family and community. Equally importantly, it can impact on their lives at school. As schooling is the most universal service provision for children, it is crucial that schools address the needs of the children who are affected by this issue. Many schools are making good progress in this area, but we know from our work that the quality varies. Barnardo’s has been involved for several years in developing services for children affected by parental imprisonment both within prisons and within the communities in which the children live. Our work is based on trying to see the ‘whole child’ in order to understand the wider impact of having a family member in prison. Barnardo’s are also involved in influencing work to raise awareness among other agencies of the needs of this group and to support partnership approaches that meet those needs. This handbook is part of that influencing work and has been adapted from a handbook that was produced by Barnardo’s South West. Our intention with this handbook is to produce a readily accessible resource that can help schools in Wales support children affected by parental imprisonment.

The Energy Saving Trust was set up by the last Conservative Government to run major programmes of investment in energy efficiency, to help meet the UK Government's targets to reduce carbon dioxide emissions. The Government was relying on the regulators OFGAS and OFFER to raise the funding required from gas and electricity consumers required rather than providing it from taxation. The regulators, however, felt that they were being expected to introduce taxes by the back door and refused to approve funds on the scale required. The Government's failure to resolve this problem suggests that competition was a more important goal of energy policy than the achievement of sustainable development, despite Government statements that they were both important. However, changes in power generation mean that the UK will meet its year 2000 carbon saving target without the Trust. This article explores the development of the Energy Saving Trust and the tensions between the roles of the regulators, OFGAS and OFFER, the Government and Parliament, in the period from 1992 to 1996. The article is based on research undertaken by the author for CSERGE, University of Norwich (Working Paper GEC 95-35), updated to reflect recent developments.

Neuronal microtubule-associated proteins (MAPs) are important components of neurons and are believed to regulate neuronal function and development by controlling the assembly of microtubules and the interaction of microtubules with other cytoplasmic organelles. We studied the immunohistochemical localization of MAPs 1, 2, 5, and tau in the intestinal tissues of five patients with Hirschsprung's disease and in five normal controls using monoclonal antibodies. Microtubule-associated proteins 5 and tau proved to be excellent enteric neuronal markers; they were specifically located in the nerve cell bodies and processes of normal intestine as well as in the abnormal hypertrophied nerve fibers of aganglionic colon. Fine fibrillar structures in the neuroplasm were revealed in greater detail than were those obtained from studies with conventional markers, including neuron-specific enolase, S-100 protein, and neurofilament protein. A slight reduction of MAPs 5 and tau immunoreactivity was observed in the aganglionic colon compared with normal colon. Microtubule-associated proteins 1 and 2 were absent from the nerve fibers in both normal and aganglionic colon. This study suggests that immunostaining for MAPs 5 and tau may be superior to other immunohistochemical methods for diagnosing Hirschsprung's disease; however, in view of its limited retrospective nature these findings need to be corroborated by a large prospective evaluation.

The potential consumer benefits from smart meters are considerable. However, any smart meter roll-out will raise significant issues from the consumer perspective. Domestic smart meters could play a central role in helping consumers to improve control over their energy use. The potential benefits for consumers are considerable - improved retail competition, accurate bills, more consumer friendly methods of prepayment and the chance to reduce consumption through better feedback. However, the commercial, technical and logistical requirements, of smart metering, including information and communications campaigns to ensure consumer acceptance, mean that the pitfalls could also be considerable. Particular concerns could include data protection, treatment of vulnerable households, potential for remote disconnection, marketing and complexity of tariffs Additional costs to customers should be minimised and the benefits flowing to consumers should be maximised. A successful smart meter roll-out will be achieved by energy suppliers working sensitively to meet their customers' needs. This presentation will outline these issues as they relate to Great Britain. (21 pages)