Although HIV testing is essential for early detection and treatment of the virus, there are very few studies in Canada that explore the factors associated with the uptake of HIV testing at the national level. Using the 2015-16 Canadian Community Health Survey and applying logistic regression analysis, we examine the associations between HIV testing and factors identified by the Andersen’s behavioural model of healthcare utilization. We find that a range of predisposing, enabling, and need factors are significantly associated with HIV testing. For example, compared to the oldest respondents (i.e., 55-64), their younger counterparts (i.e., 45-54, 35-44, and 25-34) are more likely to have been tested for HIV. Furthermore, formerly (OR=2.02, p<0.001) and never married (OR=1.67, p<0.001) respondents are more likely to have been tested for HIV than currently married ones. Also, women are more likely to have been tested for HIV than men (OR=1.13, p<0.001). Compared to those in Atlantic Canada, respondents in Quebec (OR=1.96, p<0.001), Ontario (OR=1.44, p<0.001), Prairies (OR=1.37, p<0.001), British Columbia (OR=1.99, p<0.001), and territories (OR=2.22, p<0.001) are all more likely to have been tested for HIV. We also observe that respondents within higher income categories (i.e., $80,000 or more, $60,000-$79,999, $40,000-$59,999, $20,000-39,999) are all less likely to have been tested for HIV than those within the lowest category (i.e., less than $20,000). Finally, respondents who did not use condom during last sexual intercourse are more likely to have been tested for HIV than those who did (OR=1.42, p<0.001). Based on these findings, we provide several important suggestions for policymakers and future research.

Research increasingly recognizes the role of protective factors such as individual and collective resilience in minimising people’s predisposition to adverse health outcomes including HIV infection. Consequently, HIV prevention programs are recommended to adopt a holistic approach that integrate individual and collective resilience as a strategy to empowering individuals and groups to reduce their HIV exposure. Despite evidence pointing to their heightened vulnerability to HIV infection, the role of individual and collective resilience on HIV testing among African, Caribbean, and Black (ACB) heterosexual men in Canada is understudied. Consequently, we sought to understand the role of ACB heterosexual men’s individual and collective resilience—measured by the Baruth Protective Factors Inventory—on their uptake of HIV testing. Our data are from the weSpeak study which included a cross-sectional survey of self-identified ACB heterosexual men in four Ontario cities, namely Ottawa, Toronto, London, and Windsor. Guided by Andersen’s behavioural model of health care utilization, we applied logistic regression to cross-sectional data and found that structural and personal protective factors are positively associated with HIV testing after accounting for a range of control variables (OR=1.03, p<0.01). This finding suggests that ACB men with higher levels of individual and collective resilience are more likely to have ever been tested for HIV than those with lower levels of resilience. Based on this observation, we provide several suggestions for policymakers and future research. Particularly, it is essential for policymakers to design intervention programs that recognize and promote individual and collective resilience as a critical psychosocial resource that is useful for increasing the uptake of HIV testing among ACB men in the context of Ontario and Canada.

As the world locked down in March 2020, public health authorities (PHAs) offered little to no guidance for sexual encounters to reduce the risk of COVID transmission. Sexual and gender minorities—already at risk for isolation and increased health disparities—were further marginalized. Sex is an affirming experience essential for mental, emotional, sexual, and physical well-being. The first guidance came from the City of New York’s public health department and offered a harm reduction approach and practical guidance for those seeking to have sex.

Queer men aren’t strangers to managing risk related to sex, and abstinence-only messaging is ineffective. The Gay Men’s Sexual Health Alliance (GMSH) translated technical information into relevant messaging for gay, bisexual, and queer men, including those who engage in Party & Play/chemsex. The challenge was to adapt existing messaging into formats, framing, and platforms that would reach the community.

Between April 2020 and August 2021, the GMSH released a suite of digital resources that provided clear guidance on sexual activity based on the most relevant and recent public health information.

In total, the GMSH produced:

– A detailed web resource: TheSexYouWant.ca/COVID-19
– Detailed infographics on COVID-19, sex, and HIV
– A community-based virtual discussion on Party & Play: Sex, Drugs, and COVID-19
– A curated discussion between film and TV producer Michael Yerxa and Toronto drag queen Tynomi Banks on sexual choices in the early days of the pandemic
– A direct-to-camera video with drag queen Brooke Lynn Heights with a message of encouragement for members of the LGBTQ2S+ community
– Three series of PSA videos with the queer burlesque troupe BoylesqueTO

The resources were shared on social media and run as digital ads across various sites, reaching over 300,000 people across Ontario. There remains little COVID-related guidance on sex from most PHAs in Canada.

Researchers who recruit gay, bisexual, and queer men as participants for their studies face an uphill battle. In addition to their core research work, they are expected to be good communicators, designers, and marketers. HIV researchers already know that the quality of source data can have major impacts on research findings, raising the pressure to recruit diverse and engaged participants. Unfortunately, many recruitment efforts fall short of today's standards for digital marketing and don’t capture the attention of the community. The Tri-Council ethics policy sets out that researchers must “clearly explain the nature and goals of the research, and other essential information, in a manner that best promotes understanding on the part of prospective participants.” Arguably, most recruitment falls short of this expectation, despite researchers’ best efforts. As a result, fewer potential participants are reached, and the recruitment process is ineffective.

To reach the right people, it’s time to retire the PDF recruitment poster and take advantage of the newer tools and platforms at our disposal.

The Gay Men’s Sexual Health Alliance (GMSH) regularly engages in community recruitment and supports researchers’ recruitment efforts. As a leader in digital communications in the HIV sector, the GMSH reaches hundreds of thousands of people across Ontario each year.

Drawing from this success (and the lessons learned along the way), the GMSH has developed a practical toolkit for participant recruitment. This session will present the toolkit and set out tangible guidance on recruiting participants: plain language tips and tricks, which platforms to use and when, how to set targets and measure success, and case studies from across the sector.

Background: This study examines the socio-demographic correlates of lifetime HIV testing and HIV positive serostatus across a large, diversified sample of LGBTQ2+ persons in Quebec.

Method: We ran an online survey from September 2019 to August 2020 in Quebec. Inclusion criteria were self-identifying as LGBTQ2+, understanding French or English, being ≥ 18 years old, and living in the province of Quebec. The analytical sample is composed of 3,282 LGBTQ2+ participants. Adjusted odd ratios (aOR) were estimated using Firth’s logistic regression to compare lifetime HIV testing and HIV positive serostatus across sociodemographic characteristics (gender, age, ethnicity, education, income, residential area).

Results: About 42% of the sample had never been tested for HIV. Lifetime HIV testing (58%) was lower among cisgender LGBQ+ women (aOR=0.18, 95%CI=0.15-0.22), trans women and transfeminine nonbinary persons (aOR=0.57, 95%CI: 0.38-0.83), as well as transmasculine nonbinary persons (aOR=0.26, 95%CI: 0.20-0.35) compared to cisgender GBQ+ men. It was also lower among those living in rural regions compared to those living in the greater Montreal region (aOR=0.72, 95%CI: 0.54-0.95). Lifetime HIV testing was more likely among participants born before 1991 (aOR from 2.06, 95%CI: 1.56-2.73 to 3.27, 95%CI=2.45-4.36) and among those with a university degree compared to lower education (aOR=1.88, 95%CI: 1.58-2.23). Income and BIPOC status were not associated with lifetime HIV testing. Overall HIV prevalence was 4.9% (95%CI: 4.0-6.1), with cisgender GBQ+ men (8.3%, 95%CI: 6.7-9.8) and trans women and transfeminine nonbinary participants (3.6%, 95%CI: 0.9-7.5) reporting the highest prevalence rates. HIV prevalence was also higher among those born before 1981 (aOR from 4.64, 95%CI: 1.70-12.66 to 8.84, 95%CI=3.48-22.47). Education, income, BIPOC status, and residential area were not associated with HIV positive serostatus.

Conclusion: These results highlight the importance of promoting adaptive HIV testing across multiple gender identities and modalities, as well as among younger generations and rural residential areas.

Background: HPV is an important HIV co-infection that can be prevented by vaccination. Publicly-funded HPV vaccination programs for GBM and/or those living with HIV aged ≤26 years were implemented in British Columbia (since 09/2015), Québec (01/2016), and Ontario (09/2016; GBM only) due to their high burden of HPV-associated disease. We measured 12-month changes in HPV vaccine uptake among community-recruited GBM cohorts in Vancouver, Toronto, and Montreal.

Methods: A total of 447 GBM living with HIV enrolled in the Engage Cohort Study from 02/2017-08/2019. One-year follow-up visits took place from 03/2018-01/2021 (delayed due to COVID-19 pandemic; median follow-up=12 months, interquartile range=12-13 months). We used univariable logistic regression to identify factors associated with incident vaccination (self-reported receipt of ≥1 dose during follow-up) among participants who were unvaccinated at baseline.

Results: 295 participants (79 Vancouver, 61 Toronto, 155 Montreal) completed ≥1 follow-up visit (66% retention). The median age at baseline was 52 years in Vancouver, 40 years in Toronto, and 51 years in Montreal. Vaccine uptake (≥1 dose) increased from 24.1% at baseline to 27.8% at follow-up in Vancouver, 39.3% to 44.3% in Toronto, and 6.5% to 10.3% in Montreal. Only 10 participants were aged ≤26 years (eligible for public programs); of whom, 70.0% were vaccinated at baseline, increasing to 80.0% at follow-up. Among 242 unvaccinated participants at baseline, incident vaccination by follow-up in each city was 5.0%, 8.1%, and 4.1%, respectively. Factors associated with increased incident vaccination included age ≤45 years (OR=3.99, 95%CI=1.16-13.61), having private insurance (OR=3.34, 95%CI=1.02-10.88), and being diagnosed with anogenital warts (OR=7.17, 95%CI=1.28-40.08).

Conclusions: Despite being at higher risk, less than half of GBM living with HIV were vaccinated against HPV in Canada’s three largest cities. Most were ineligible for publicly-funded programs. Findings suggest the need for expanded age eligibility or insurance coverage for HPV vaccines.

Background:
To better understand the potential impact of PrEP in Chinese MSM communities, we quantified an anticipated PrEP cascade in a community-based sample of Chinese MSM in Toronto.

Methods:
Using convenience sampling, we recruited adult Chinese cis-gender men via social media and service agency postings to an online survey during July 2019– December 2020 if they had anal sex with men (past 6 months) and self-identified as HIV-negative or status-unknown. Among respondents deemed suitable for PrEP based on Canadian guideline criteria, we constructed a three-step anticipated PrEP cascade by sequentially quantifying respondents’ PrEP awareness, acceptability and drug coverage. Additional questions addressed barriers and facilitators of PrEP access.

Results:
Of 266 participants, 41.0% were born in Canada, 36.1% in Mainland China, and 12.8% in Hong Kong. Most had an undergraduate degree or more (89.1%) and full-time employment (64.7%), but only 41.7% had a family doctor. One third (37.2%) were taking PrEP. Of those not on PrEP (n=167), 119 (71.2%) met PrEP eligibility criteria based on self-reporting condomless anal sex, plus prior syphilis (n=4), rectal gonorrhea/chlamydia (n=21), a sexual partner with detectable viral load (n=32), HIRI-MSM score >10 (n=115), and/or using PEP more than once (n=18). Among eligible non-users of PrEP, 77 (67.7%) were aware of PrEP, 93 (55.6%) were willing to use PrEP, and 89 (74.8%) had any drug coverage. The anticipated cascade suggested that only 46 (27.5%) of PrEP-eligible respondents could likely access PrEP. Barriers included discomfort discussing sexual health, lack of drug coverage, and PrEP-related stigma. Facilitators included PrEP access via community-based venues and decrease psychological concerns about getting HIV.

Conclusion:
Many Chinese MSM in Toronto could benefit from PrEP, but there are gaps in PrEP awareness, acceptability, and drug coverage. Culturally competent, community-driven strategies for overcoming barriers to PrEP are needed for this population.

Background: The COVID-19 pandemic is comparable to the HIV pandemic. It is an infection that presents with diverse functional problems amplified by other health conditions and aging, and disproportionately affects vulnerable populations, including people living with HIV (PLHIV). The multi-system challenges experienced by people living with Long Covid is also comparable to the episodic disability described by PLHIV. Rehabilitation is a fundamental health service that enables greater participation in education, employment, and community life. The HIV and rehabilitation leadership has provided a model for informing rehabilitation responses for other chronic conditions. Purpose: Nineteen researchers, scientists and activists from seven countries with years of experience working in the field of HIV, disability, and rehabilitation collaborated to present key lessons outlining how HIV rehabilitation can inform COVID-19 rehabilitation. Lessons learnt: Six key lessons emerged from this collaboration, namely: 1) Anticipate disability during and after acute management of COVID-19 and recognize its potentially episodic nature; 2) Understand that the disability dimension “Uncertainty or Worry About the Future” may play a role in COVID-19–related disability; 3) Develop disability- and rehabilitation-focused responses to COVID-19, as in the 2016 Political Declaration of HIV and AIDS; 4) Prepare for the long-term impact of COVID-19 on key and vulnerable populations to help prevent inequality, stigma, and unintended social consequences, making every effort to leave no one behind; 5) Build on existing research networks in HIV rehabilitation to provide foundations for developing the field of COVID-19 Rehabilitation; 6) Include and focus on people living with and affected by the infection in all responses to the pandemic. Conclusion: Rehabilitation is effective in managing the multi-system effects of communicable viral diseases, including both HIV and COVID-19. Lessons from HIV rehabilitation can expedite evidence-based community-engaged rehabilitation responses to COVID-19 that are designed for, and include the input of, vulnerable populations.

Background: Gay, bisexual, trans, and other men who have sex with men (GBTMSM) experience higher rates of adverse health outcomes (e.g., HIV, mental health concerns, and access to services) compared to heterosexual/cisgender counterparts. A large proportion of Canadian studies on GBTMSM communities rely on samples obtained from larger metropolitan regions, which do not reflect lived experiences of these communities across Canada's vast geography. AIDS service organizations (ASOs) serving these communities outside of metropolitan regions often rely on these studies despite them not being relevant to the populations/communities they serve. This research aims to characterize service delivery, region-specific nuances, and facilitators/barriers to implementing knowledge uptake for GBTMSM within ASO catchment areas in Southwestern Ontario.

Method: As part of a larger multi-phase project, this study involved exploring current and past approaches to GBTMSM health promotion and prevention programming within ASOs. This was done through semi-structured interviews (n=14) with leaders and GBTMSM sexual health workers within six ASOs in Southwestern Ontario. Transcribed interviews were analyzed using NVIVO software. A code report was generated, thematically capturing commonalities and differences across regions.

Results: Four larger global themes emerged: 1) Organizational and sector characteristics (e.g., funding; sector-specific issues; the evolution of the sector); 2) Data and informational availability and utility (e.g., region-specific availability of data; quality of data, including ability to explore data intersectionally); 3) Outreach and engagement with GBTMSM (e.g., connecting with local GBTMSM; COVID-19-related challenges; innovations in outreach); and 4) Sexual health and broader health of GBTMSM (e.g., stigma, discrimination, and violence; sexual education; COVID-19 and well-being; community connection and cohesion).

Conclusions: Findings have implications for local service delivery. Next steps include ongoing discussions with ASO representatives about themes; interviewing GBTMSM directly; collecting quantitative data; and using several data sources to holistically inform future service provision for GBTMSM in Southwestern Ontario.

Background: Data on SARS-CoV-2 vaccine immunogenicity in people living with HIV (PLWH) remains sparse. Stop the Spread Ottawa (SSO) is a 1000-member cohort study on SARS-CoV-2 immune response in participants at risk of exposure and/or severe disease. PLWH comprise an important subgroup.

Methods: Blood was collected from all participants at baseline for serum and PBMC isolation. Questionnaires are completed at baseline, 3 and 10 months post-baseline. Participants submit monthly dried blood spots for serology surveillance and saliva/sputum samples for viral RNA testing. Approximately 500 participants with history of SARS-Cov-2 infection and/or vaccination also attend monthly blood draws. 300 participants will extend participation by an additional 24 months. Participant recruitment began in October 2020. Results are described up to December 2021.

Results: As of December 2021, SSO has recruited 1032 individuals. Participants living with HIV (n=31) have a median age of 60 (IQR=10.8, range 32-71) and 87.1% are male. Median length of years living with HIV is 15 (IQR=19, range 5-40). 100% are currently treated with antiretroviral medications and 96.8% (n=30) report a fully suppressed viral load. 12.9% (n=4) are current smokers, 9.7% (n=3) are overweight. The study team will present a descriptive analysis of the PLWH subgroup. Pending availability of post-vaccine SARS-CoV-2 serosurveillance results, signal-to-cut-off (S/CO) ratios and binding antibody units (BAU) will be compared between SSO PLWH and healthcare worker/control (n>400) subgroups.

Discussion: This longitudinal cohort study has enabled serial collection of specimens for SARS-CoV-2 testing from a diverse range of participants. The 24-month study extension will maximize opportunities to track SARS-CoV-2 immune and vaccine efficacy, and detect and characterize emerging variants among PLWH and other high priority subgroups.

Background: Timely HIV testing and initiation of antiretroviral therapy are major determinants in achieving optimal health for people living with HIV and preventing ongoing transmission. We examined self-reported history of HIV testing and use of prevention modalities among a population of people living with HIV (PLWH) in Ontario to identify missed opportunities for prevention and diagnosis.
Methods: Results are from analysis of the 2020 annual questionnaire of the Ontario HIV Treatment Network (OHTN) Cohort Study (OCS), a longstanding prospective biobehavioural (clinical and questionnaire data) longitudinal study of >8000 PLWH across 15 clinical sites in Ontario.
Results: Description of the sample and history of HIV test prior to HIV diagnosis are shown in table 1. 42.7% (n=173/405) of participants reported experiencing symptoms at diagnosis indicative most likely of chronic HIV infection. Of the 86 participants who completed our baseline survey in 2020, 9.3% (n=8) were diagnosed through anonymous testing. Post-exposure prophylaxis (PEP) was first available in Ontario in 2006; 9 of the 595 participants (1.5%) diagnosed in Ontario after 2005 had used PEP prior to their HIV diagnosis. Pre-exposure prophylaxis (PrEP) was approved in Ontario in 2016; fewer than 5 of the 148 participants diagnosed in Ontario after 2015 had used pre-exposure prophylaxis (PrEP) prior to their HIV diagnosis.
Conclusions: Results suggest differential uptake of HIV testing, and potential testing barriers. Biomedical prevention modalities are in use in Ontario and small counts of OCS participants are reporting having used them, possibly indicative of successful retention of PrEP users.

Introduction:
Disparities across the HCV cascade of care for people who use drugs (PWUD) highlight the necessity of patient-centered approaches to engage under-served clients. We provide preliminary results from an HCV testing and linkage to care intervention nested within a supervised consumption site (SCS) in Vancouver, BC.

Methods:
The Hep C Connect study was launched in October 2021 to monitor progress across the HCV cascade of care amongst a prospective cohort of SCS clients with access to a pilot nurse-led HCV testing and linkage to care intervention. SCS clients who provide informed consent are offered an on-site, point-of-care HCV test. A survey is administered at once baseline and once at 3-6 months follow-up. Survey data collection includes demographic information, drug use history, recent health care utilization, and history of HCV testing and treatment. Standard of care (HCV RNA test and treatment) is available to participants who have a reactive HCV antibody test.

Results:
As of November, 2021, 55 participants have been surveyed of whom 28 (50.9%) had a reactive HCV test. Of the 55 participants, 26 (47.2 %) were aged 35-49 years, 15 (27.2%) identified as cisgender women, 17 (30.9%) identified as Indigenous, 45 (81.8%) reported ever being incarcerated, and 34 (61.8%) reported homelessness in the previous 3 months. Nine participants (16.3%) had no existing connection to primary care and 32 (58.1%) indicated that their most recent or current healthcare provider has not discussed HCV with them in the previous 5 years; 13 (23%) reported never being tested for HCV or were unable to recall ever being tested.

Conclusion:
Preliminary data suggest that our intervention is reaching under-served clients. Our evaluation will assess the efficacy of co-locating HCV testing and linkage to care within a service for PWUD in addressing treatment disparities and reaching patients at high risk of disengagement.

Background: Most existing vaccines require higher or additional doses or adjuvants to provide similar protection for people living with HIV (PLWH) compared to HIV-uninfected individuals. Additional research is necessary to inform COVID-19 vaccine use in PLWH.
Methods: This multi-centred observational Canadian cohort study will enroll 400 PLWH aged >16 years from Montreal, Ottawa, Toronto and Vancouver. Subpopulations of PLWH of interest will include: 1) >55 years of age 2) CD4 counts <350 cells/mm 3) multimorbidity (>2 comorbidities) and 4) “stable” or “reference” PLWH (CD4 T cells >350 cells/mm3, suppressed viral load for > 6 months and <1 comorbidity). Data for 1000 HIV-negative controls will be obtained via a parallel cohort study, (Stop the Spread Ottawa (SSO), using similar time points and methods. Participants receiving >1 COVID-19 vaccine were scheduled to attend 5 visits: pre-vaccination; 1 month following the first vaccine dose; and at 3, 6 and 12 months following the second vaccine dose. With the advent of the booster vaccine anticipated to be delivered to the majority of participant at 6-12 months post second vaccination, the protocol was amended to include visits at 1, 6 and 12 months post booster. The primary endpoints will be the percentage of PLWH with COVID-19-specific antibodies at 6 months following the second vaccine dose and at 6 months post-booster. Humoral and cell-mediated immune responses, and the interplay between T cell phenotypes and inflammatory markers, will be described.

Analysis:
Regression techniques will be used to compare COVID-19-specific immune responses to determine whether there are differences between the “unstable” (CD4<350) PLWH group, the stable PLWH cohort and the HIV-negative controls, adjusting for factors believed to be associated with immune response. Unadjusted analyses will reveal whether there are differences driving factors associated with group membership. Preliminary results will be presented.

Background: Gay, bisexual, and other men who have sex with men (GBM) are disproportionately affected by sexually transmitted and blood-borne infections (STBBIs). As the potential for online STBBI testing grows, understanding factors associated with acceptability of online testing will be useful in expanding access. We examined factors that may be associated with acceptability of online STBBI testing among GBM living in Ontario.

Methods: Sex Now 2019 was an online national bilingual cross-sectional survey of GBM aged ≥15 conducted from November 4, 2019 until February 6, 2020. We asked participants in Ontario if they were likely or unlikely to use an online STBBI testing service. Prevalence ratios (PR) and 95% confidence intervals (95% CI) for univariate and multivariable analysis were calculated using modified Poisson regression with robust variances due to convergence issues when using log-binomial regression. The multivariable model was built using the iterative Hosmer-Lemeshow-Sturdivant approach.

Results: Among 1355 respondents, 80.9% reported being likely to use online STBBI testing. Older age (PR: 0.993; 95% CI: 0.991 – 0.996), increased sexual behaviours associated with higher risk of STBBI infection (PR: 1.034; 95% CI: 1.020 – 1.049), being born outside of Canada (PR: 1.099; 95% CI: 1.026 – 1.177), and not completing high school (PR: 0.798; 95% CI: 0.648 – 0.984) remained statistically significant in the final model. Being on pre-exposure prophylaxis for HIV (PrEP) became statistically significant in the final model (PR: 0.893; 95% CI: 0.827 – 0.965).

Conclusion: Likelihood of using online STBBI testing was high among GBM in Ontario, particularly among those: younger in age, not born in Canada, with higher levels of education, and who are currently using PrEP. Implementation in Ontario may expand access to testing for these subpopulations.

Background: WHO targets to eliminate HCV globally require that 50% of people living with HCV are treated by 2025 and 80% by 2030. People with HIV-HCV coinfection are an important population for HCV micro-elimination -they experience faster liver disease progression and most are already linked to care.

Methods: We assessed progress towards HCV elimination and examined characteristics of patients who remain uncured in the CCC, a multi-site open prospective cohort following HIV-HCV co-infected participants since 2003 from 18 sites in 6 provinces. For the population overall, by province, and priority population, we calculated annual proportions[95% CI] with negative HCV RNA, and cure rates stratified by treatment periods (interferon-based (IFN):2003-2011; early direct acting antivirals (DAA):2012-2014; late DAA:2015-2020).

Results: The annual proportion with negative HCV RNA increased in the late DAA period to 81[78,83]% overall (Fig.1A), across provinces (highest in QC:89[84,92]%, lowest in SK:66[57,74]%) and priority populations (highest among gay bisexual men who have sex with men:90[85,94]%, lowest among persons who actively inject drugs:64[58,70]%). Cure rates increased dramatically in the late DAA period (Fig.1B). Among participants who remain uncured, 49% were LTFU, of whom 81% had never initiated treatment.

Discussion: There has been a marked increase in cure rates across priority populations and geographic regions since the availability of DAAs in Canada suggesting that we may reach elimination targets among HIV-HCV co-infected persons linked to care. However, many are lost to follow-up prior to initiating treatment. Interventions to retain patients in care and ensure prompt treatment are needed to sustain elimination efforts.

Background: Street-connected young people (SCY) experience structural and social barriers to engaging in the HIV prevention-care continuum. We sought to elicit recommendations for interventions that may improve SCY’s engagement along the HIV prevention-care continuum from healthcare providers, policymakers, community members, and SCY in Kenya.

Methods: This qualitative study was conducted across 5 counties in western Kenya
between May 2017 and September 2018 to explore and describe the public perceptions of, and proposed and existing responses to, the phenomenon of SCY. We conducted 41 in-depth interviews (IDIs) and 7 focus group discussions (FGDs) with 100 participants, of which 43 were SCY. In total 48 participants were women and 52 men. This secondary analysis focuses on a subset of data interviews that investigated SCY’s healthcare needs.

Findings: Our analysis resulted in four major themes corresponding to stages in the HIV prevention-care continuum for key populations. We identified the need for an array of strategies to engage SCY in HIV prevention and testing services that are patient-centered and responsive to the diversity of their circumstances. The use of PrEP was a biomedical prevention strategy that SCY and healthcare providers alike stressed the need to raise awareness around and access to for SCY. Several healthcare providers suggested peer-based approaches for engaging SCY throughout the continuum. Though, SCY heavily debated the appropriateness of using peer-based methods. Structural interventions, such as the provision of food and housing, were suggested as strategies to improve ART adherence.

Conclusion: This study identified contextually relevant interventions that should be adapted and piloted for use with SCY to determine their feasibility and effectiveness for improving SCY’s engagement in the HIV prevention-care continuum. Notably, this work emphasises the importance of addressing structural factors that increase SCY’s risk of acquiring HIV and impede SCY’s ability to engage and re-engage in care.

Background
Given changes in guidelines, practice, and other factors related to HIV care, understanding patterns in healthcare use after an HIV+ test result, a crucial period of care, is important. We examine trends in days until first HIV-related care events after an HIV+ test result.

Methods
The Seek and Treat for Optimal Prevention of HIV/AIDS (STOP) Study includes population-based linkages of clinical/treatment data from the BC Centre for Excellence in HIV/AIDS, HIV testing data from the BC Centre for Disease Control, and healthcare records from the BC Ministry of Health. We included persons residing in BC ≥1 year before and after their HIV+ test (n=3,698). We visualized longitudinal trends, overall and stratified by risk group, in median days until first: HIV-related physician encounter, antiretroviral (ARV) prescription dispensing, and undetectable plasma viral load (uPVL; using period-specific thresholds).

Results
For the period following an HIV+ test: median days (interquartile range, IQR) until first HIV-related physician encounter decreased steadily from 183 (IQR=1,454) in the 1997/98 fiscal year to 13 (IQR=27) in 2015/16. Median days until first ARV prescription dispensing increased initially from 247.5 (IQR=866) in 1997/98 up to 1204.5 (IQR=1866.5) in 2001/02, before steadily declining thereafter to 35 (IQR=41) in 2015/16; this is expected given changes in treatment guidelines/practices. Similar patterns were observed for uPVL. All trends were generally comparable across risk groups (Figure 1).

Conclusion
Descriptive analyses of population-based linked datasets allowed us to further characterize HIV care trajectories among people who recently tested positive for HIV across various treatment guideline eras.

Background: There are concerns that people living with HIV may experience more adverse impacts from circulating SARS-CoV-2 and pandemic restrictions on health care. Here, we describe the design of the CHESS Study that will assess the burden of COVID-19 among people living with HIV in Ontario.
Aims: 1) to estimate SARS-CoV-2 sero-prevalence among people living with HIV; and 2) using administrative health data linkages, (i) to measure rates of and identify risk factors for COVID-19 testing, diagnosis and COVID-19-related outcomes compared to HIV-negative individuals; (ii) to estimate vaccine effectiveness against laboratory-confirmed infection with SARS-CoV-2; and (iii) to assess the impact of the pandemic on HIV care engagement.
Methods: Aim 1: We are conducting a sero-epidemiological investigation among active participants of the Ontario HIV Treatment Network Cohort Study (OCS), an established clinical cohort. Up to 1,000 participants will self-collect a one-time dried blood spot sample using at-home collection kits for SARS-CoV-2 serology as well as complete a brief COVID-19 questionnaire at the time of self-collection. Questions include: COVID-19 symptoms, testing, diagnosis, and vaccine history. Aim 2: The second aim will be addressed using provincial health administrative databases at ICES. All OCS participants have consented to linkage of their data at ICES. Analyses will be conducted using three cohorts: the linked OCS cohort; a validated, ICES-derived HIV cohort, representing all people living with HIV in Ontario who access health services; and a matched cohort of HIV-negative individuals. We will ascertain COVID-19-related outcomes (vaccine uptake, testing, hospitalization, mortality) and changes in health service utilization including HIV care engagement prior to and during the pandemic.
Implications: Results will provide reliable, efficient, and comprehensive information on the burden of COVID-19 among people living with HIV in Ontario. Findings will fill a knowledge gap in immunocompromised populations that can inform immunization and clinical guidelines.

Background: HIV drug resistance limits the effectiveness of antiretroviral therapy. Adequate surveillance of HIV drug resistance is challenged by heterogenous and inadequate data reporting. This study sought to develop a reporting checklist for studies of HIV drug resistance by achieving consensus among experts on what items should be reported in these studies.

Methods: We conducted a sequential explanatory mixed methods study among authors and users of studies of HIV drug resistance. The two-phase design included a cross-sectional electronic survey (quantitative phase) followed by a focus group discussion (qualitative phase). Survey participants rated the essentiality of various reporting items like study-level items, participant items, and HIV resistance testing items. Responses were analyzed using a validity ratio to determine the items that were retained for further evaluation in a focus group discussion to produce a finalized set of reporting items.

Results: Study invitations were sent via email to 160 HIV drug-resistance experts, of which 46 participants completed the electronic survey. Respondents were mostly male (63%) with at least one participant from each WHO region. The mean age of respondents was 48.1 (SD=10.5) years with an average of 17 years (SD=9.45) in their primary role. Of the 22 initial reporting items surveyed, fourteen were rated as essential and were evaluated further during focus group discussions. Nine participants participated in virtual focus groups to evaluate the list reporting items and additional items suggested by survey participants. From these discussions thirty-two additional items were added to in the final version of the reporting item checklist.

Conclusion: We present the complete reporting checklist aiming to improve the complete and uniform reporting of HIV drug resistance data. The results of this work will be refined and elaborated on by a writing committee of HIV drug resistance experts and external reviewers to develop finalized reporting guidelines.

Vaccine hesitancy is a normal phenomenon experienced by many that refers to a state of uncertainty towards vaccines despite their availability. With the rise of the COVID-19 pandemic, a multitude of vaccines have been developed with the collaboration of scientists around the world. Despite the reported high efficacy and marginal side effects of these vaccines, a huge number of individuals are still vaccine-hesitant. While a huge proportion of Canadians are fully vaccinated, several Canadians and other populations around the world have yet to be vaccinated which can sustain the community spread of the virus over a longer period and result in mutations that may promote the rise of new variants of concern. Resulting mental and physical health challenges have surfaced due to the pandemic and have been compounded by isolation, quarantine, and lockdown measures. We conceptualize a smartphone application that incorporates an approach utilized in various counselling approaches and healthcare settings called Motivational Interviewing (MI) which may be more beneficial in promoting vaccine uptake than traditional approaches. MI, a guiding and collaborative approach, can be used to tackle various COVID-19 related issues that sustain and promote vaccine hesitancy such as misinformation related to the pandemic and vaccine, concerns about the speed of the development of vaccines, and their long-term side effects, and needle phobia. The smartphone app will employ a hybrid deterministic/conversational artificial-intelligence-based approach that will mimic a realistic MI session as opposed to the frequently used chatbot approaches. This approach incorporates the ask-offer-ask and decisional balance frameworks which are employed during MI to promote change talk and guide one’s decision-making through personal autonomy. Due to the nature of the pandemic, a virtual approach through a smartphone app has the possibility of being deployed on a national and international level to address COVID-19 vaccine hesitancy.

Introduction: Some provinces and territories offer publicly-funded HPV vaccine to GBM and/or people living with HIV ≤26 years old. We explored how social and programmatic determinants of vaccine hesitancy intersect among GBM and influence stage of HPV vaccine uptake (Stages: 1=HPV vaccine unaware; 2=undecided/unwilling to get vaccinated; 3=willing; 4=vaccinated[1+ dose]).

Methods: Engage is a community-recruited study of GBM in Vancouver, Toronto, and Montreal. Latent class analyses were conducted by city to create subgroups of GBM 16-26 years old (N Vancouver=178; Toronto=123; Montreal=249) according to immigration, financial strain, ethnicity/race, sexual orientation non-disclosure, education, hepatitis A/B vaccination, and healthcare provider access. Next, by latent class, we predicted the probability of being in and association with vaccination stage using the Bolck, Croon, and Hagenaars approach.

Results: Three percent of men were living with HIV and 19% of HIV-negative men tried to access or were on pre-exposure prophylaxis (PrEP). Class membership was associated with vaccination stage in Vancouver (p=0.003) and Montreal (p=0.048) but not Toronto (p=0.642; data not shown). The ‘no vaccine hesitancy determinants’ classes had the highest probability of being vaccinated (Table 1). In Vancouver, the ‘ethnoracial/immigration/non-disclosure/low healthcare access’ class had the highest probability of being vaccine unaware. In Montreal, the ‘immigration/low hepatitis A or B vaccination’ and ‘non-disclosure/financial strain/low healthcare access/less education’ classes had the highest probabilities of being vaccine unaware and undecided/unwilling.

Conclusion: GBM unaware of or undecided/unwilling to receive HPV vaccine shared common but differing combinations of vaccine hesitancy determinants by city. Tailored interventions for subgroups across cities are needed.

Background: Identification of physical frailty is important to people with HIV as the occurrence could be 10 years earlier than the general population. Systematic identification of physical frailty is difficult as it requires regular testing of physical function and body composition. Self-rated health (SRH) is known predictor of disability and mortality. Therefore, we designed a study to estimate the extent to which physical frailty and frailty indicators are statistically predictive of self-rated health (SRH) in people living with HIV.

Methods: Baseline data from the Brain Health Now Study (n=856) was used. Fried’s 5 criteria for physical frailty (exhaustion, low physical activity, slow gait speed, hand weakness, and low BMI) were approximated by self-report items. People with ≥3/5 criteria were classified frail. SRH, measured on a 0 to 100 visual analog scale, was regressed on the 5 frailty indicators and on a binary classification frail or not. All models included age and sex.

Results: Overall, 14.7% of the sample were classified as physically frail and their SRH was, on average, 59.2 (SD: 18.3), lower than those classified as not frail (mean: 78.5; SD: 13.8; β: -18.7; SE: 1.4). People classified as frail would be categorized with poor to fair health. In contrast, those not frail would be categorized with good to very good health. The strength of the relationship between frailty and SRH were exhaustion and proxy grip strength (β: -8.1); proxy slow gait speed (β: -6.5); low physical activity (β: -4.9); and low body mass (β: -3.0; p=0.06).

Conclusion: While the global concept of “physical frailty” predicted SRH, no single criteria predominated. However, among those reporting fair/poor health (n=123), 46.3% were classified as frail and among those reporting good/better health (n=713) 9% were classified as frail. Thus, using a single item for SHR could prioritize people for in-depth frailty testing.

Introduction: Community-based exercise (CBE) is a rehabilitation strategy that promotes health amongst people living with HIV. During the COVID-19 pandemic, needs for novel modes of CBE delivery escalated. The Tele-coaching Exercise (TEx) study is a CBE intervention for adults living with HIV, delivered entirely online. We report on factors influencing the initial TEx implementation.

Methods: The TEx study aims to evaluate a 6-month intervention/6-month follow-up CBE program, including 13 biweekly personalized Zoom sessions with a YMCA trainer; 6 monthly online group self-management educational sessions; basic home exercise equipment; access to the YMCA exercise app; and a Fitbit to track physical activity (synced weekly). Fitness and questionnaire assessments are administered online, bimonthly. Two researchers documented and verified implementation factors articulated by participants and the implementation team (i.e., researchers and YMCA staff) during early implementation (from recruitment to equipment distribution, technology orientation, and baseline testing).

Results: Thirty-three Toronto-based participants enrolled in the study. Factors, as reported by participants, spanned four domains: Personal, including health (e.g. episodic illness, stress levels), disposition (e.g. commitment, e-literacy, communication preferences) and resources (e.g. time/cost constraints); Environmental including home (e.g. privacy, space) and technology (e.g. device access, device/app interoperability); Organizational including information dissemination (e.g. email updates, tech support) and logistics (e.g. baseline scheduling); and Societal, including COVID-19 impacts (e.g. public transit health risks impacting equipment pick-ups).

Accordingly, the implementation team experienced heightened needs to respond rapidly; sustain engagement, and provide a/synchronous training and support. Additional Organizational factors included a committed staff with skills spanning administration and logistics, participant engagement, technology training, instructional design, physical therapy, research ethics, and project management.

Conclusion: Numerous factors spanning multiple domains signals the complexities of this online CBE launch. Initial implementation required a dedicated, multi-skilled, multi-stakeholder team. Future work includes systematically mapping these and other factors to visualize and inform implementation scale-up.

Background: COVID-19 restrictions required that many healthcare services be offered virtually, alone or combined with in-person care. We assessed whether restrictions altered how women living with HIV (WLWH) accessed healthcare services compared with HIV-negative women.

Methods: We used survey data from the British Columbia CARMA-CHIWOS Collaboration (BCC3) study, which examines healthy aging among WLWH and controls. Participants were asked about their healthcare needs since COVID-19 restrictions began (03/2020), whether and how they accessed services (virtual and/or in-person), and difficulties accessing services. Virtual care satisfaction and preference were assessed. Wilcoxon rank sum or Fisher’s exact tests assessed differences by HIV status.

Results: Between January-November 2021, 65 WLWH and 59 controls (median age=51 [IQR:42-58] vs. 46 [IQR:28-55]; p=0.050) completed COVID-19 survey questions. WLWH reported being “much more/more likely” to consult a healthcare provider for medical concerns now compared to before COVID-19 restrictions (45% vs 15% controls; p=0.002). Most WLWH reported needing HIV medical care (95%), of whom 98% accessed care (40% in-person; 7% virtual; 52% combination), with 9.7% reporting access difficulties. Similarly, 92% of WLWH reported needing antiretrovirals, 98% accessed them, with 3.3% reporting difficulties. Notably, 23% (3/13) of all those needing sexual health services did not access them (25% WLWH vs. 20% controls; p=1.00). Difficulties accessing other needed health services were highest for routine check-ups (18%), grocery/food programs (18%), and cancer screening (13%), with no differences by HIV status (p>0.05). Participants accessing virtual care were largely satisfied (78%), with 44% preferring to receive virtual care alone or combined with in-person care (48% WLWH vs 41% controls;p=0.47).

Conclusions: WLWH were more likely than controls to need healthcare services during COVID-19 restrictions. While WLWH were able to access HIV-related care with few difficulties, women experienced challenges accessing other essential services. Satisfaction with virtual care offers insights into hybrid care delivery models for WLWH.

Background: GBT2Q are disproportionately affected by HIV, Hepatitis C Virus (HCV), and syphilis. COVID-19 has exacerbated barriers to in-person testing. We implemented and evaluated a mail-home dried blood spot (DBS) self-collection pilot intervention for HIV, HCV, and syphilis screening among GBT2Q aged 18+ in British Columbia.
Method: Participants were recruited via social media, socio-sexual websites/apps, and via community-based agencies from 10/2019-02/2020. Participants self-completed an online questionnaire on demographics, sexual behaviours, and sexual health. Participants could opt-in to learn more about the pilot. Consenting participants were mailed a DBS self-collection kit. DBS were screened at the Public Health Agency of Canada. Interested participants received their results with appropriate linkage to care. Bivariate logistic regression identified factors significantly (p<0.05) associated with: interest in the pilot (versus not), consent to participate (versus not), and return of DBS (versus not).
Results: Of 1442 participants, 52% (752/1442) wanted to learn about the pilot, 83% (622/752) consented to participate, 74% (458/622) received a self-collection kit, and 50% (229/458) returned their DBS. Shipping issues included incomplete mailing addresses (n=105) and inability to deliver by shipper (n=59). Laboratory screening could be completed on 97.3% of DBS. Overall, 91% had a good overall experience, 89% would use at-home DBS again, and 94% would recommend it to others. GBT2Q interested in the pilot were more likely to be people of colour, international students, transgender, financially strained, report transactional sex, use substances, and report more new sex partners. Few differences existed between those who consented (versus not) and returned DBS (versus not). However, GBT2Q who were bisexual, less out, less educated, and reported transactional sex were less likely to return DBS.
Conclusions: Mail-home DBS self-collection reached key sub-groups of GBT2Q, was highly acceptable, and DBS specimen quality was excellent. This promising intervention should be evaluated in other priority populations.

Introduction: Data on HIV prevalence among transgender (trans) people are not routinely collected nor reported in national estimates, including in Canada. This lack of data may contribute to gender-based inequities in the HIV response. Our study sought to examine the HIV prevalence and associated factors among trans women engaged in clinical care in the two largest Canadian cities.

Methods: Retrospective data were collected from clinic charts of trans women aged 16+ across six family medicine and/or HIV clinics in Montreal and Toronto, Canada from 2018-2019. The prevalence of HIV was reported overall and then compared across sociodemographic and clinical subgroups followed by univariate and multivariable logistic regression.

Results: Among 1,059 patients, 7.5% were living with HIV, 54.4% were HIV negative, and 38.1% were missing HIV status data. Multivariable logistic regression analyses comparing those with HIV to those with HIV negative/unknown HIV status showed higher odds of HIV for those aged 50+ vs. <30 years (aOR: 2.52, 95% CI: 1.10, 5.81), Black race vs. white (aOR: 4.35, 95% CI: 1.41, 13.43), landed immigrant/permanent resident status vs. Canadian citizen (aOR: 5.76, 95% CI: 1.54, 21.42), receiving social assistance vs. not (aOR: 4.63, 95% CI: 1.43, 14.93), ever used recreational drug vs. never (aOR: 3.95, 95% 1.19, 13.06), and a history of hepatitis B vs. no history (aOR: 4.44, 95% CI: 1.12, 16.75), among trans women.

Implications: The prevalence of HIV in this cohort of trans women in clinical care was high at 7.5%, while lower than expected based on global estimates. Over one-third of patients did not have a documented HIV status. These findings highlight socioeconomic, psychosocial, and medical realities among trans women that may be associated with HIV or represent differential realities of trans women post HIV-diagnosis. Findings inform future HIV prevention programs and support opportunities for trans women in Canada.

Background: A decision-making guide has been developed and validated to help organizations monitor access to their services for gbMSM, make informed decisions and establish an action plan accordingly. The approach is based on a framework by Lévesque, Harris and Russell (2013), characterizing access to services using 5 dimensions (approachability, acceptability, availability and accommodation, affordability and appropriateness) targeting changes on the intra and interorganizational level (service providers).

Methods: Between 2016 and 2021, a four-step process has led to the development and validation of a monitoring tool for service providers to assess access to their services for gbMSM: 1) an environmental scan using an ethnographic approach with more than 400 health services offered to gbMSM (screening, sexual health, PEP, PrEP, mental health, etc.), 2) 22 focus groups with gbMSM and service providers, 3) an online questionnaire filled out by key informants and community members using the Delphi method (n=66), and 4) support in the deployment of the tool in some pilot organizations.

Description of the intervention: The decision-making guide regarding access to health services is divided in 4 modules: 1) presentation of the context surrounding the production of the guide, and its application, 2) methodology for implementing an environmental scan to map the services in a given region and their accessibility for gbMSM, 3) a monitoring tool allowing service providers to self-assess access to their services on the five dimensions of access to services, using indicators and criteria, 4) knowledge transfer methods to present the results obtained and to promote the involvement of organizations in a knowledge application process.

Conclusion: The guide and monitoring tool allows organizations to review the strategies put in place to optimize access to their services and to ensure that they are approachable, acceptable, available and accommodating, affordable and appropriate for gbMSM.

Objectives
COVID-19 and efforts to contain its spread have significantly impacted access to healthcare both in Canada and globally, with such barriers especially felt by marginalized communities such as members of the GBT2Q community and racialized populations. The initiation and promotion of PrEP, an extremely safe and effective means of preventing HIV transmission, has been hampered by many such barriers. Our study thus sought to investigate barriers to PrEP access during the COVID-19 pandemic through an intersectional lens, examining how racialization, location, and age affected healthcare access during COVID-19.

Methods
Our data was drawn from the SexNow survey, an initiative of the Community-Based Research Centre collecting quantitative health data on GBT2Q Canadians distributed electronically during the COVID-19 pandemic. We then analyzed variables relating to PrEP access, racialization, age, and location.

Results
Our analysis showed a variety of barriers to PrEP access during the COVID-19 pandemic, especially in situations requiring in person access to healthcare such as regular bloodwork. Several of these barriers also showed significant interactions with location, age, and racialization.

Conclusion
Overall, our results point towards the need for initiatives aimed at improving healthcare access for racialized individuals and marginalized groups, which the current pandemic has only made more imperative. It also demonstrates the benefits of existing policies aimed at improving PrEP affordability and access, while highlighting areas in need of improvement.

Background: For over 35 years, researchers from the University of Manitoba have collaborated with the sex working (SW) community in Nairobi, Kenya to prevent and control HIV/STIs. This collaboration has led to the development of the peer engagement model where researchers and community leaders work together to disseminate key research findings to the wider community. During the COVID-19 pandemic, there has been global spread of misinformation resulting in mistrust and reduced compliance to public health measures. Unfortunately, this further elevates the risk of the SW community as many continue to provide in-person services to secure financial resources. To address this issue, an initiative called “COVID-Alerts” was developed to disseminate accurate information about COVID-19 via SMS to the SW community in Nairobi, Kenya.

Method: In August 2020, surveys were administered to all incoming clients at seven major health clinics in Nairobi, Kenya run by the Sex Work Outreach Programme (SWOP). The surveys were self-administered, available in both English and Swahili, with the following outcome measures: participants’ (1) access to communication devices, (2) preferred mode of communication, (3) and preference about receiving weekly updates about COVID-19.

Results: The survey was completed by 294 clients across all seven SWOP clinics. About 96% of survey respondents shared that they had access to a cell phone, of which 54.4% had access to smartphones, and 45.6% had non-smartphones. For mode of communication, majority of respondents preferred SMS/Text Message (75%), followed by WhatsApp (38%) and Facebook (13%). Finally, when asked if they would like to receive text updates about COVID-19, 83% of participants responded “yes”.

Conclusion: Given this acceptability, COVID-Alerts has since disseminated 15 text messages about COVID-19 to ~18,000 community members subscribed to the SWOP SMS broadcast system. This represents a way in which researchers can help provide accurate information to communities on the COVID-19 pandemic.

Context: Routine viral load testing is essential to attain the 90-90-90 targets aimed to eliminate HIV. Public health measures precipitated by the COVID-19 pandemic have posed a threat to the continuum of care for people living with HIV (PLWHIV). The goal of this project is to describe the evolution of the rate of viral load (VL) tests before and during the COVID-19 pandemic.

Design: A single-armed cohort study was conducted. Patients in an open cohort were followed through pre-pandemic (before) and per-pandemic (during) periods at the Clinique Médecine Urbaine du Quartier Latin (Montréal, Québec).

Methods: Observed incidence rates of VL tests were computed in the pre-pandemic and per-pandemic periods. 95% confidence intervals and covariate-adjusted linear regression were used to compare the incidence rates for these period.

Results: 1712 patients were included in the study. The mean rate of VL testing was 2.35 tests per person-years (PY) during the pre-pandemic period (CI : 2.30 – 2.42) and 1.35 tests per PY during the per-pandemic period (CI : 1.30 – 1.40); resulting in a rate difference of 1.04 tests per PY (CI: 0.93 – 1.08). The adjusted rate difference in linear regression was 0.96 tests per PY (CI: 0.83 – 1.01, p < 0.001). Men that have sex with men and patients with a detectable VL had higher rates of VL tests than their counterparts (p < 0.001). Intravenous drug users, patients following ART treatment and treatment-naïve patients had lower rates (p < 0.001). No significant differences were observed amongst sexes, age, duration of HIV and CD4 count at cohort entry.

Conclusions: A reduction of VL test rates supports existing qualitative literature suggesting the COVID-19 pandemic has hindered vital aspects of the HIV care continuum. Further measures need to be implemented to minimize the disruption of HIV care during public health crises.

Background
With a prevalence almost twice as high as the national average, South African townships are particularly impacted by the HIV epidemic. Yet, it remains unclear whether the risk of acquiring HIV differs across townships and what role contextual variables play in predisposing individuals to HIV infection. Our objective is to explore whether contextual factors impact the risk of HIV infection.

Methods
Using Bayesian logistic regression, we analysed secondary data from a quasi-randomised trial on HIV self-testing. Our trial (N = 3095) recruited participants from the townships of Cape Town: Klipfontein, Mitchell’s Plain and Western. Contextual factors included township of residence, type of dwelling, employment status and education/ income level. We obtained priors for age and sex from the extant literature. We accounted for the uncertainly due to missing data through multiple imputation. We calculated the posterior medians, 89% and 95% credible intervals of the adjusted odds ratios.

Results
After controlling for age, sex and other contextual variables, participants residing in Mitchell’s Plain and Western townships were at increased odds of HIV infection compared to participants from Klipfontein. Furthermore, those living in hostels or informal dwellings were at greater odds of acquiring HIV infection relative to those living in a house. Finally, individuals without post-secondary education had nearly twice the odds of having an HIV infection compared to those with a post-secondary education (Table).

Conclusions
Understanding how contextual factors impact risk of acquisition of HIV infection can help inform HIV prevention programs and optimize targeted screening initiatives for township populations.

Background: Urban refugee youth—understudied in HIV research—may live in social contexts characterized by structural drivers of HIV such as poverty and violence. In Uganda, which hosts more than 1.4 million refugees, nearly one-quarter are youth and over 90 thousand live within informal settlements in urban areas where social environments are shaped by economic insecurity, overcrowding, and elevated violence. This study examined social contextual factors associated with lifetime HIV testing among urban refugee youth in Kampala, Uganda.
Methods: We analyzed baseline data from a peer-recruited cohort of urban refugee youth aged 16-24 years living in Kampala’s informal settlements enrolled between February and March 2020. We conducted descriptive statistics and logistic regression to examine socio-demographic (e.g., age, gender), material (e.g., income insecurity, education, employment), relational (e.g., having children, social support), and symbolic contexts (e.g., HIV-related stigma, intimate partner violence) associated with lifetime HIV testing.
Results: A total of 450 urban refugees were included. The mean age was 20.4 years (standard deviation: 2.4 years), most participants lived in Uganda for 1-5 years (53.2%), and just over half the participants identified as cisgender men (50.7%), and half as cisgender women (48.7%), with a small proportion identifying as transgender (0.7%). Overall, less than half reported lifetime HIV testing (43.4%). In multivariable analyses, odds of lifetime HIV testing were higher among youth with secondary school education or higher (adjusted odds ratio [aOR]: 2.30, 95% confidence interval [CI]: 1.27-4.17), currently employed (aOR: 1.79, 95%CI: 1.03-3.10), and reporting physical intimate partner violence (aOR: 3.61, 95%CI: 1.43-9.10). Having children was marginally associated with HIV testing (aOR: 2.17, 95%CI: 0.98-4.81, p=0.052).
Conclusion: Findings demonstrate suboptimal HIV testing and the need to meaningfully engage urban refugee youth to create enabling environments for sexual health. Advancing this understanding of social contextual factors can inform targeted HIV testing initiatives.

Peer navigation is a promising model for increasing engagement with HIV health services. Here, we consider the early stages of implementing peer navigators (PN) to increase access to HIV services among street-involved youth (SIY) in Kenya and Canada. This includes how PNs integrate into host institution activities and the greater service sector network in preparation for supporting SIY. Challenges and facilitators were documented during monthly research meetings. Analysis followed the Consolidated Framework for Implementation Research (CFIR) to organize and guide interpretations of the challenges and facilitators to the PNP implementation process. Challenges were associated with: (1) recruiting PN; (2) COVID-19; (3) HIV criminalization in Canada; (4) hiring policies, (5) expectations of support; (6) limits in infrastructure resources; and (7) cross-site PN training. Facilitators were observed emerging from (1) COVID-19; (2) service provision networks and relationships; and (3) PN champions. Navigating these early implementation components has resulted in hiring and integrating PNs in five out of six project sites. Considering the early challenges and facilitators of implementation shapes scale-up activities by identifying further areas for adaptation and systemic barriers in institutional policies that must be addressed to optimize the use of peer-models when responding to the HIV prevention, treatment and testing needs of SIY.

INTRODUCTION: Women living with HIV are at higher risk for cervical cancer, such that timely screening is critical. Our aims were to examine beliefs towards cervical cancer screening according to the timing of the most recent Pap test among women living with HIV in Ontario.

METHODS: Between 2017-2020, the Ontario HIV Treatment Network Cohort Study, a multi-site clinical HIV cohort, administered a one-time questionnaire that assessed women’s beliefs about cervical cancer screening. Beliefs were designed based on the Theory of Planned Behaviour. Agreement with each statement was assessed using a 5-point scale; responses were collapsed to represent disagreement, neutral/don’t know and agreement with beliefs. Women were categorized as “up-to-date” on screening if they received a Pap test within the past 3 years vs “delayed/unscreened” if their last Pap test was more than 3 years ago, they were never screened, or the date was unknown.

RESULTS: Among the 512 women (mean age = 46 years), 56% were immigrants from a country where HIV is endemic and 87% reported an undetectable viral load. 85% of women reported being up-to-date on their cervical cancer screening. There were significant differences in beliefs by timeliness of screening (Table 1). Of note, 80.1% of up-to-date women agreed that their healthcare provider would recommend screening compared to 52.6% of those delayed/unscreened (p<0.01).

CONCLUSIONS: The findings highlight the importance of healthcare provider recommendation and availability of accessible and convenient screening options for women living with HIV, such as self-sampling for HPV testing as the primary screening test.

Introduction: Adolescent girls and young women (AGYW) are at dual risk of HIV infection and unintended pregnancy. This risk is compounded for refugee youth living in informal settlements, where poverty is prevalent and access to sexual and reproductive health (SRH) services is constrained. Being a young mother in informal settlements could aggravate existing conditions of resource scarcity and poor access to SRH services. To explore this, we analysed the factors associated with motherhood among refugee AGYW in Kampala, Uganda.

Methods: We conducted a cross-sectional study with refugee youth aged 16-24 in five informal settlements in Kampala. Peer research assistants administered questionnaires collecting information on sociodemographics (age, education), resource insecurity (employment, food insecurity), mental health (depression), and uptake of SRH services in the past three months. The SRH services examined were HIV counselling and testing; STI testing; and contraception (condoms, contraceptive pills, injections, intrauterine device, emergency pill, emergency patch). We used a generalised linear log binomial regression to test the factors associated with motherhood. Our multivariable model adjusted for age and generated adjusted prevalence ratios (aPR) with 95% confidence intervals (CI).

Results: We included AGYW (n=313) aged 16-24 with a median age of 19 (interquartile range: 17-22), 23% (n=76) of whom had children. Having children was associated with greater odds of reporting food insecurity (AOR: 1.96, 95% CI: 1.07-3.61), depressive symptoms (aPR: 2.03, 95% CI: 1.09–3.80), and contraception uptake (aPR: 2.37, 95% CI: 1.58–3.56) compared to not having children.

Conclusion: Having a child was associated with higher uptake of contraception and higher likelihood of depression and food insecurity. Mental health and resource insecurity interventions are required for AGYW with children in informal settlements. SRH services should be promoted to refugee AGYW without children to prevent HIV and unplanned pregnancy.

Background: HIV testing is a key to effective HIV prevention. Provincial STBBI screening guidelines generally recommend GBM who regularly engage in high-risk behaviours to undergo HIV testing every 3-6 months. We investigated factors associated with not being tested for HIV in the past six months(P6M) among high-risk, self-reported HIV-negative/unknown status GBM.

Methods: The Engage Study recruited sexually active cisgender and transgender men ≥16 years via respondent-driven sampling(RDS) in Montreal(M), Toronto(T) and Vancouver(V). High-risk for HIV was defined as: HIRI-MSM score ≥10 or having ≥6 male partners(P6M). Using literature, expert knowledge, and a health-services model of access, we selected factors related to not getting tested for HIV(P6M). After considering correlation and missingness, associated factors were identified using city-specific regression models and Akaike information criteria (AIC) for model selection. Factors across the cities were compared. Results are RDS-adjusted.

Results: Among 2008 HIV-negative/unknown participants (M:968,T:418,V:622), 1491 were defined as high-risk for HIV(RDS-adjusted%: M:62%,T:55%,V:71%). Of these (median age:31, range:16-80), 534 were not tested for HIV in P6M (M:43%,T:35%,V:36%). Not having a primary healthcare provider (HCP) had a significant or trending association with not testing in all cities (M:OR:2.2:95%CI:1.3-3.9, T:2.5:0.98-6.4, V:3.5:1.6-8.3). Furthermore, receiving sexual health information from a healthcare professional in P6M was associated with testing in all cities (M:OR:0.13:95%CI:0.1-0.22, T:0.10:0.03-0.26, V:0.06:0.02-0.12). Not identifying as gay was associated with not testing in Toronto (OR:3.3:95%CI:1.1-10) and Vancouver (OR:4.5:95%CI:1.5-13.7) but was associated with testing in Montreal (OR:0.52:95%CI:0.27-0.99). Not being out to HCP was associated with not testing in Montreal (OR:4.1:95%CI:1.8-9.4) and Toronto (OR:4.5:95%CI:1.2-18.3), but was not significant in Vancouver (OR:0.96:95%CI:0.37-2.47).

Conclusion: Over a third of high-risk GBM across cities were not HIV tested(P6M). Providing GBM, regardless of sexual orientation, with access to non-judgemental HCPs who evaluate risk and recommend STBBI screening accordingly, appears important for achieving recommended HIV screening.

Aims: Increasingly, HRQL measures that produce one value across multiple dimensions are being developed. The preferences patients have for each health state are then used to weight the dimensions so that one value is produced.
The aim of this project was to develop a short, HIV-specific, HRQL measure with a scoring system based on patient preferences for the different dimensions, the Preference Based HIV index (PB-HIV).

Methods: The data from the Canadian Positive Brain Health Now (BHN) cohort (n=854 participants with HIV; mean age 53 years) that used the Wilson-Cleary model for the measurement framework included both standard format and individualized measures. The latter identified the important areas of life that are affected by HIV and items from the standard format measures were mapped to these areas and formed the domains. Rasch analysis was used to identify the best performing item to represent each dimension. To develop a prototype scoring system, each dimension was then regressed on self-rated health (scored 0 to 100) and the regression parameters were used as weights. To customize the dimensions, cognitive debriefing and simultaneous translation in English and French was conducted with patients and healthcare professionals.

Results: Seven independent (item-to-item correlations. 0.16 to 0.55) dimensions with three declarative statements ordered as response options, formed the PB-HIV Index (pain, fatigue, memory/concentration, sleep, body image, depression, motivation). Regression parameters from a multivariable model yielded a measure with a scoring range from 0 (worst health) to 100 (perfect health). Table 1 shows, for BHN participants, values for the PB-HIV Index, for measures of convergent domains as well as inter-measure correlations.

Conclusions: Preference-based measures are optimal when cost- or comparative-effectiveness is of importance as the total score reflects gains in some dimensions balanced against losses in others. PB-HIV index is the first HIV specific preference-based measure.

Systemic racism drives health inequities among Indigenous people who use drugs in BC, including HCV treatment access. The HCV Blanket Program, conceptualized by Cedar Project’s Indigenous governance, was developed to mitigate inequities by providing culturally safe support before, during, and after treatment. We examined program’s impact on HCV treatment, reinfection, and factors disrupting adherence.

Blanket Program is a two-site pilot study nested in an Indigenous governed cohort in Vancouver and Prince George, BC. Main outcomes were sustained virologic response (SVR) at 12 weeks post-treatment and HCV RNA 9 months post-treatment. Adherence was measured through self-report scale. A priori non-inferiority margins, based on HCV specialists’ recommendations, were set at: >80% SVR12 and <20% HCV RNA. Logistic regression was used to assess factors associated with imperfect adherence (>5% missed doses). Results were adjusted for location, age, and sex.

Between 2017-2019, 60 participants enrolled in the program. Fifty-three percent were female, 32% HIV coinfected, and 78% used injection drugs. Intention to treat proportion reaching SVR12 was 92% (55/60) remaining above non-inferiority margin of 80% (p=0.012, 95%CI: 0.833, 1.000). HCV RNA at 9 months post-treatment was 9% (5/55) remaining below non-inferiority margin of 20% (p=0.025; 95%CI: <0.001, 0.116). Forty-two percent (25/60) demonstrated imperfect adherence. In adjusted regression analysis, housing instability (aOR: 11.01; 95%CI: 2.22, 54.57; p= 0.003) and living in Vancouver (aOR: 5.30; 95%CI: 1.39, 20.25; p= 0.015) were associated with imperfect adherence. Recent overdose (aOR: 4.04; 95%CI: 0.91, 17.99; p= 0.067) was marginally associated with imperfect adherence. Older age (aOR: 0.90; 95%CI: 0.83, 0.99; p = 0.025) was associated with strong adherence and recent access to traditional food (aOR: 0.32; 95%CI: 0.09, 1.10; p=0.070) was marginally associated with adherence.

Findings demonstrate a culturally safe case management approach can yield high HCV cure rates and mitigate reinfection risk among Indigenous people who use(d) drugs.

To address inequities in HCV treatment among Indigenous people who use(d) drugs including those living with HIV, Cedar Project’s Indigenous governance developed the Blanket Program, providing culturally safe care before, during and after treatment. In this study, 92% (55/60) of participants cured HCV; 91% (50/55) remained HCV-free 9 months post-treatment. Qualitative findings indicated psychological benefits from the program. This analysis used established psychological scales to examine the health impacts of receiving culturally safe care and having HCV cured.

Blanket Program is a two-site pilot study nested in an Indigenous governed cohort in Vancouver and Prince George, BC. Participants completed psychological measures at baseline and monthly during and after treatment (2017-2020). Symptom Checklist-90 Revised assessed psychological distress; PTSD Checklist – Civilian version measured post-traumatic stress response (PTSR); and Connor-Davidson Resilience Scale captured resilience. Generalized estimating equation modelling was used to examine effects on psychological health. Results were stratified by location and adjusted for age and sex. Cohen’s d for paired samples was used to assess effect size of associations.

In Prince George, psychological distress mean score during treatment (¯x = 0.648) was significantly lower than baseline (¯x = 1.052) (aβ: -0.414;95%CI: -0.632, -0.195), representing a moderate mean shift in distress. Effect size was medium (Cohen’s d = 0.671;95% CI: 0.265, 1.077). Similarly, PTSR mean score during treatment (¯x = 34) was significantly lower than baseline (¯x = 42) (aβ: - 8.21;95%CI: -12.0, - 4.42), representing a responsive change, on average. Effect size was medium (Cohen’s d = 0.593;95% CI: 0.289, 0.898). No significant change in resilience was found. In Vancouver, no significant changes were found across psychological measures. No significant changes were reported on psychological measures post-treatment.

Culturally safe case management supporting HCV cure has the potential to uphold (w)holistic health; however, integration of healing-centered programming is essential.

Background: Despite substantial progress over many decades, continued improvements in programming remain essential to address HIV/STBBI epidemics. Persistent gaps between public health sciences and approaches to optimize service coverage in public health programs for priority populations contribute to these shortcomings. Programs require timely, context-specific evidence for refinement and adaptation to address gaps and improve inequities in health outcomes.

Methods: During February-July 2021, we hosted a virtual workshop series to develop a research and implementation framework for HIV/STBBI prevention and care programs. The framework serves as one tool for facilitating the integration of embedded research into programs to support equity-focused programming and optimize population-level outcomes.

Results: The Effective Coverage Cascade framework (Figure) expands upon prevention and treatment cascades and health service coverage models. Centred on Program Science and grounded in public health programming, the framework guides the development of program-embedded research agendas that iteratively generate evidence for program optimization and equitable population-level health outcomes. By identifying and quantifying gaps in four dimensions of HIV/STBBI service coverage (required-, availability-, contact-, effective-), this framework examines inequities in coverage, considers how context influences them, and informs strategies to address them through program-generated evidence-informed refinements.

Discussion: Strategies and frameworks for operationalizing principles of health equity and measuring progress toward equity remain scarce. The Effective Coverage Cascade framework is a novel tool to address this gap. Health service coverage is a fundamental element of achieving equity in HIV/STBBI outcomes; greater consideration for how to optimize and expand delivery strategies and platforms for HIV/STBBI services is critical.

Background
Several studies have described higher hospitalization rates among females compared to males living with HIV. Our study characterizes trends in hospitalizations by sex among people living with HIV (PLWH) across Canada.

Methods
We used data from the Canadian Healthcare Use Study (CHESS) which contains longitudinal administrative data for PLWH hospitalized in an acute care facility in Canada from April 2006 to March 2020. PLWH were included if they were >19 years old on or after 1 April 2006 and had at least one hospitalization in the Discharge Abstract Database (DAD) containing an ICD-10-CA diagnosis code indicative of HIV (B24, O98.7, R75, Z21). For each hospitalization, the most responsible diagnosis (MRD) was tabulated and stratified by sex and jurisdiction of residence. Hospitalizations with a pregnancy or pregnancy-related condition as the MRD were excluded.

Results
Our study included 27,420 PLWH with at least one hospitalization containing an HIV-related ICD-10-CA code—of which 21,250 (77.5%) were male and 6149 (22.4%) were female—from all Canadian provinces and territories. Included females were younger than males (median 42 versus 48 years, respectively) and females (3096, 50.3%) were more often from the lowest neighbourhood income quintile compared to males (8437, 39.7%). There was a total of 123,901 hospitalizations contributed throughout the study period, of which 30.0% and 69.9% were among females and males, respectively. For both sexes, roughly 1 in 5 hospitalizations contained ‘Certain infectious and parasitic diseases’ as the MRD while 11.7% and 11.0% of hospitalizations were reportedly due to ‘Mental and behavioural disorders’ and ‘Diseases of the respiratory system’, respectively.

Conclusions
Between 2006 and 2020, females were more likely to be hospitalized than males among PLWH with at least one hospitalization containing an HIV-related diagnosis code. Excluding pregnancy-related conditions, the top three MRDs for acute care hospitalizations were the same for both sexes.

Pre-exposure prophylaxis (PrEP) has been available in British Columbia (BC) since January 2018 at no cost to clients. We tested whether phylogenetic clustering and drug resistance differed between previous PrEP users who seroconverted (PUWS) compared to non-PrEP users who seroconverted (NPUWS). Phylogenetic trees were inferred from 38,539 HIV pol sequences from 10386 Drug Treatment Program participants. Drug resistance mutations and scores (sum of mutation penalty scores by drug) were called using the Stanford HIVdb algorithm on pre-ART baseline sequences. Clusters comprised 5 or more members with pairwise patristic distances less than 0.02 substitutions/site. Date of first detectable viral load was used as proxy for diagnosis. From 1 January 2018, 7465 persons had ever received PrEP via the BC program, of whom 15 (0.20%) had seroconverted by 24 June 2021 (diagnosis range: 23 October 2018 - 20 November 2020). Over this diagnosis range, there were 314 NPUWS. PUWS were not significantly more likely to cluster than NPUWS (61.5% vs. 43.7%, chi-square p=0.26). All five unique clusters joined by PUWS were also joined by NPUWS. Although there was no difference between the proportions of PUWS or NPUWS with any baseline resistance mutation (0.27 vs. 0.20, chi-square p=0.67), PUWS had significantly higher baseline resistance scores to emtricitabine and lamivudine than NPUWS (mean 4.33 vs. 0.51, Kruskal p=0.002). This trend was driven by a single PUWS carrying M184V (p=0.136 when removed) who had 229 days between last HIV test and diagnosis, yet 64 days between last prescription and diagnosis (median 200), as well as the lowest proportion of days covered by PrEP (0.6 vs. median 0.94), suggesting potential PrEP exposure during acute infection. M184V was absent among phylogenetic neighbours, suggesting it was acquired or selected from a minority variant. The multitudinous benefits of PrEP could be ameliorated by supporting adherence and proper monitoring.

Introduction: This study reviewed the economic evidence of rapid HIV testing versus conventional HIV testing in low-prevalence high-income countries; evaluated the methodological quality of existing economic evaluations of HIV testing studies; and made recommendations on future economic evaluation directions of HIV testing approaches.

Methods: A systematic search of selected databases for relevant English language studies published between Jan 1, 2001, and Jan 30, 2019, was conducted. The methodological design quality was assessed using the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) and the Drummond tool. We reported the systematic review according to the PRISMA guidelines.

Results: Five economic evaluations met the eligibility criteria but varied in comparators, evaluation type, perspective, and design. The methodologic quality of the included studies ranged from medium to high. We found evidence to support the cost-effectiveness of rapid HIV testing approaches in low-prevalence high-income countries. Rapid HIV testing was associated with cost per adjusted life year (QALY), ranging from $42,768 to $90,498. Additionally, regardless of HIV prevalence, rapid HIV testing approaches were the most cost-effective option.

Conclusions: There is evidence for the cost-effectiveness of rapid HIV testing, including the use of saliva-based testing compared to usual care or hospital-based serum testing. Further studies are needed to draw evidence on the relative cost-effectiveness of the distinct options and contexts of rapid HIV testing.

Introduction: Gay, bisexual and other men who have sex with men (GBM) are a priority population for microelimination of hepatitis C virus (HCV). We estimated HCV care cascade indicators and correlates of detectable HCV RNA among GBM recruited in Montreal, Toronto and Vancouver.
Methods: Sexually active GBM, aged ≥16 years, were recruited through respondent-driven sampling (RDS) from February 2017 to August 2019. Participants completed a computer-assisted self-interview and tests for HIV, HCV, and other sexually transmitted infections. We conducted bivariate analyses comparing the RDS-II adjusted proportions for indicators across cities. Using pooled three-city data, we used RDS II weighted logistic regression to examine associations with detectable HCV RNA among HCV- positive participants.
Results: We recruited 1179 participants in Montreal, 517 in Toronto, and 753 in Vancouver. HCV seroprevalence was 6.8% in Montreal, 3.8% in Toronto, and 5.9% in Vancouver (p=0.006). Among HCV-seropositive participants, 3.1%, 1.1% and 2.3% were unaware of their status, in Montreal, Toronto, and Vancouver, respectively. In Montreal, 65% of HCV-positive participants reported receiving HCV treatment and 38% had detectable HCV RNA; in Toronto, 93% reported receiving treatment and 7% had detectable HCV RNA; in Vancouver, 89% reported receiving treatment and 11% had detectable HCV RNA (p=0.372 for treatment and p=0.039 for detectable RNA). Multivariable modelling found no differences in detectable HCV RNA by city; adjusted odds ratio [AOR] for Vancouver= 0.26 (95% CI 0.05-1.46); AOR for Toronto=0.19 (95% CI 0.01-3.54) compared to Montreal. Age (AOR 0.90 per year increase; 95% CI 0.84 - 0.97) and recent injection drug use (AOR = 8.39; 95% CI 2.11-33.4) were associated with detectable HCV RNA.
Conclusion: Among GBM in these three cities, we found very low proportions of undiagnosed HCV but gaps remain in treatment uptake. Additional interventions may be required to better engage younger GBM and those using injection drugs.

Background: People living with HIV (PLWH) experience disproportionate violence-related burdens which have important implications for healthcare utilization. This study aims to understand the association between recency of violence and rate of hospitalizations among PLWH in British Columbia (BC).

Methods: We analysed cross-sectional survey data from the Longitudinal Investigation into Supportive and Ancillary Health Services study (LISA) of PLWH ≥19 years old in BC (2007-2010). LISA participants reported if they had experienced any kind of violence recently (in the 6 months prior to interview [p6m]), in the past [>p6m] or never. Unadjusted and adjusted Poisson regression examined the independent association between recency of violence and rate of hospitalization p6m using linked administrative health data, and adjusting for potential confounders. Potential confounders were selected based on the magnitude of change in the violence coefficient.

Results: Of 985 participants (74.7% men, median age 45), 25.3% never experienced violence, 59.9% experienced violence p6m, and 14.8% experienced violence >p6m. In the p6m, 207 (21%) were hospitalized, with 329 total hospitalizations. In the adjusted model (see table), participants with past (Rate Ratio: 1.41; 95%CI 1.05-1.89) but not recent violence had significantly higher rates of hospitalization than those who had never experienced violence.

Conclusion: The rate of hospitalization was significantly elevated among PLWH who had experienced past violence. This may be due to long-term complications resulting from past physical and emotional trauma in addition to potentially improved access and utilization of healthcare services after exiting violent environments.

BACKGROUND: Owing to ongoing marginalization, racialized sexual and gender minority populations experience adverse social determinants of health and resultant health disparities that increase vulnerability amid the COVID-19 pandemic. Nevertheless, pandemic response preparedness and public health responses typically operate from Eurocentric, hetero- and cis-normative perspectives that fail to account for marginalization. We assessed impacts of the COVID-19 pandemic on HIV prevention/sexual and reproductive health, mental health, and substance use among racialized LGBTQ+ individuals in the Greater Toronto and Hamilton Area (GTHA).

METHODS: Sexual and gender minority, predominantly racialized, people ≥18-years were recruited online from March to November 2021 through CBO and health-centre listservs and LGBTQ+ media. A 60-minute, mobile-optimized online survey assessed COVID-19 pandemic impacts on HIV prevention/sexual and reproductive healthcare access, mental health (PHQ-2, GAD-2), and alcohol (AUDIT)/substance use. Gender- and sex-based analysis identified subgroup differences.

RESULTS: Participants (n=197) (median age:27 [IQR:23-32]) identified as African/Caribbean/Black (29.5%), South/East/Southeast Asian (27.5%), Latinx/Hispanic (9.0%), white (20.3%), and other (13.7%). Half (54.3%) identified as cisgender lesbian/bisexual/women who have sex with women (LBWSW), 25.9% cisgender gay/bisexual/men who have sex with men (GBMSM), and 19.8% transgender/gender-nonbinary people. Participants reported decreased access to HIV testing (30.3%), STI testing (38.8%), PrEP (20.0%), condoms (25.7%), other reproductive health products (30.3%; 40.7%* for LBWSW), and gender-affirming hormones (15.4%) among transgender people. LBWSW (63.6%*/73.8%*) and transgender/gender-nonbinary people (66.7%/71.8%) were more likely to screen in for depression and anxiety than GBMSM (43.1%*/54.9%*; *p<.05). Over one-third reported increased illicit drug (33.8%) and alcohol use (37.2%) since COVID-19, and 44.2% hazardous drinking.

CONCLUSIONS: Tailored community-based outreach and interventions based on intersecting marginalized identities and intersecting pandemic threats for gender minority, sexual minority, and racialized people are needed to address high rates of mental health and substance use issues, and increase access to HIV and sexual/reproductive health services amid the COVID-19 pandemic in the GTHA.

BACKGROUND: Approved in Thailand in 2017, fee-based PrEP is currently available. Despite national estimates of 50% of new HIV infections diagnosed among young people aged 15–24 years—the majority MSM and transgender women—PrEP usage remains low. With scale-up planned under universal health coverage, we explored a matrix of multilevel factors and public health practices that impact engagement with PrEP among young MSM and transgender women.

METHODS: We conducted 4 Thai-language focus groups (FGs) with 16–20-year-old, peer-recruited, gay men and transgender women from high schools, vocational schools, and universities, and key informant (KI) interviews (Thai or English) with HIV and youth experts, from June–August 2018 in 3 Thai provinces. FGs/interviews were transcribed and reviewed using framework analysis in Atlas.ti by a bilingual team.

RESULTS: FG participants’ (MSM, n=20; transgender women, n=5) mean age was 18.0-years (SD=1.3). KIs were healthcare providers (n=5), public health officers (n=2), NGO leaders (n=5), and youth advocates (n=5). We identified intersecting individual-level barriers (competence factors: low risk-perception and condom negotiation skills; material factors: low-/no-income; symbolic factors: anticipated sexual/gender-nonconformity stigma) and facilitators (inchoate PrEP awareness, motivation to learn more) to PrEP engagement. Micro-level (relational factors: fear of disclosure to intimate partners and parents) and meso-level barriers (material: unclear PrEP guidelines, lack of local availability; relational: unsupportive healthcare providers; symbolic: sociocultural taboos around ‘promiscuity’), interacted with facilitators at micro- (peer outreach/education) and meso-levels (LGBT+ community groups, gender-affirmative clinics). Government funding for free/subsidized PrEP, national/local youth-engaged PrEP campaigns, and youth-friendly clinics emerged as vital macro-level facilitators of PrEP engagement.

CONCLUSIONS: Treating PrEP not only as a biomedical intervention added to combination prevention, but as a social and public health practice contingent on a constellation of multilevel factors, can identify public health interventions and policies to facilitate PrEP engagement among young MSM and transgender women in Thailand.

Objectives: Despite the benefits of exercise among people living with HIV, their engagement in exercise is variable, and more so for women with HIV. Our aim was to explore experiences engaging in exercise among women living with HIV, specifically i) the nature and extent of exercise, ii) factors that characterize exercise experiences, iii) perceived impacts, iv) challenges and barriers, and v) recommendations for uptake.
Methods: We conducted a qualitative descriptive study involving web-based semi-structured interviews with women living with HIV who may or may not have engaged in exercise (≥150 minutes of moderate-vigorous physical activity/week). We asked about engagement in and perceptions of exercise, perceived impacts, challenges, and recommendations for future uptake. We administered a demographic questionnaire to describe personal, health and exercise characteristics. We conducted a thematic analysis of interview data.
Results: Of the 10 women who participated in the study, the median age was 52 years (25-75th percentile: 57,49), 4(40%) identified as Black or African, and 6(60%) had children. Six(60%) were classified as exercisers and 4(40%) non-exercisers. Women characterized their experiences with exercise with six intersecting themes that included: cultural factors (expectations, intersecting identities, social media, exposure, food diversity), gender (gendered roles, self-care, objectification, social norms, self-defense), stigma (misconceptions, ignorance, discouragement, exercise benefits), episodic nature (symptoms, uncertainty, multi-morbidity), perceptions of exercise (exercise priority determined likelihood to participate; difference between ‘exercise’ and ‘physical activity’), and sense of belonging (lack of community, racial divide, support network). Women perceived benefits of exercise as health promotion. Challenges and barriers to exercise were personal and environmental. Recommendations included providing resources and support networks to promote exercise with women living with HIV.
Discussion: Experiences with exercise were characterized by multiple intersecting personal and environmental contextual factors. Results may help to inform tailored implementation of exercise as a rehabilitation strategy with women living with HIV.

In preparation for Health Canada’s approval of Canada’s first HIV self-test in November 2020, a pilot study was implemented in Ottawa from July 20, 2020 to March 31, 2021 to offer free self-test kits and linkage to care (GetaKit). On April 1, 2021, we began expanding GetaKit across Ontario through AIDS Service Organizations which predominantly serve HIV priority populations; i.e., gay, bisexual, and other men who have sex with men (gbMSM); persons who are trans; Indigenous Peoples; African, Caribbean, or Black people (ACB); and people who use drugs (PWUD). GetaKit functions by having participants register and complete a sexual health self-assessment, which determines eligibility for HIV testing based on current provincial and federal HIV testing guidelines. Those deemed eligible can order a free HIV self-test to be delivered by mail or obtained via curbside pick-up at one of over a dozen locations across Ontario. Participants are requested to report their result to GetaKit and are linked to prevention and HIV care if necessary. From April 1, 2021 to December 14, 2021, there were 1665 requests for kits, of which 1248 (90%) were eligible. Notably, 990 (80% of eligible requests) were from members or priority populations: 26% were ACB, 67% gbMSM, 2% Indigenous, 10% PWUD, and 10% trans. As well, 26% of participants who belonged to HIV priority groups reported no prior HIV testing. For self-test results, 38% were not reported, 39% were negative, 1% were ‘prefer not to report’, and 0.5% (n=6) were positive. All participants with positive results underwent confirmatory testing; five were confirmed and 1 was determined to be a false positive self-test. These results suggest that GetaKit, through its partnership with ASOs and during the COVID pandemic, provides appropriate HIV testing to members of HIV priority populations, to first-time testers, and to persons with undiagnosed HIV.

Objective: Women living with HIV (WLWH) face ongoing structural marginalization and current evidence outlines how COVID-19 has exacerbated health and social inequities among key populations. This mixed methods study investigated how the COVID-19 pandemic and associated public health responses shaped social support and economic security among WLWH.
Methods: We drew on a COVID-19-specific quantitative survey with 166 cis and trans WLWH (April 2020-August 2021) as part of SHAWNA, an open longitudinal community-based research project with WLWH in Metro Vancouver. Additionally, we conducted 28 semi-structured interviews with a subset of WLWH in SHAWNA (May 2020-July 2020). Drawing on a socio-ecological framework, we sought to characterize how COVID-19 and related public health responses shaped social support and economic security.
Results: Among 166 respondents, 6.0% identified as trans, 53.0% were Indigenous, 35.5% were White and 10.2% were Black and/or otherwise racialized. Overall, 38.6% reported increased social isolation and 57.8% reported increased difficulty maintaining social networks since COVID-19 began. Over one-quarter of participants (26.5%) reported negative changes to their economic situation despite a temporary increase in BC’s income and disability assistance, and 61.5% reported negative changes to food security since COVID-19 began. In qualitative interviews, participants described how food access was shaped by financial barriers and loss of programs. Participants highlighted precarity in many types of informal work, including peer-based work during COVID-19. In addition to loss of income and employment opportunities due to the pandemic, many participants’ narratives reflected uncertainty around eligibility and potential retaliation for accessing COVID-19 government financial supports.
Conclusion: Our findings highlight heightened experiences of social isolation and economic insecurity during the COVID-19 pandemic among WLWH. Structural responses that can facilitate social support and respond to lost income, program closures, employment opportunities, and economic security, with a focus on culturally-safe Indigenous-led responses, remain critical to supporting women’s health and well-being.

Background
Hepatitis B (HBV) disproportionately affects people at risk of HIV and active vaccination is the standard of care for prevention. We quantified susceptibility to HBV among HIV post-exposure prophylaxis (PEP) seekers and estimated the number needed to prevent (NNP) HBV in this setting using Hepatitis B immune globulin (HBIG).

Methods
Data are from an ongoing retrospective chart review of patients requesting PEP from 2001-2021. We classified patients as HBV infected, immune, or susceptible, stratified by exposure type (sexual vs. parenteral). We defined HBV infection as a self-report of chronic HBV or reactive HBsAg, and HBV susceptibility as HBsAb<10IU/mL (plus non-reactive HBcAb, if available). For HBV susceptibles, we determined how often HBV vaccine and HBIG were administered. We calculated the HBIG NNP based on published estimates of HBIG and vaccine efficacy, per-sex act risk of HBV transmission, and HBV prevalence, assuming susceptible patients routinely receive HBV vaccine.

Results
Among 370 HIV PEP episodes (among 277 unique patients reviewed to date), 298(83.9%) and 57(16.1%) were for sexual and parenteral exposures, respectively. Mean age was 34.5(SD=10.8), and most were men who have sex with men (MSM) (74.6%). Among those with sexual exposures, 84(28.2%) were HBV-susceptible and 4(1.3%) were HBV positive at baseline. Among parenteral exposures, 20(35.1%) were HBV-susceptible and 1(1.7%) were HBV positive. Most (66.5%) patients were HBV immune; two sexually exposed patients had acute HBV. Thirty-nine (35.8%) susceptible patients received HBV vaccine and 16(14.7%) received HBIG, although no source patients were known to be HBV positive. Most (95.7%) PEP regimens were HBV-active (contained tenofovir/emtricitabine). We estimated that HBIG NNP=40928 among MSM (range, 9640-218833). For a known HBV-positive source, NNP=733 (200-3282).

Conclusion
A third of HIV PEP seekers were HBV susceptible, suggesting that PEP visits are important opportunities for HBV prevention interventions. The high estimated NNP suggests that HBIG is not efficient.

Background: Cohort studies, especially community-based, rely on self-reported data about chronic/latent viral infections and HIV health parameters. There are limited data describing how self-reported information reflects those obtained from clinical chart review or laboratory testing. This interim analysis of the BCC3 cohort data aimed to confirm important self-reported variables to inform ours and other cohort studies in the field of HIV research.
Methods: Self-reported HIV-related parameters (CD4 counts, viral load) and chronic/latent viral infection history were obtained as a part of the BCC3 clinical survey and compared to data obtained by chart review and serological testing. The latter included anti-hepatitis B (HBV) virus core antibody, anti-hepatitis C virus (HCV), and anti-herpes simplex virus types 1 (HSV-1), 2 (HSV-2) antibodies. Self-reported and serology-based prevalence were compared using Chi-Squared or Fisher’s Exact test, as appropriate.
Results: Self-reported and serology-based prevalence of HBV, HCV, HSV-1, and HSV-2 are summarized in Table 1. Chart review data were compared with self-report among women who could remember/estimate their CD4 nadir (66/85), recent CD4 count (61/88), and recent viral load (84/88) (Table 1).
Conclusions: Self-reported and serological prevalence did not differ for HBV and HCV. However, for HSV-1 and HSV-2, both groups were less aware of having been exposed to the virus. While a high proportion of WLWH were aware of HIV-related heath parameters, our finding that 11% of WLWH were unaware that they recently had a detectable (>40c/ml) viral load emphasizes the importance of clearly communicating this information to WLWH, to best inform their care and actions.

Background
HIV self-testing recently received regulatory approval in Canada and experience with its use in the general population is limited. We assessed the usability of the Biolytical INSTI HIV self-test in a randomized controlled trial of the antiretroviral drug Lopinavir/ritonavir as COVID-19 post-exposure prophylaxis.
Methods
The COVID-19 Ring-Based Prevention trial randomized individuals with a confirmed SARS-CoV-2 exposure to 14 days of LPV/r or control (no drug). Active arm participants performed the INSTI self-test at baseline with remote assistance (Zoom). Study staff assessed the quality of test conduct. Participants completed an electronic survey about testing experience satisfaction. We analyzed results descriptively.
Results
123 participants were enrolled before the trial was terminated early due to COVID-19 vaccine availability. Of 60 active arm participants, 41 (68.3%) were female, 7 (11.7%) healthcare workers and the most common age category 19-39 years (46.7%). 22/45 (48.9%) participants had previously been HIV-tested with 2 having done point-of-care testing. 48 participants performed the INSTI self-test, with 37 non-reactive and 11 (22.9%) indeterminate results. Only 3 of the indeterminate results were observed to be performed correctly; common problems included incorrect lancet use and insufficient blood volume for the test. 4/60 (6.7%) participants refused to self-test. Roughly one third of active arm participants did not complete the survey. Among survey respondents, 37/41 (90.2%) survey respondents agreed/strongly agreed that the test was easy to do, 37/40 (92.5%) agreed/strongly agreed the instructions were easy to follow, 33/41 (80.5%) were confident in the results and 31/41 (75.6%) would prefer it over standard blood testing, but 14/41 (34.1%) were not sure if they performed the test correctly.
Conclusions
While most participants in this general population COVID-19 prevention trial appeared satisfied with their HIV self-testing experience, a considerable proportion declined to self-test or obtained indeterminate results despite remote staff supervision.

Objectives: We undertook the present study to evaluate the uptake and adherence to SARS-CoV-2 vaccine protocols, and adverse events associated with vaccination among a marginalized urban population of people living with HIV who use unregulated drugs.

Methods: Study participants completed an interviewer-administered questionnaire between June-September 2021 in Vancouver, Canada. Multivariable logistic regression models were used to analyze the correlates of SARS-CoV-2 vaccine uptake and adverse events associated with vaccination.

Results: We enrolled 97 participants, of whom 56 (58%) reported receipt of two SARS-CoV-2 vaccine doses, 23 (24%) reported receipt of one dose and 17 (18%) reported being unvaccinated. Among those who had received two vaccine doses, the median time between doses was 67 days (interquartile range= 48-117 days). In the adjusted analysis of vaccine uptake, only female sex was significantly associated with receipt of both SARS-CoV-2 vaccine doses (female odds ratio (OR)=0.25, 95% confidence interval: 0.07-0.89, P=0.03). Of the 17 unvaccinated participants, 12 (71%; or 12% of the total sample) were undecided or opposed to vaccination. The most common reasons for vaccine hesitancy were concern about vaccine side effects and safety. A total of 30 (31%) participants reported at least one adverse event and there were no factors significantly associated with adverse events in the multivariable analysis (P>0.05). No serious adverse events were reported.

Discussion: We observed low rates of vaccine hesitancy and no serious adverse events among a marginalized urban population during the rollout of SARS-CoV-2 vaccine programs. With the exception of female sex, rates of vaccination and adverse events did not differ across sociodemographic, behavioural or clinical strata. These findings indicate that despite targeted vaccine services, vaccination rates among marginalized populations (58% double vaccinated) were below the Provincial rates (75%) at the time the data was collected.

Background: Since the COVID-19 pandemic in March 2020, availability of sexual health services including STBBI testing has been negatively impacted due to their designation as ‘non-essential’ health services. As a result, many individuals wanting to access sexual health care continued to have unmet sexual health needs throughout the pandemic. In response to this, sexual health service providers have adopted alternative models of care, such as virtual interventions and self-sampling/testing. The objective our analysis was to investigate service providers’ experiences of disruptions to STBBI testing during the COVID-19 pandemic in Ontario and the acceptability of alternative models of care among service providers.

Methods: Between October 2020-February 2021, we conducted semi-structured virtual focus groups (3) and in-depth interviews (11) with a diverse group of sexual health service providers (n=18) including frontline workers, public health workers, sexual health nurses, physicians, and sexual health educators across Ontario. As part of a larger community-based research study, data collection and analysis were led by 3 Peer Researchers. Transcripts were transcribed verbatim and analysis techniques were used informed by grounded theory.

Results: Service providers identified the reallocation of public health resources and staff toward COVID-19 management, and the closures, reduced hours, and lower in-person capacities at sexual health clinics as the causes for a sharp decline in sexual health testing services. Virtual and self-sampling interventions for STBBI testing were adopted to increase service capacity while reducing the risk of COVID-19 transmission. Participants suggested that alternative models of testing were more convenient, accessible, safe, comfortable, cost-effective, and less workload heavy compared to traditional clinic-based models, and that they filled the gaps in testing caused by the pandemic.

Discussion: Acceptability of virtual and self-sampling interventions for STBBI testing was high among service providers, and their lived experiences of implementing such services demonstrated their feasibility in the context of Ontario.

Background: Despite ongoing rollout of Pre-Exposure Prophylaxis (PrEP) in Ontario, only 3% of users are female. We describe woman enrollees in the Ontario PrEP Cohort Study (ON-PrEP) to shed light on the characteristics of those reached with this prevention technology.

Methods: ON-PrEP is a cohort of HIV-negative individuals using/initiating PrEP throughout Ontario. Data on biological, sexual activity and healthcare utilization outcomes were collected using 6-monthly electronic questionnaires. We describe baseline characteristics of cis, trans and non-binary women enrolled into ON-PrEP by Dec/2021.

Results: Of 20 women in a cohort of 679 (2.9%), 12 were assigned female and 8 male at birth. Eighteen (90%) identified as female while 2 identified as queer or non-binary. Median age was 38 (32, 41) years and 19 (95%) preferred speaking English with healthcare providers. Nine were bisexual, 6 heterosexual and 5 lesbian/gay/other. Eleven (55%) people had a primary sexual partner. Ten of those partners were non-transgender men, 5 (45%) HIV+ with undetectable viral load and 6 HIV-/unknown status. Among the same 11 enrolees, 5 had discussed sexual monogamy with their partners and 6 either had not discussed or agreed to have other sex partners. Eight (40%) participants had exchanged sex for commodity/money with a median of 12.5 (6.25, 21.25) people in the past 3 months. Fourteen (74%) women went to family doctors for immediate care of minor health problems. Participants also received regular healthcare from specialists (35%), pharmacists (30%), mental health professionals (30%) or other family doctors (30%). Most participants (60%) had taken >1 HIV test in the past year and 80% reported equally or more frequent STI versus HIV testing.

Conclusion: Preliminary data suggest that PrEP-using women in Ontario represent diverse gender identities, sexual orientations, and patterns of sexual and health-seeking behaviours. Multiple strategies are needed to expand PrEP uptake in Ontario women.

Objectives: Studying the recent HIV crisis and increased infective endocarditis (IE) rates in 2016 among PWID in London, a link to hydromorphone controlled-release (CR) use was discovered. Heating the drug preparation prior to injection was found to be a potential harm reduction intervention for PWID injecting hydromorphone-CR and public health education of these findings is warranted.

Methods: Two focus groups with PWID injecting opioids and 11 structured interviews with front-line staff (FLS) from community agencies engaging PWID were conducted. We aimed to understand the barriers existing in heating hydromorphone-CR and identify effective dissemination strategies to then educate the community about the harm reduction practice of heating hydromorphone-CR.

Results: It was found that PWID and FLS, while aware of the harms associated with sharing or reusing injection drug preparation, were not completely knowledgeable about heating drugs, specifically hydromorphone-CR. Barriers in cooking hydromorphone-CR injectates were mainly due to the time and dexterity required to heat especially when experiencing severe withdrawal symptoms. Other factors were negative peer influences and environmental factors (e.g. weather conditions/safety/public scrutiny). The use of the temporary overdose prevention site ameliorated many of these identified barriers. PWID peer-to-peer word of mouth and one-to-one interactions with an outreach worker were considered the most trusted sources for education about harm reduction.      

Conclusions: These findings informed a public health initiative around the benefits of heating all drugs including hydromorphone-CR in our city. The project results informed a harm reduction campaign that provided the following educational resources: two targeted slide decks for PWID and FLS shared through community drop-in sessions; printed resources with key messages that align with best practice recommendations for harm reduction; and the provision of a heat source (lighter). This will be the first campaign worldwide to promote cooking drugs to reduce infectious harms associated with drug injection practice.

Gay, bisexual (GB) and other men who have sex with men (MSM) are disproportionately affected by HIV globally and domestically. Reliable and recent population size estimates are necessary to allocate resources to meet prevention needs and are important for modelling the HIV epidemic. However, previous estimates were identity-based and did not account for GB men that would not reveal their sexual identity to a government survey. Our objective was to develop national population size estimates of GBMSM and those who report anal sex.

Estimates for males aged ≥15 years were drawn from Statistics Canada’s population size estimates, the Canadian Community Health Survey and the SexNow Survey. Estimated proportions of GB identity, those not likely to disclose GB identity, and MSM that do not identify as GB were applied. We then considered prior year anal sex history to limit estimates to those sexually active. Stratification by rural/non-rural geography, based on areas with a population cut-off at 1,000 residents, was carried throughout all calculations.

We estimate that 3.5% of the ≥15 male population identified as GB, 13.5% of GB males would not disclose their sexual identity to a government survey, and 0.2% of non-GB identified males reported past year anal sex with a man. The national GBMSM population size in 2020 is estimated at 640,785 (617,263-664,307), 4.1% (3.9%-4.2%) of the Canadian male ≥15 population. Among these, an estimated 560,575 were in non-rural centres (4.2% of ≥15 males), and 80,210 were in rural areas (3.1% of ≥15 males). The estimate of anal sex-active GBMSM was 432,267, representing 2.7% of the male ≥15 population.

Using data from multiple sources, these estimates account for GBMSM previously unaccounted for in Canada’s estimate. Stratification of results by rural/non-rural environments provides additional information to guide health services and promotion. Efforts are underway to develop these estimates by Province/Territory.

Background: This study examined the relationship between socio-demographics, social determinants of health, and access to HIV testing during the COVID-19 pandemic among Two-Spirit, gay, bisexual, and queer (2SGBQ+) men in Manitoba.

Method: Data were drawn from a community-based study (conducted in 2021) which examined the impacts of the COVID-19 pandemic on access to sexual health services and HIV testing among 2SGBQ+ men in Manitoba. Logistic regression analyses assessed the relationship between socio-demographics/social determinants of health (age, ethnicity, sexual orientation, gender identity, income, education, geographic location, relationship status) and the impact of COVID-19 on reduced access to HIV testing (analytic outcome).

Result: Among 347 participants, 27.7% reported that COVID-19 affected their access to HIV testing in Manitoba. In multivariate analyses, living in Brandon, medium size city of 30,000 to 49,000 people (AOR =11.58, 95%CI = 3.48 - 38.48) and living in rural and remote areas with less than 1,000 people (AOR =25.19, 95%CI = 1.98 - 32.01) compared to living in Winnipeg, were both associated with higher odds of reporting a reduced access to HIV testing during the COVID-19 pandemic. Participants who were dating (compared to those who were married or partnered) were also significantly more likely to report a reduced access to HIV testing (AOR=6.07, 95%CI:2.06-14.95).

Conclusion: Healthcare services must be prepared to respond to the impact of COVID-19 on HIV testing among sexually active 2SGBQ+ men, as well as 2SGBQ+ men who live in medium size cities or rural and remote areas in Manitoba. Rural providers should be encouraged to routinely offer HIV screening to 2SGBQ+ men throughout the COVID-19 pandemic. Targeted interventions are also needed to remove structural barriers to HIV testing in smaller and rural communities for both the pandemic and the post-pandemic periods.

Background: Saskatchewan has a unique HIV epidemic in Canada, driven largely by injection drug use, and steps are being undertaken to better understand our care cascade. HIV care in Saskatoon is primarily accessed at the Royal University Hospital (RUH) and the Westside Community Clinic (WSCC). While the clinic at RUH is a specialized Infectious Diseases clinic, WSCC provides community-based access to primary care, HIV and addictions care. These clinics cater to over 1100 persons living with HIV. With complementary, yet different, care models, the HIV care continuums of the clinics offer insights into each of the care models, and exemplify the impact and opportunities created by the COVID-19 pandemic.

Data: Cascade of care data is presented and compared for three timepoints: 2019, 2020, 2021 across two sites: PLP and WSCC. The care continuum data demonstrates where gaps in care are most prevalent before and during the COVID-19 pandemic.

Findings: The strengths and limitations of each of the care models in retaining patients into care and ultimately supporting viral suppression is evident. Access to care during the COVID-19 period has been relatively undisrupted in the community-based care model, while adversely impacting the care offered by hospital-based clinic. The rates of virologic suppression are noted to be lowest during the peak period of the pandemic lockdown in May, 2020 for both clinic sites.

Significance: Gaps in the care continuum exacerbated by the pandemic offer an opportunity for clinics in Saskatoon to advocate for integrated and outreach services to better support access and engagement in care for a large cohort of persons living with HIV seeking care in Saskatoon.

Background: The PrEP cascade is a useful heuristic for evaluating the health system’s ability to link individuals to PrEP services.
Methods: Using electronic and paper records at 17 sites in urban British Columbia and Ontario, we documented the number and proportion of healthcare encounters with HIV-negative, non-PrEP-using gay, bisexual and other men who have sex with men (GBM) who met the following cascade steps: 1) identified as meeting evidence-based Canadian guideline criteria; 2) staff recommended PrEP; 3) individual accepted PrEP referral; 4) PrEP referral made; 5) PrEP clinic attended; 6) PrEP initiated; 7) maintained on PrEP for ≥6 months. For each cascade step, we assessed for differences over the five 6-month periods (P1-P5) between Dec/2018-May/2021 using the Spearman’s rank correlation coefficients to test for trends, and compared overall results between provinces using Chi-square tests.
Results: Data on 5116 encounters (Table) showed no significant changes in any cascade steps between P1-P5 (Table). Across all five periods, there were no significant differences between BC and ON, except in steps “2) staff recommended PrEP” (94% vs 75%, p<0.001) and “4) PrEP referral made” (57% vs 40%, p=0.016). The largest cascade gap relates to eligible individuals declining recommendations for PrEP. The next largest gaps related to recommending PrEP to eligible individuals (BC) and failure to attend PrEP clinic (Ontario).
Conclusions: The large majority of healthcare encounters with GBM meeting evidence-based criteria for PrEP initiation did not result in PrEP initiation. New interventions to optimize the PrEP cascade are urgently needed.

Background: Fraudulent data can jeopardize the validity of web-based HIV research. We describe a multi-pronged approach to removing fraudulent responses from a cross-sectional online survey about sexual orientation disclosure in primary care.
Methods: We used the Hosted-in-Canada web-platform and recruited participants via sexual networking applications and community-based organizations. A literature review identified 10 potential fraud-detection criteria. Participant paradata (behaviour) criteria: duplicated IP addresses, short survey completion time, and identical survey start/end times. Participant response criteria: anti-fraud questions pertaining to 1) embedded directives (i.e. “Select the fifth option…”, 2) community knowledge (i.e. “When is Pride month in Ontario?...” and 3) honeypot questions that only bots can visually see. We also assessed straightlining (i.e. repeated responses) on open-ended questions. Assuming IP address duplication is the most reliable criterion, we calculated tetrachoric correlation coefficients between this and other criteria. Assuming internal data consistency would improve with removal of fraudulent responses, we calculated Cronbach’s alpha for the 10-item Nebraska Outness Scale, after removing responses meeting each criterion.
Results: Of 1407 responses, 1006 were suspected to be fraudulent. Most criteria had positive weak associations to the IP address criterion (rtet) and produced improved internal consistency (α after criterion applied). Honeypot questions failed to identify any fraudulent responses. Ultimately, five criteria were applied sequentially: duplicated IP addresses, identical start/end times, completion time <10-minutes, anti-fraud questions and straightlining, yielding 401 retained responses with good internal consistency (α=0.836).
Conclusion: Paradata, anti-fraud questions and serial assessment of internal consistency are useful ways to remove fraudulent data from web-based surveys.

Background: Hepatitis C virus (HCV) education may be changing following the simplification of HCV treatment and emergence of direct acting antiviral (DAA). We aimed to characterize HCV knowledge among people who recently completed DAA therapy.

Methods: The Per-SVR (Preservation of Sustained Virologic Response) is a prospective cohort of patients who achieved a sustained virologic response upon successful completion of DAA therapy. The primary aim of the study is to characterize HCV reinfection rates and factors associated with reinfection. The per-SVR study provided the sampling frame of participants who completed a psychometrically validated HCV knowledge scale at cohort entry (n=227). We assessed mean HCV knowledge score in the overall sample and not mutually exclusive key populations: baby boomers (n=178); people with indication of injection drug use (IDU) (n=100); people with HIV co-infection (n=50). Using a latent class analysis, we identified latent groups and assessed HCV knowledge amongst them.

Results: The median age (Q1, Q3) was 52 years (44, 59) and 64.8% were men. Total mean (SD) percent of correct responses were 83 (0.11) in the overall sample; 0.82 (0.11) in baby boomers; 0.83 (0.10) in people with indication of IDU; 0.80 (0.11) in people with HIV co-infection. Three latent groups were identified: baby boomers who ever experienced homelessness (n=126); women sex workers who ever experienced homelessness (n=68); men with indication of IDU who ever experienced homelessness and had ever diagnosis of mental health disorders (n=18). Knowledge level remained high in the identified latent groups and similar to that of the overall sample.

Conclusion: Patients successfully treated with DAAs had a high HCV knowledge. High knowledge and awareness of reinfection among complex patient groups often facing barriers to HCV care is encouraging and emphasizes the positive outcomes of universal access to treatment.

Background
People living with HIV (PLWH) in rural areas face unique challenges when accessing healthcare services. Despite this, patterns of healthcare service usage in this population have not been fully explored. Using linked administrative health data, we examined differences in the healthcare service utilization patterns of rural and urban-dwelling PLWH in British Columbia (BC).

Methods
We analyzed 2,243,405 Medical Services Plan (MSP) claims reflecting physician visits from 11,196 PLWH in the Seek and Treat for Optimal Prevention (STOP) of HIV/AIDS Study. This analysis used population-based linkages of MSP claims from the BC Ministry of Health and clinical/treatment data from the BC Centre for Excellence in HIV/AIDS. We compared the frequency, physician specialty, and geographic location of services accessed by PLWH who lived in rural and urban settings between 1996 and 2017. Study participants were considered to be rural-dwelling if their home postal code’s second digit was 0.

Results
Of the 11,196 PLWH, 5.7% lived in a rural area at least once during the study period, and 2.6% lived exclusively in rural areas. Urban-dwelling PLWH had, on average, more physician visits per year than those in rural areas (urban: 20.5 per year; rural: 16.6 per year). MSP claims reflecting specialist visits were less common among rural-dwelling PLWH (28.4% of visits for rural-dwelling PLWH and 37.4% for urban-dwelling). Rural-dwelling PLWH were also more likely to travel to different health service delivery areas (HSDA) for care; 54.2% of the physician visits among rural-dwelling PLWH occurred outside of their local HSDA, compared to 27.6% in the urban-dwelling population.

Conclusion
Rurality impacts healthcare service utilization patterns, including frequency of physician visits reflected in MSP claims, physician specialty, and whether a patient travels for care. Expanding upon this exploratory descriptive work is necessary to further characterize healthcare utilization of PLWH in rural areas in BC.