Background: The COVID-19 pandemic has caused global disruptions to sexual and reproductive health (SRH) services, including HIV prevention, testing, and care. Yet such disruptions are not well understood among the 79.5 million forcibly displaced persons globally. This study examined access to SRH services during the COVID-19 pandemic among refugee youth in Kampala, Uganda.

Methods: This mixed-methods study involved qualitative in-depth interviews (March 2021) with refugee youth aged 16-24 years and key informant professionals supporting refugee health and well-being. This was followed by a cross-sectional survey (April 2021) on COVID-19 impacts, nested within a longitudinal cohort of urban refugee youth in Kampala, Uganda. Data on individual and community access to SRH services and reasons for not accessing services were collected. Qualitative data were coded, and thematic analysis was used to identify themes related to SRH access. Leveraging quantitative data, we report access to, and utilization of, SRH services.

Results: Qualitative participants included 24 refugee youth (50% men; 50% women; mean age: 20.7, standard deviation [SD]: 2.3), and 6 key informants. Disrupted access to SRH services was identified as a significant problem facing refugee youth; linked with unplanned pregnancies, ART non-adherence, and transactional sex. Among survey participants (n=346, 48.0% men, 50.3% women, mean age: 21.2, SD: 2.6), one-third (35.0%) reported reduced community access to SRH services. Individuals reported not accessing contraception (94.5%), condoms (86.4%), HIV testing (81.2%), and pregnancy testing (94.8%). For SRH outcomes, 9.5% reported unplanned pregnancy and 8.7% engaged in transactional sex. Lack of transport, family poverty, and clinic closures were noted as reasons for reduced SRH access.

Conclusions: Among urban refugee youth, COVID-19 disrupted SRH service access and was linked with adverse outcomes. These results can be used to inform integrated HIV and SRH service delivery in humanitarian contexts to leave no one behind in accessing HIV prevention.

Objectives: To describe demographics, antiretroviral treatment during pregnancy, and vertical transmission rates in the Canadian perinatal HIV surveillance cohort of births to women living with HIV and to assess the effect of COVID-19 on access to optimal therapy and transmission.

Methods: 22 Canadian pediatric and HIV centres update data yearly in January. The results reported in this abstract reflect 2020 but will be updated to include 2021 results.

Results: The number of HIV exposed infants per year has increased over time, with 250 infants born in 2020; 32% came from Ontario, 24% from Quebec, 17% from Alberta, 14% from Saskatchewan, 7% from British Columbia and 4% from Manitoba; 60% were Black, 21% were Indigenous, and 13% were white. Overall, 63% of people acquired HIV heterosexually, 13% through injection drug use and 4.4% perinatally. The proportion and number of pregnant women sub-optimally treated in May-December 2020 was 7.7% (12/155) compared to 6.6% (86/1297) in the period from 2015-2019. The corresponding transmission rates were 3.2% (5/155) versus 1.3% (17/1297), respectively. Among those who had acquired HIV through IDU, the sub-optimal treatment rate was 26.1% during COVID-19, versus 13.6% in the pre-COVID-19 period.


Conclusions: The increase in perinatal transmission rate from 1.3% (2015-2019) to 3.2% during the pandemic is a clinically important increase; it is the highest reported rate in over 5 years. Women acquiring HIV through IDU may have been at highest risk of vertical transmission because of sub-optimal treatment. These data serve as a disturbing signal of problems in accessing care for addictions, prenatal care and HIV-specific care in the first waves of the pandemic. Additional attention to at-risk populations is needed as the pandemic continues to affect Canada.

Background: COVID-19 pandemic public health restrictions, imposed March 2020 in Ontario, impacted accessibility to HIV testing. We describe HIV testing and first-time HIV diagnoses in Ontario in 2020 relative to 2019.
Methods: Ontario’s HIV surveillance is laboratory-based. Demographic information is collected on requisition forms and follow-up with clinicians for positive test results. Diagnoses reported are those learning their status for the first-time, as assessed by linkage with prior positive diagnostic or viral load, or no report of prior positive test.
Results: HIV tests decreased by 28.5% among males in 2020 from 2019 and by 23.3% among females. The HIV test positivity rate increased among males from 0.154% to 0.169%, and decreased among females from 0.051% to 0.042%. The number of males diagnosed decreased by 21.4% from 514 in 2019 to 404 in 2020; the number of females decreased by 37.1% from 167 to 105. The proportions diagnoses attributed to each of Ontario’s five mutually inclusive priority populations were consistent with 5-year (2015-2019) trends: 61.8% gay, bisexual, and other men who have sex with men; 24.6% African, Caribbean, and Black people; 11.0% people who use injection drugs; 5.2% Indigenous Peoples; and 20.6% were Women.
Conclusions: HIV diagnoses decreased in Ontario in 2020, likely as a function: (1) missed HIV diagnoses due to reduced access to HIV testing; (2) a true decrease in HIV transmission facilitated by COVID-19 restrictions and HIV PrEP uptake; and (3) decreased numbers of misclassified diagnoses. Each year, some cases with a previous HIV diagnosis are misclassified as a first-time HIV diagnoses due to unreported test history information. COVID-19 restrictions affected the number of people previously diagnosed with HIV migrating to Ontario, and their contribution of misattributed diagnoses. The unchanged distribution of diagnoses across priority populations suggests there was no/little disproportionate impact from COVID-19 on access to testing.

Background: GBM uniquely face concurrent pandemics, HIV and COVID-19, and it is unknown to what extent they are impacted by SARS-CoV-2 infection. We provide a descriptive profile and estimates of COVID-19 infection among GBM living in Montreal, Toronto, and Vancouver.

Methods: From 16-Sep-2020 to 19-May-2021, we conducted a cross-sectional SARS-CoV-2 seroprevalence study in an ongoing closed cohort study (Engage). SARS-CoV-2 antibody seropositivity due to infection was detected using a bespoke enzyme-linked immunoassay and was coupled with a self-administered questionnaire. City-specific crude and RDS-II adjusted SARS-CoV-2 seroprevalence estimates as well as unadjusted descriptive analyses of three-city-combined data are reported.

Results: Data from 1,063 participants were included in analyses. RDS-adjusted seroprevalence in Montreal, Toronto, and Vancouver was 4.9(95%CI: 1.9-8.0), 3.1(0.5-5.7), and 4.7(0-12.2), respectively. COVID-19 seroprevalence among those living with HIV was 7.9%. Additionally, COVID-19 seroprevalence was higher in participants who belonged to the age group 30-44, had annual income of <30K or >60K, or reported potential COVID-19 exposure such as employment as an essential worker or using online social networking/dating apps to hook up with men on a weekly/daily basis (Table 1).

Conclusion: As of the end of May 2021, COVID-19 infection estimates among GBM in Montreal, Toronto and Vancouver were low and roughly comparable across the three cities. Occurrence of COVID-19 among Canadian GBM appears to vary not only by known potential COVID-19 exposures, but also by HIV status. This may have important health implications for GBM living with HIV. Further work is needed to explore the extent of these differences.

Background: People living with HIV may experience a higher risk of severe COVID-19 outcomes because of their immune status. Our aim was to describe SARS-CoV-2 infection and COVID-19 vaccine uptake among people living with HIV.
Methods: We analysed data from the OCS, a cohort of people receiving HIV care at 15 clinics across Ontario. OCS data are collected from clinical chart abstraction, linkage with the Public Health Ontario Laboratory database, and annual interviewer-administered questionnaires. Since May 2020, a module was added to the questionnaire to assess the impacts of the COVID-19 pandemic. Questionnaires administered between May 2020 and October 2021 were included in the current analyses, with the most recent questionnaire for participants who completed two or more questionnaires.

Results:
3,186 participants completed the COVID-19 module of whom 36% (1,157; median age: 49; 869 men; 189 women) reported testing for SARS-CoV-2. Among those tested, 94 (8%) reported testing positive for SARS-CoV-2. Test positivity was higher among women/transwomen compared to men (16% vs. 6%) and Black and Latin American participants compared to White participants (16.1% Black, 17.9% Latin American, 4.2% White). Among 1,876 participants (median age: 55) interviewed in 2021, an increasing proportion reported having received 1+ doses of the COVID-19 vaccine, from 0.7% in February 2021 to 84.3% in October 2021 (Figure 1).

Conclusions:
Similar to the general population of Ontario, racial minorities living with HIV shoulder a disproportionate burden of COVID-19 infection. Our results also indicate a higher vaccine uptake compared to the general population of Ontario.

Background: The intersection of the COVID19 and HIV pandemics has presented new but familiar challenges. While data on COVID19 vaccination in people living with HIV (PWLH) are only now beginning to emerge, the recommendation was made for all eligible populations (including PLWH, who are at higher risk of severe disease) to get vaccinated. However, historical distrust and fear of exploitation among racialized people has limited vaccine uptake despite their higher COVID19 burden.

Description: The AIDS Committee of Ottawa (ACO) partnered with Ottawa Public Health and Bruyère Family Medicine Clinic to provide a low-barrier COVID19 vaccination clinic for PLWH/people affected by HIV. Information sessions on COVID19 including vaccine safety and COVID19 burden among PLWH were held in partnership with Canadian AIDS Treatment Information Exchange to answer questions and build confidence. A first-dose clinic was held on 22-23/5/2021, with 438 people vaccinated; a second-dose clinic was held on 10-11/7/2021, with 238 people vaccinated. Government-issued identification was not required for vaccination. A survey of clients attending the second clinic was conducted.

Lessons learned: 236/238 (99%) of clients responded. 71% identified as racialized, with the largest group identifying as Black (49%). Most were <40 years (28% 30-39; 29% 18-29; 9% 12-17), with 51% male, 43% female, and 5% transgender/non-binary/gender non-conforming/two-spirited. Most were Canadian citizens (78%), with 14% permanent residents, 3% temporary residents, 3% refugees. Respondents noted convenient location (97%), ease of booking appointment (96%), and culturally-safe care (99%) as ways the clinic had reduced barriers for them to get vaccinated.

Conclusions: This low-barrier, culturally-safe approach to providing COVID19 vaccine to PLWH is an excellent example of how to reach racialized/marginalized populations to help address the COVID19 pandemic. Community-based organizations represent trusted allies that can address vaccine hesitancy and lack of trust in partnership with public health services to deliver necessary care to these populations.

Background:
Despite access to effective antiretroviral therapy (ART), people living with HIV (PLWH) continue to experience an elevated risk of premature mortality. We sought to characterize sociodemographic factors associated with mortality among PLWH.

Methods:
Between January 2016-September 2018, we used purposive sampling to enrol PLWH aged ≥19 in British Columbia (BC) into the STOP HIV/AIDS Program Evaluation (SHAPE) study. Participants completed a baseline survey which included questions on socio-demographic characteristics, quality-of-life, co-morbidities, and social support (MOS-SSS scale), and were followed until September 2021. Deaths and causes of death were identified through Vital Statistics linkages with the BC HIV Drug Treatment Program. We conducted bivariate analyses (Chi-squared/Wilcoxon rank sum tests) examining all-cause mortality in SHAPE and conducted a survival analysis employing a multivariable Cox proportional hazards model.

Results:
As of September 2021, 71(11.0%) of 644 participants had died. The majority were aged 40-59 (n=48,67.6%) and male (n=57,80.3%). The most common specified cause of death was overdose (n=12,16.9% of deaths), followed by non-AIDS related cancers (n=10,14.1%). A higher proportion of individuals who died had a history of incarceration (52.1% vs. 33.3%;p=0.002), recent homelessness (28.2% vs. 12.6%;p<0.001), and recent injection drug use (32.4% vs. 19.0%;p=0.009), compared to those alive at the end of follow-up. In the survival analysis, older age (adjusted hazard ratio [aHR]:1.37 per 10 year increase, 95%CI:1.07-1.77) and history of Hepatitis C co-infection (aHR:2.60, 95%CI:1.61-4.19) were associated with increased hazard of death, while higher quality of life (aHR:0.77 per 0.1 unit increase, 95%CI:0.64-0.94) and higher social support (aHR:0.89 per 10 unit increase, 95%CI:0.82-0.98) were protective.

Conclusion:
Those with higher quality of life and higher social support had a lower risk of death whereas older individuals and those with Hepatitis C ever had an increased risk. Our findings highlight how socio-structural inequities continue to impact the longevity of PLWH despite universal ART.

Introduction: A large group of people is aging with HIV and face age-related conditions such as frailty. Frailty is a multifactorial syndrome with causes originating from morbidities, genetics, lifestyle, and environment. Consequently, frailty manifests on physiological, physical, emotional, cognitive, and social dimensions of health. The interconnectedness between frailty constructs is of interest. Therefore, the objective of this study is to estimate the structure and relationships between and among physical, emotional, cognitive, and social frailty subdomains and their relationship with personal and HIV-related factors in people living with HIV.

Methods: First and second visit data from the Positive Brain Health Now Study (n=856) was used. The structural model included four non-hierarchical frailty subdomains: physical, emotional, cognitive, and social. Items covering areas that were too similar to each other’s were excluded. All scales were standardized for ranging from 0 to 100 and for high scores to indicate better outcomes. Data from the second visit was used to estimate the internal validity of the model.

Results: A total of 514 persons’ data (female=13.4%) from the first visit with complete data were analyzed. The mean age was 52.3 (8.1). The hypothesized 4-factor model showed adequate model fit. Correlations among frailty subdomains ranged from 0.40 to 0.82. Sex, nadir CD4-count, and diagnosis before 1997 didn't predict any frailty subdomains. On the other hand, age (β range: 0.10-0.24), number of symptoms (β range: -0.37 to -0.59), and measured cognition (β range: 0.09 to 0.24) directly predicted all frailty subdomains. Current CD4 predicted only social (β=0.09) and CRP predicted only cognitive frailty (β=-0.15). The model remained the same using the second visit data.

Conclusion: This is the first time that a multidimensional model of frailty is tested in HIV. Measures used here are connected to evidence-based interventions that could improve the lives of people living with frailty.