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Dr Cathal \u00d3 Broin<\/p>\nDr Cathal \u00d3 Broin, Consultant in Infectious Diseases at St Vincent\u2019s University Hospital, Dublin, speaks to Niamh Cahill about the steps required to further advance HIV prevention and care<\/p>\n
Significant improvements in HIV prevention and care have occurred in Ireland in the last 10 years, according to Dr Cathal \u00d3 Broin, Consultant in Infectious Diseases, St Vincent\u2019s University Hospital, Dublin.<\/p>\n
Speaking to the Medical Independent (MI), Dr \u00d3 Broin welcomed these developments, including the introduction of a pre-exposure prophylaxis (PrEP) programme.<\/p>\n
Dr Cathal \u00d3 Broin<\/p>\n
But he underlined that greater investment and new strategies are needed to eliminate HIV transmissions in line with global commitments.<\/p>\n
Dr \u00d3 Broin made the remarks following the publication of a new HIV Ireland report \u2013 Towards a National Action Plan for HIV in Ireland. The report warned that Ireland was unlikely to meet its goal of ending HIV transmissions by 2030.<\/p>\n
It is estimated that around 8,000 people in Ireland are living with HIV. In 2024, Ireland had the second highest HIV transmission rate per capita in Europe, according to data from the HSE Health Protection Surveillance Centre.<\/p>\n
Dr \u00d3 Broin has worked in the area of infectious diseases since 2014, becoming a consultant in 2020. He believes that the planned HIV national action plan and the National Sexual Health Strategy 2025-2030 will help to build on \u201chuge improvements\u201d in HIV prevention and care.<\/p>\n
\u201cCertainly from a prevention perspective, I think there has been significant investment by the Department of Health,\u201d Dr \u00d3 Broin told MI.<\/p>\n
According to the new HIV Ireland report, achieving the 2030 goal is possible, but only with immediate political commitment, sustained investment and a willingness to adopt proven interventions at scale.<\/p>\n
\u201cThe cost of complacency is stark with the report\u2019s findings estimating that the total cost of care for people living with HIV in Ireland between 2025 and 2030 could reach over \u20ac694 million, with the additional lifetime costs associated with new diagnoses alone estimated at \u20ac2.02 billion,\u201d it outlined.<\/p>\n
The charity called for the introduction of routine opt-out testing for HIV in emergency departments (EDs), wider access to testing and treatment, the elimination of waiting lists for HIV PrEP, and the provision of treatment in the community outside of secondary care settings.<\/p>\n
\u201cIreland has the knowledge and the tools to end new HIV transmissions. What this report makes clear is that we are not currently applying them at the scale or speed required,\u201d said Mr Stephen O\u2019Hare, HIV Ireland\u2019s Executive Director.<\/p>\n
\u201cIreland is reporting rising cases of HIV in certain demographics, we continue to see unacceptable levels of late diagnosis and people seeking pre-exposure prophylaxis are waiting up to a year. We urgently need the Government to publish a national action plan for HIV.\u201d<\/p>\n
Prevention<\/p>\n
One of Dr \u00d3 Broin\u2019s lead roles at St Vincent\u2019s is in the area of HIV prevention. The hospital has 1,450 patients on HIV PrEP, an oral antiretroviral therapy taken by people at risk of HIV. When taken correctly, HIV PrEP reduces the risk of acquiring HIV by about 99 per cent. The therapy does not protect against other sexually transmitted infections (STIs).<\/p>\n
The HSE commenced a HIV PrEP programme in November 2019, following a HIQA health technology assessment which found that the introduction of a PrEP programme would be safe, effective, and cost-saving. Nationally, there were 8,521 patients on PrEP in the first quarter of 2026, according to data from the HSE.<\/p>\n
\u201cIn the last six or seven years, we have seen a really big improvement in prevention and, certainly in people born in Ireland, we\u2019ve seen a small reduction in new cases acquired,\u201d Dr \u00d3 Broin noted.<\/p>\n
\u201cBut I think we can lose focus because while HIV is a very chronic, manageable infection, it is an incurable infection. We have a lot of the tools to get this under control and we\u2019ve done amazing work, but the last hurdle is always the most difficult. Now it\u2019s about finding the patients who are a little bit more challenging to find. We need to work harder. We need to have processes in place that are more accessible to everyone in the country; that\u2019s the next level of challenge we face.\u201c<\/p>\n
At St Vincent\u2019s, there is a 30 per cent STI detection rate at every HIV prevention clinic, according to Dr \u00d3 Broin. He said it is a statistic that reflects the fact that the right patients are being seen at clinics.<\/p>\n
But the demand for HIV prevention services remains high and other more creative ways of meeting the needs of patients are required, he underlined.<\/p>\n
\u201cThere is a huge demand for HIV prevention and whenever any resources are allocated they are very quickly saturated,\u201d he said.<\/p>\n
Similar to services in place in the UK, Dr \u00d3 Broin suggested ways in which care and treatment could be offered more efficiently \u2013 for example, by making greater use of digital technology to improve the patient journey.<\/p>\n
A further expansion of the role of nurses in PrEP, who Dr \u00d3 Broin stated are \u201chighly competent\u201d, and the utilisation of all multidisciplinary team staff would also lead to improvements.<\/p>\n
Dr \u00d3 Broin said the HSE SH:24 home testing service, introduced in 2021, is \u201coutstanding\u201d and has provided an avenue to testing for patients who heretofore did not have access. However, he argued Ireland needs to go further and embed testing in certain healthcare processes.<\/p>\n
Opt-out Testing<\/p>\n
In 2024, there were 239 first-time HIV diagnoses, up from 182 in 2023. Data for 2025 has not yet been published.<\/p>\n
Around 40 per cent of people in Ireland are diagnosed late, which means that HIV is already negatively affecting their immune system.<\/p>\n
Research shows that many people have attended healthcare services several times before they are offered a HIV test.<\/p>\n
Dr \u00d3 Broin believes that routine opt-out testing should be introduced more widely.<\/p>\n
\u201cRoutine opt-out testing picks up many more cases of hepatitis in addition to HIV,\u201d he noted. The service is in place in some UK hospitals and data has shown it is effective.<\/p>\n
Currently, St James\u2019s Hospital, Dublin, is the only hospital in Ireland offering routine opt-out HIV and hepatitis (B and C) testing in its ED.<\/p>\n
Dr \u00d3 Broin noted that the Mater Hospital in Dublin did \u201can outstanding study\u201d over 10 years ago, demonstrating that cases are picked up much earlier this way.<\/p>\n
Other Irish hospitals are hoping to introduce the service, but accessing funding for such initiatives remains challenging, he said.<\/p>\n
\u201cWhen you have opt-out testing, you pick people up earlier. [The] 40 per cent of people who are being diagnosed too late \u2013 we need to tackle that group. Because that 40 per cent who are diagnosed too late, they are the ones who suffer with more infections, they have a weakened immune system, they are the ones who end up in hospital in intensive care. There is a significant cost to the patient and individuals\u2019 health, as well as an economic cost in terms of care. If we diagnose people earlier, everyone wins,\u201d said Dr \u00d3 Broin.<\/p>\n
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Pictured L-to-R: Dr Cathal \u00d3 Broin; Prof Yvonne Gilleece, Honorary Clinical Professor and Consultant in HIV Medicine and Sexual Health, Brighton and Sussex Medical School and University Hospitals Sussex NHS Foundation Trust, UK; and Mr Stephen O\u2019Hare, Executive Director, HIV Ireland, at the launch of the Towards a National Action Plan for HIV in Ireland report<\/p>\n
Injectable Therapies<\/p>\n
Injectable therapies are an important part of HIV prevention and treatment and are likely to have an even greater role in the future.<\/p>\n
\u201cThere is a lot of research into HIV cures, but where we\u2019re ultimately headed is towards injectable therapies that control the virus effectively, so patients do not have to take tablets. That\u2019s the most realistic thing we\u2019re going to see in the next five years,\u201d Dr \u00d3 Broin stated.<\/p>\n
Rekambys injection (rilpivirine) and Vocabria injection (cabotegravir) are used together as a complete long-acting injectable antiretroviral therapy for HIV. The therapy, which is available in Ireland, is licensed for two dosing regimens \u2013 once-monthly or once every two months. Where patients are suitable for this therapy, it removes the need for daily oral antiretroviral therapy. However, new injectable therapies administered every six months are in development and will help to reduce the stigma around HIV, Dr \u00d3 Broin outlined.<\/p>\n
\u201cStigma is one of the greatest barriers to HIV testing. Patients carry stigma, healthcare staff carry stigma and it\u2019s in the general public. There is a lot of Irish data to show this. There have been some really great public health campaigns in Ireland on reducing HIV stigma, but I think we need to do more. We need to keep that message strong.\u201d<\/p>\n
There are also injectable therapies for the prevention of HIV, but these are unavailable in Ireland currently.<\/p>\n
It is clearly established that certain populations face particular barriers to adherence to daily oral PrEP. \u201c[For example] we see that with heterosexual women and the studies actually have highlighted that where women have a risk of HIV there is also a risk of other things like domestic violence. So perhaps a woman [in these circumstances] doesn\u2019t have the ability to take a tablet because their personal safety is at risk, some studies have highlighted that risk very clearly,\u201d Dr \u00d3 Broin stated.<\/p>\n
\u201cWe\u2019re a little bit ahead in [the area of HIV] prevention globally in Ireland, but we need to get these injectable therapies available for patients here, and there is no sign of that happening anytime soon.\u201d<\/p>\n
Global Concerns<\/p>\n
The US administration under President Donald Trump has made severe cuts to the President\u2019s Emergency Plan for AIDS Relief (PEPFAR) programme. The situation is of major concern to all those working in the area of HIV.<\/p>\n
PEPFAR has provided billions of dollars for HIV treatment and prevention since its establishment in 2003.<\/p>\n
The funding cuts will have a significant negative impact on progress made in reducing HIV transmissions, and will have a global impact, Dr \u00d3 Broin warned.<\/p>\n
\u201cThere was initially a pause and now there is going to be a steady reduction [of funding] to PEPFAR and South Africa has suffered hugely as a result of this funding reduction. UNAIDS has estimated there will be a significant rise in HIV infections, HIV deaths, and also orphaned children.<\/p>\n
\u201cHIV knows no borders. Infections know no borders. I think we need to be aware in Ireland that anything that happens in the world is also going to affect us. At a global level we need to have a political commitment to supporting people with HIV.\u201d<\/p>\n
Access to Care<\/p>\n
As efforts continue to reduce HIV transmission in Ireland, less traditional models of care must be utilised, Dr \u00d3 Broin stated.<\/p>\n
In Ireland, it is estimated 90 per cent of people living with HIV have a diagnosis. The vast majority are on treatment and have an undetectable viral load.<\/p>\n
\u201cSo they\u2019re doing really well,\u201d noted Dr \u00d3 Broin. \u201cIt\u2019s the last 10 per cent we\u2019re trying to find, the ones that are not controlled.\u201d<\/p>\n
\u201cWe have to think about the current model of hospital-delivered care and how that doesn\u2019t always meet the patient in the right place,\u201d he said.<\/p>\n
\u201cIf you\u2019re homeless, if you have mental health issues, if you have substance [misuse] issues, if you don\u2019t speak the language, if you have to travel four or five hours to your nearest clinic with your kids and no childcare, that\u2019s going to be a huge barrier. I think we need to be able to meet the patient where they are if we\u2019re to deliver on the commitment to eliminate HIV transmission.\u201d<\/p>\n
He would like to see a model that is adaptable to patient needs. It would involve close connections between the hospitals and the community, \u201cwhere if someone requires a nurse to see them in the community, we can offer that, where we can go out in the community and give someone an injection every two months, which controls their HIV\u2026.\u201d<\/p>\n
The system needs to be more creative to ensure access to diagnosis and care is provided for under-served populations, he emphasised.<\/p>\n","protected":false},"excerpt":{"rendered":"Dr Cathal \u00d3 Broin, Consultant in Infectious Diseases at St Vincent\u2019s University Hospital, Dublin, speaks to Niamh Cahill…\n","protected":false},"author":2,"featured_media":625538,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2],"tags":[61,60,43],"class_list":["post-625537","post","type-post","status-publish","format-standard","has-post-thumbnail","category-ireland","tag-ie","tag-ireland","tag-news"],"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/posts\/625537","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/comments?post=625537"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/posts\/625537\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/media\/625538"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/media?parent=625537"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/categories?post=625537"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/ie\/wp-json\/wp\/v2\/tags?post=625537"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}