Objective: HIV Pre-exposure prophylaxis (PrEP) is a highly effective option for the prevention of HIV. The use of PrEP for HIV prevention among PrEP-eligible Black patients remains far below thresholds necessary to achieve the goal of zero new HIV infections. Previous research has shown that most PrEP-eligible Black patients experience decisional conflict, which ultimately affects the quality of their decision-making process for the initiation and adherence to PrEP. Decision support tools (DST) can reduce decision conflict and improve decision making for patient facing health decisions. However, there is currently no decision support tool for PrEP-eligible Black patients who are being asked to consider PrEP for HIV prevention. The purpose of the study was to design, develop and evaluate an HIV PrEP decision support tool for Black patients.

Methods: Using self-determination theory and the Ottawa Decision Support Framework Guideline for Developing and Evaluating Patient Decision Aid, we designed, developed, and evaluated the PrEP Decision Support Tool in three distinct phases; Phase I – Data collection to determine the purpose and content of the DST; Phase II – Design and development of the DST; Phase III – Evaluation of the DST - alpha and beta testing.
Results: The web-based decision support tool contain seven distinct sections; 1).Introduction, 2)clarify the decision, 3) information about PrEP, 4)value clarification exercise, 5) support system, 6) re-assessment of decision-conflict, and 7)plan for next step. Both potential patients and PrEP providers rated the DST high in relevance and content.
Conclusions: A decision support tool to reduce decision conflict for PrEP-eligible Black patients was developed and rated high in content and relevance by patients and PrEP providers.

This work is part of an implementation science project to increase HIV pre-exposure prophylaxis (PrEP) adoption in Southeastern Ontario (SEO), a mixed urban-rural setting. We broadly invited clinical and managerial staff in primary care practices and sexual health clinics. We used the Consolidated Framework for Implementation Research (CFIR) to develop a semi-structured interview and guide the thematic analysis. To date, we have interviewed 13 participants among physicians, nurses and clinic managers. We identified three types of adopters: 1) those who prioritize PrEP adoption (with or without institutional support); 2) those with a plan for PrEP adoption; and 3) those with interest but without a clear plan. This preliminary analysis revealed the following facilitators for adoption: 1) the availability of a PCP able to prescribe PrEP; 2) the commitment of a PrEP leader (local or provincial expert); 3) the interviewees’ perception that the population they serve need/want PrEP and HIV/STI care; and 4) existence of a partnership between PCP and a local public health unit. Participants recommended 1) more PrEP and HIV care training; 2) a commitment from public health units’ leadership and the Ministry of Health towards supporting PrEP implementation, 3) increased access to PrEP in terms of medication coverage and availability of PrEP clinics, 4) increased availability of PrEP prescribers in sexual health clinics, and 5) external feedback about the impact that PrEP provided by clinics has in the local community. This data will be matched with implementation strategies, literature reviews, and focus group discussions to design rapid implementation strategies that promote PrEP prescribing among PCP in Ontario.

Background: No studies have examined PrEP access among people living with disabilities within Two-Spirit, Gay, Bisexual and Trans men, Queer and Non-Binary communities (2S/GBTQ+) in Canada, despite inequities and structural barriers to health. We investigated PrEP access barriers experienced by 2S/GBTQ+ people living with disabilities with increased likelihood for HIV acquisition, and associations with disability subgroup.
Method: Participants self-completed an online, community-based survey, including demographic, disability, and PrEP access barrier questions. Participants were recruited through 2S/GBTQ+-oriented sex-seeking apps, social media, and community-based organizations. Using bootstrapped multivariate logistic regression analyses (1000 iterations), we estimated differences in experiencing PrEP access barriers by disability subgroups presented as adjusted odds ratios (aOR) with 95% confidence intervals (95%CI).
Results: Of 1299 PrEP-naïve participants, most identified as cisgender men (88.26%), gay (78.06%) and non-Latino white (77.23%). 803 people (61.82%) reported living with at least one disability. Disabilities were grouped into visual (n=172; 21.42%), hearing (n=40; 4.98%), mobility (n=102; 12.70%), memory (n=284; 35.37%), emotional (n=564; 70.24%) or other disabilities (n=306; 38.11%). While participants living with disability and those not living with disability both reported high rates of any PrEP access barriers (95.39% vs. 95.85%; aOR=0.89; 95%CI [0.37-1.80]), patterns varied by disability subgroup and barrier. Participants with mobility disabilities were more likely to report cost barriers to PrEP (42.42% vs. 28.78%; aOR=2.08; 95%CI [1.12-3.80]) and have concerns about PrEP effectiveness (10.61% vs. 2.73%; aOR=4.08; 95%CI [1.22-9.54]). Participants with memory disabilities were also more likely to report testing requirements as a barrier (23.16% vs. 14.29%; aOR=1.58, 95%CI [1.02-2.42]).
Conclusion: PrEP-naïve 2S/GBTQ+ people living with disabilities have unique needs and experiences accessing PrEP that may relate to the nature of their disability/ies. To ensure equitable PrEP implementation, further investigation of PrEP access needs for people with disabilities is warranted to inform policy and health service delivery.

Background: Maintaining viral suppression requires stringent adherence to ART. Suboptimal adherence can lead to treatment failure, development of drug resistance, fewer ART options, and increased morbidity/mortality. Recent advances have reduced pill burden and dosing frequency, but some PLWH are unable to maintain optimal ART adherence levels. The aim of this study was to describe real-world ART adherence among PLWH across Canada and identify factors associated with suboptimal adherence.

Methods: This retrospective study used medical/pharmacy claims data sources to examine data from PLWH aged ≥18 years who initiated an ART regimen between 2010-2020 across seven provinces (Alberta, Manitoba, New Brunswick, Newfoundland and Labrador, Ontario, Saskatchewan, and Quebec). Index date was defined as the date of first dispensing of a multi-class ART regimen. PLWH were followed for ≥12 months and baseline characteristics were summarized using descriptive statistics. Adherence was calculated using a Proportion of Days Covered approach, based on ART dispensing, recorded between April 2010 and the last available date. Linear regression analysis was used to determine correlations between suboptimal adherence and baseline characteristics.

Results: We analyzed data from 19,322 eligible PLWH. Among 12,594 PLWH with evaluable baseline data, 10,673 (84.8%) were ART naïve, 74.2% were male, mean age was 42.9 years, and 54.1% received a multi-tablet ART regimen. Of the 19,322 eligible PLWH, 44.7% had suboptimal adherence (<95%), with approximately 18% having <85% adherence. Based on multivariate regression analysis, suboptimal adherence was significantly associated with multi-tablet ART (p<0.001) and younger age (p<0.001).

Conclusion: This large study examined real-world ART adherence patterns, encompassing 45% of the total Canadian PLWH population. Almost half of adult PLWH in Canada had suboptimal ART adherence, with 1 in 5 having adherence levels <85%. Better understanding of factors influencing adherence may help address gaps in current care practices that may impact treatment outcomes.

BACKGROUND
Living in a rural area has been associated with higher risk for hospital readmissions. We compared the association between rurality and 30-day hospital readmission in people with (PWH) and without HIV (PWoH).

METHODS
We used linked administrative health data from the Comparative Outcomes and Service Utilization Trends (COAST) study. Index episode of care (EOC) was defined as the first hospitalization between 01/04/2001-31/03/2020 and 30-day readmission as any readmission within 30 days of index EOC discharge date. We classified rurality using Statistical Area Classification; census metropolitan areas were classified as urban (UA), census agglomeration areas as small urban (SUA) and census metropolitan-influenced zones as rural (RA). Multivariable logistic regression was used to examine the association between rurality, HIV-status, their statistical interaction, and readmission following an index EOC adjusting for age, sex, neighborhood income-quintile, health authority, ICU-admission, length of stay, and discharge against medical advice during index EOC.

RESULTS
The study sample consisted of 207,763 individuals (PWH=7,434; PWoH=200,329). HIV-status was associated with higher odds of readmission. We found a significant interaction effect between HIV and living in an SUA (pinteraction=0.046) or RA (pinteraction=0.027) on the risk of readmissions. Among PWoH, living in an SUA or RA were associated with higher odds of readmissions compared to UA; while among PWH, there was no difference in the odds of remissions for any geographical area (see Table 1).

CONCLUSION
Whereas in PWoH living in a more rural area was significantly associated with a higher risk for readmission, the association was significantly reduced among PWH.

Background: We examined psychosocial, clinical, and structural variables as determinants of QoL at baseline and over time in a cohort of PLWH in BC.

Methods: We recruited PLWH aged ≥19 years in BC between January 2016-September 2018 from the STOP HIV/AIDS Program Evaluation (SHAPE) study using purposive sampling. Participants completed surveys at enrollment and at two follow-up visits, approximately 18 months apart. We collected data regarding sociodemographics, past medical history, substance use, health service utilization, and QoL using the Short Form-6D. Social support was measured using the MOS-SSS and depressive symptoms with the CESD-10. With time between follow-up visits controlled, multivariate generalized linear mixed models analyzed which factors were associated with higher QoL at enrollment and improvements in QoL scores over time.

Results: Of the 644 participants enrolled, 71.6% identified as male and 51.9% were ≥50 years old. Participants with significant depressive symptoms (β = -0.009, p<0.001) and a mental health disorder diagnosis (β = -0.021, p = 0.027) had lower QoL scores, while food security (β = 0.041, p<0.001) and earning >$30,000/year (β = 0.042, p<0.001) were associated with higher QoL scores at enrollment. Among the 494 participants with at least one follow-up visit before March 2020, increases in QoL scores were associated with lower depressive symptom scores at follow-up (β = 0.048, p 0.005). Decreases in QoL scores from enrollment to follow-up were associated with higher MOS-SSS scores at enrollment (β = -0.0004, p = 0.022) and increased depression scores from enrollment to follow-up (β = -0.019, p = 0.264).

Conclusions: Our results highlight the importance of structural factors, such as food security and income, as well as mental health, as important determinants of QoL for PLWH. Our finding that higher social support was associated with lower QoL scores at enrollment warrants further investigation.

As of December 31, 2022, 190 mpox cases have been confirmed in British Columbia (BC). The recent global mpox outbreak has been characterized by human-to-human transmission and has disproportionately affected gay and bisexual men who have sex with men (gbMSM). We describe mpox cases in BC’s population-level HIV treatment and PrEP programs.

Adults aged ≥19 years, enrolled in BC’s HIV Treatment or PrEP programs who had program contact (based on drug dispensing or lab test results) on or after 1-May-2022 were included. Between 1-Jun-2022 and 31-Dec-2022, mpox testing and cases over time, and client demographic and clinical characteristics are described. Wilcoxon rank-sum test was used for age comparison.

Of 16,471 program clients, 148 cases of mpox were diagnosed [51/8247 (0.6%) HIV treatment clients and 97/8224 (1.2%) HIV PrEP clients]. Cases had median age 42 years (Q1-Q3, 35-51) in HIV treatment and 36 years (Q1-Q3, 31-42) in PrEP (p< 0.001). All were cis-gender male, and 87% were known gbMSM (risk group unreported in 13%). Of HIV treatment cases, median CD4 count was 665 cells/µL (Q1-Q3, 450-920); two had CD4 count <200 cells/mL. Three clients were diagnosed with mpox within 6 days of new HIV diagnosis. Overall, mpox testing was performed in 166 HIV treatment and 367 PrEP clients. Monthly mpox cases between June to September were 13, 55, 45, 20 respectively, with a decline observed thereafter (<10 cases/month).

A high number of mpox cases in BC were prescribed HIV PrEP, consistent with overlapping risk behaviour and eligibility criteria for HIV PrEP with mpox transmission and vaccine eligibility. A smaller number of HIV treatment clients were similarly affected. Cases of concurrent HIV and mpox diagnosis emphasize the importance of screening for sexually transmitted infections while evaluating for mpox. Declining mpox cases suggests a potential effect of mpox vaccine uptake and/or altered behaviour.

Background
Amidst the COVID-19 pandemic and related public health service interruptions, there was an unprecedented need to understand public acceptability of virtual health and other service innovations while optimizing prevention of HIV and other sexually transmitted infections (STI). Fraser Health (FH), British Columbia’s most populous Health Authority serving 1.9 million residents, supports clients across the region with Sexual Health Clinics for adults and youth.

Methods
In June of 2021, a cross-sectional online anonymous survey was launched using a multi-pronged recruitment strategy. It was administered using a FH public survey panel (Health Chat), via targeted social media advertisements and through promotion with partner agencies. The survey link was also sent via text message to over 600 previous clients. It used convenience and purposive sampling. Analysis included descriptive and bivariate statistics.

Results
Out of the 998 respondents (50% aged 45-74 years), 26% identified as males, 13% identified as sexual minorities, and 19.5% as ethnic minorities. Despite the majority reporting only one recent sexual partner (66%), there were positive responses regarding STI testing with 42% indicating they see STI testing as part of routine health care and staying healthy, and 28% had had an STI test in the past five years. Responses from those who had tested in the past five years (n=281) indicated that 32% had avoided/delayed accessing sexual health services due to service interruptions during COVID and 77% agreed that they were comfortable with in-person services, despite the ongoing pandemic. The vast majority of this sub-group (78%) reported being likely to use at-home self-collection kits and willingness to access other virtual services (including texting, phone, and video) ranged from 51%-69%.

Conclusions
Survey results indicate a desire for continuing with high quality in-person STI services and expansion of virtual service options. These findings will inform sexual health service redesign in FH.

Background
Fraser Health’s (FH) Regional HIV Case Management (CM) Program supports people living with HIV (PLWH) who may have challenges adhering to treatment. It promotes timely engagement in care using a team-based approach, including outreach workers, social workers and public health nurses. The program was evaluated in order to characterize the clients who use the service and program effectiveness.

Methods
We conducted a retrospective cohort (2015-2021) analysis of FH CM client information from the BC HIV Drug Treatment Program (DTP). We compared demographics and clinical characteristics of those PLWH in the FH region who were referred for CM to those who were not. We used Wilcoxon rank-sum test and Chi-square to compared CM participants with non-CM DTP participants. We examined changes in HIV health service measures before and after CM referrals for those with at least 12 months of follow-up.

Results
The CM Program followed 560 clients, representing 22.1% of the 2523 FH DTP clients during the study period. Compared to non-CM clients, those in CM were less likely to self-identify as White (28.5% vs. 35.9%; p<0.001) and male 64.3% vs. 79.1%; p<0.001) and were more likely to have a history of injection drug use (33% vs. 15%; p<0.001). Among 89 CM participants with ≥1 year of follow-up after enrollment, CM clients saw improvements in viral load testing (79-83% in follow-up vs 58% in year prior to referral), filling ARV scripts (62-72% vs 45%), and viral suppression (33-56% vs 31%).

Conclusions
This evaluation demonstrated positive associations between CM enrollment and client’s clinical outcomes and will be informing the program’s strategic redesign. This will include tailoring models of care to the most salient needs of the highly marginalized clients and building on program strengths.

BACKGROUND: HIV drug resistance (HIVDR) is a major challenge to the effectiveness of antiretroviral therapy. Global efforts in addressing HIVDR require clear, transparent, and replicable reporting of HIVDR studies. METHODS: We describe the rationale and recommended use of a checklist of items that should be included in reports of HIVDR incidence or prevalence. After preliminary consultations with experts and establishing the need for guidance, we used a sequential mixed methods approach to create the checklist. RESULTS: The Checklist for studies of HIV Drug Resistance prevalence or incidence (CEDRIC-HIV) includes 15 recommended items that would enhance the transparency and facilitate interpretation and comparability of HIVDR studies. CONCLUSIONS: This checklist will help authors of HIVDR studies prepare more complete research reports and assist in statistical pooling and interpretation of HIVDR data.

Background: Epidemic and pandemic infectious diseases, including HIV, are a distinct challenge for clinical research. Timely data generation are important to optimize consistently applied individual and population access, particularly when a clear standard of care does not exist or rapidly evolves. Traditional clinical trial design is slow and does not usually focus on programmatic treatment delivery, especially outside established trial centers. We describe design and implementation of the NS pragmatic, moderate-to-severe COVID treatment study (COVIC) to facilitate timely access and outcome delineation across all NS COVID care centers.

Methods: In March 2020, a provincial health systems' decision was made to provide all inpatient COVID therapeutics for patients with moderate-to-severe infection hospitalized at 6 defined academic and non-academic COVID treatment sites through a NSHA ethics approved pragmatic study using a hub-and-spoke model. Baseline clinical phenotype, laboratory data, and outcomes were collected as standard of care. A pragmatic implementation framework[1] was used to retrospectively identify successes, challenges, facilitators, implemented solutions, and unmet needs.

Results: 362 people have been enrolled in the study to date. Successes include: structured data collection supported by strong health authority and frontline provider buy in; timely ethics review (3 weeks); access equity and treatment consistency for rural and urban patients; and drug supply durability. Challenges include: large volume research documentation despite pragmatic approach using already approved medications and lack of hospital and community research embedded EMR to facilitate rapid data collection.

Conclusions: Embedding centralized, locally adapted clinical care into pragmatic research facilitated equitable and consistent geographic access to care, including new therapeutics, while clinical expertise was developed. For emerging and re-emerging infections, such as COVID and HIV, that are characterized by rapidly evolving information, this approach may provide better access to scarce resources and improve real world and health system information.

[1] Loudon K et al., BMJ 2015;350:h2147

Background: The transcontinental spread of a novel variant of lymphogranuloma venereum (LGV) has prompted broad surveillance in British Columbia (BC). First identified in BC in 2019, this recombinant strain of Chlamydia trachomatis (L2b/D-Da) possesses a non-LGV ompA genotype which confers increased virulence and the emergence of antimicrobial resistance. Still, the clinical presentation of this variant remains unknown. We aimed to compare the prevalence and clinical presentation of L2b/D-Da LGV to non-recombinant L2b LGV.

Methods: A retrospective chart review of all LGV cases in BC from 01/2019—10/2022 was performed. In BC, all chlamydia-positive rectal specimens are routinely forwarded for LGV testing, where positive cases additionally undergo DNA sequencing. We collected information pertaining to LGV serovar, HIV status, symptoms, and risk factors. Chi-square tests were used to compare L2b/D-Da to non-recombinant L2b LGV.

Results: Among 298 cases of LGV identified during this period, 217 (72.8%) were the non-recombinant L2b serovar and 29 (9.7%) cases were caused by the L2b/D-Da recombinant strain. Most cases were among men who have sex with men (n=288/292 [98.6%]) with a mean age of 38.5. The proportion of recombinant cases increased from 2019 to 2022 (n=4/95 [4.2%] vs. n=19/92 [19.6%]; p <0.001). A higher proportion of recombinant cases were among individuals who have sex with women, including bisexual men and transgender women (n=3/28 [10.7%] vs. n=3/212 [1.4%]; p=0.054). Compared to non-recombinant LGV, a higher proportion of recombinant cases occurred among transgender women (n=3/29 [10.3%] vs. n=1/217 [0.0%]; p=0.002). There was no difference in experiences of proctitis (n=13/25 [52.0%] vs. 111/199 [55.8%]; p=0.885) or asymptomatic infection (n=9/27 [33.3%] vs. n=71/200 [35.5%]; p=0.995) between the two strains.

Conclusion: L2b/D-Da recombinant LGV is increasing, particularly among individuals who have sex with women. Though molecular studies suggest increased virulence of the strain, the clinical presentation appears to be similar to non-recombinant LGV.

Background:
Linkage-to-care and access to treatment for hepatitis C virus (HCV) remain important gaps in the cascade of care for people who use drugs (PWUD) and represent significant challenges for HCV elimination in Canada. This study provides preliminary results and lessons from a novel pilot project designed for PWUD attending a supervised consumption site (SCS) in Vancouver, British Columbia.

Methods:
The Hep C Connect pilot was launched in November 2021 to monitor progress across the HCV cascade of care amongst a cohort of SCS clients. Study participants are offered a point-of-care HCV test from a research nurse and an interviewer-administered survey. The survey captures data on healthcare utilization, drug-use history, HCV testing and treatment history, and HCV knowledge.

Results:
To date, 188 participants (median age of 42) have been surveyed, 59 (31%) of whom identify as women. Preliminary results show that 86% of the cohort do not view HCV as a health priority. Of this cohort, 111 (59%) participants had a reactive HCV antibody test (Ab+), 62 (33%) of whom chose to engage in RNA testing and 30 (16%) returned a positive HCV RNA result. A high proportion of participants (44%) chose not to engage in RNA testing following an HCV Ab+ result, signaling a need for better clinical follow-up for those most at risk for HCV. Importantly, over one-third (35%) of participants report not currently having a primary care provider and 27% report having not been to a doctor in over a year, suggesting a need for supportive linkage-to-care for PWUD.

Conclusion:
The relatively low uptake of follow-up testing and access to primary care suggests the need for patient-centered approaches in order to educate and enable PWUD and to improve linkage-to-care. This work will inform an implementation science project to improve the HCV cascade of care among PWUD.

The HIV epidemic disproportionately affects Indigenous people in Canada, and individuals who use substances while experiencing houselessness are at a higher risk of infection. Traditional HIV testing methods can be stigmatizing and inaccessible for people with drug use and unstable housing experiences. Self-testing has emerged as a potentially effective way to increase testing uptake and reduce stigma. However, there is limited research exploring the feasibility and acceptability of self-testing methods in this population.

A community-based research project was conducted to assess the feasibility and acceptability of HIV self-testing among Indigenous people who experience substance use and unstable housing in inner-city Saskatoon. Participants were recruited through community outreach and provided the option to provide saliva and dried blood spot (DBS) samples for HIV testing. Participants completed a questionnaire regarding their experiences with self-testing.

All participants (n=56) self-identified as Indigenous. Of the 45 participants tested for HIV, 12.2% of saliva samples (n=41) tested positive for HIV, while none of the DBS samples (n=8) returned positive results. Only 61% of participants were previously aware of self-testing methods. Most (89%) participants indicated no reason not to choose self-testing over traditional testing methods. The primary reasons cited by the remainder to opt out of self-testing methods included stigma and anxiety over the results. Cultural facilitators played a critical role in providing support and creating a welcoming and safe space for the results to be shared, as well as answering questions about HIV and self-testing.

HIV self-testing is a feasible and acceptable option for Indigenous individuals with substance use and unstable housing experiences in inner-city Saskatoon. The use of cultural facilitators and community research associates may increase the uptake and acceptability of self-testing in this population. Future research should explore the scalability and sustainability of this approach to improve HIV testing and reduce HIV-related disparities.

Objectives: HIV treatment attitudes are associated with sexual behaviors that lead to increased bacterial STIs. We examined the relationship between these attitudes and bacterial STI diagnoses among GBM living in Montreal, Toronto, and Vancouver.
Methods: The sample included GBM from the Engage cohort study who reported they were aware of Treatment-as-Prevention (TasP). Participants were recruited using respondent-driven-sampling (RDS). Using a structural equation model adjusted for sampling bias (RDS-II weights), we examined the association between HIV treatment attitudes, sexual behaviours, and bacterial STI diagnoses. We estimated direct and indirect paths between HIV treatment attitudes and STIs via condomless anal sex (CAS), number of anal sex partners, and oral sex
Results: Among 1384 GBM, there was a simple direct association between HIV treatment attitudes and STI diagnosis such that more positive attitudes led to increased STI diagnosis (see Table). The mediation model suggests that these effects were mediated indirectly through 2 paths: 1) via increased CAS (β=0.18, 95%CI[0.09, 0.28], p<.001) and 2) via an increase in the number of anal sex partners, which led to CAS (β =0.09, 95%CI[0.05, 0.12], p<.001). There was no statistically significant pathway via oral sex.
Conclusions: More supportive HIV treatment attitudes led to an increase in the number of anal sex partners and condomless anal sex, which in turn increased STI diagnoses. These findings highlight the importance of providing effective STI counselling that addresses how HIV treatment attitudes may lead to STIs, providing regular HIV/STI testing, and developing efficacious prevention strategies for bacterial STIs.

Background: Patterns of STI and HIV testing among a cohort of people living with HIV (PLWH) prior to their HIV diagnosis can give insight into prevention and missed opportunities.

Methods: The Ontario HIV Treatment Network (OHTN) Cohort Study (OCS) is a longitudinal, 15-site clinical and questionnaire-based study. Analysis included participants diagnosed with HIV for the first time in Ontario between 2011 and 2021 interviewed from 2020-2021, with more detailed STI testing questions in 2021. Self-reported HIV and STI (Syphilis/Gonorrhea/Chlamydia) testing habits prior to HIV diagnosis were analyzed. Multinomial logistic regression was performed where the outcome was any HIV testing prior to HIV diagnosis (never, yes-once/twice, yes-routinely).

Results: Among participants (n=460), prior to their HIV diagnosis, HIV testing frequency occurred routinely (33.7%), once/twice (34.1%) and never (32.2%). Multinomial logistic regression showed compared to never testers: non-heterosexual males versus females were significantly more likely to be routine testers (adjusted odds ratio [aOR]:7.7,95%Confidence Interval:3.6-16.6) or once/twice testers (aOR:3.0,95%CI:1.5-5.8). Participants aged 36-49 years compared to those aged 50+ were significantly more likely to have tested routinely (aOR:3.0,95%CI:1.6-5.7) or once/twice (aOR:2.1,95%CI:1.2-3.8). Those more recently diagnosed (for every year more recently diagnosed) with HIV were more likely to test routinely (aOR:1.2,95%CI:1.1-1.3) or once/twice (aOR:1.2,95%CI:1.1-1.3). Race, income, age <36 versus 50+, or being a heterosexual male compared to female were not significantly associated with frequency of testing. Among gay/bisexual/queer men (n=52), 7.7% never tested for HIV or STIs prior to HIV diagnosis, 5.8% tested for STIs but not HIV, 13.5% tested for HIV but not STIs and 73.1% tested for both (p=0.03).

Discussion: Differential uptake of HIV and STI testing existed among OCS participants prior to their HIV diagnosis. Missed opportunities for HIV prevention interventions existed, especially for participants who did not test at all or tested for STIs but not HIV prior to their HIV diagnosis.

Background: Since 1995, the OHTN Cohort Study (OCS) has collected data from people living with HIV. Efforts to increase representativeness of key populations and geographies began in 2017. The OCS collects clinical data and conducts an annual interview with participants at 15 clinical sites in Ontario. Public Health Ontario (PHO) analyzes linked diagnostic and viral load data for the provincial HIV Care Cascade. Our goal is to examine the representativeness of the OCS.
Methods: We examined the demographics of OCS participants who were active and consented as of 2021 compared to people living with diagnosed HIV in Ontario estimated by PHO in 2020. OCS and PHO data are compared by health region, key population and sex. PHO demographic and population data is collected through forms completed by testing providers, while the OCS captures it in a participant interview.
Results: Overall the OCS is fairly representative of the population of people living with HIV in Ontario, but there are key differences. The OCS over-represents Toronto and under-represents Central East and West regions. It represents gay, bisexual and other men who have sex with men well but under-represents people who use injection drugs. Both ACB and Indigenous participants are represented proportionally. The median age in the OCS is slightly higher than the province overall and the length of time living with HIV in the OCS is 18 years.
Discussion: OCS participants reflect people living with HIV in Ontario. More efforts should be made to improve geographic representation and recruitment from key populations.

Background
Treatment-related costs are a known barrier to antiretroviral therapy (ART) use by people living with HIV (PLWH). Canadian provinces and territories vary regarding ART-related costs for patients. This review summarizes the results of studies examining the impacts of free ART on care and related outcomes.

Methods
A literature review was conducted using Medline and Embase databases from 1996 onward, with the terms Anti-HIV Agents, Health Expenditures, Insurance, Pharmaceutical Services, HIV, Free, Low-Cost, Cost-Free and Full Coverage. Papers were included if they were original articles in English or French that focused on PLWH receiving free ART compared to those who paid a fee. Studies were excluded if free ART was offered as part of a bundle of free services, limiting attribution of effects on care and ART-related outcomes.

Results
A total of 21 studies reporting on free ART were found (Table 1). Most papers focused on adherence to ART, showing better outcomes with free ART (10/13). Five studies reported on the impact on retention in care, followed by viral suppression (3), mortality (2), and CD4 cell count (1). Most studies reported favourable effects results. Of the studies in high-resource country populations (5), 4 reported on adherence to ART and 2 on viral suppression.

Conclusion
Free ART appears to result in better adherence, retention in care, virologic control and reduced mortality. Efforts to increase the knowledge base, especially in high-resource countries, are needed to determine how free ART could help achieve the United Nations' 95-95-95 targets by 2030.

Background: The I’m Ready program provides participants with access to free HIV self-test kits for delivery or pick-up at participating locations across Canada. I’m Ready, Talk is a secure telehealth platform where participants can book an appointment with peer navigators (PNs) who counsel and support participants before, during, and after their HIV self-test. This study describes the uptake, satisfaction, and evaluation of the peer navigator program.

Methods: Evaluation of the program included the number of appointments booked, attended, mode, and the reason for appointments between June 2021 to December 2022. An optional post-test survey (n=1,269) collected information on demographics and satisfaction with the platform and with the PNs.

Results: Of the post-test respondents, 195 (15%) reported that access to PNs was the greatest benefit of the platform. Of 172 scheduled appointments, 80 were attended. Appointments were conducted predominately in English (<1% French), with 79% via message chats and 21% by video. There were 31 appointments booked for pre-test support and 40 booked for testing and post-test support. Of the 39 participants who engaged with PNs and provided post-test survey feedback, the majority were between 18-34 years old, self-identified from a key HIV population, and from large urban areas. Most participants (>80%) reported high levels of satisfaction with the I’m Ready, Talk platform, citing the knowledgeability of the PNs as a primary reason, and would use the platform again or recommend it to others.

Conclusion: Participants utilizing I’m Ready, Talk were satisfied with the platform and support received. Although peer navigator services were widely available, the program was underutilized. This may suggest that most participants reached so far felt comfortable with using an app to access self-testing and related resources and supports. More work is needed to determine who we may not be reaching who could benefit from peer navigator supports.

Background: Observational epidemiologic evidence relating to advances in antiretroviral therapy has helped turn HIV into a chronic manageable condition in Canada. However, the benefits of randomization within a randomized controlled trial (RCT) remain difficult to mimic in observational data analyses. Therefore, as we continue to shift into new HIV treatment eras (i.e., two-drug regimens, long-acting injectable therapies), RCTs will remain necessary to evaluate the safety and effectiveness of novel treatments/interventions. To ensure timely and valid evidence is generated to inform the care of people at risk of, and living with HIV, researchers must continue to use tools in both the experimental and observational epidemiology domains.

Discussion: Pragmatic RCTs (PRCTs), sometimes referred to as “real-world” trials, combine elements of traditional trials (i.e., randomization) with observational data. PRCTs are frequently embedded within routine clinical care and, therefore, can leverage routinely collected health data (e.g., provincial administrative health data). It is known that the secondary use of these observational data expedites the trial and greatly reduces costs; this is particularly true in settings where organizations such as (but not limited to) Population Data BC (British Columbia) or ICES (Ontario) can facilitate administrative data linkages to the individuals (or clusters) involved in randomization. Nevertheless, while PRCTs are an established tool, they were, historically, vulnerable to unaddressed post-randomization confounding (from incomplete adherence to the treatment/intervention), selection bias (from losses to follow-up), and ethical complexities. More recently, however, methodological innovations, often from causal inference efforts in observational research, and modernized ethical guidelines (tailored to PRCTs) are becoming available.

Conclusion: Given the current advances in PRCT methodology and ethics, as well as the expanding administrative health data research infrastructure in Canada (e.g., HDRN Canada: www.hdrn.ca), it is an opportune time for those involved in HIV research to consider whether their research objectives can be met using PRCTs.

Introduction: Gay, bisexual and other men who have sex with men(GBM), particularly those living with HIV, commonly report using cannabis for recreational and medicinal purposes. We examined the impacts of the October 2018 Canadian cannabis legalization and the COVID-19 pandemic on cannabis-use and problematic cannabis-use among GBM in Montreal, Toronto and Vancouver.
Methods: Sexually active GBM, aged ≥16 years, were recruited through respondent-driven sampling beginning in February 2017. Participants completed a computer-assisted self-interview every 6-12 months until August 2022 which included the Alcohol, Smoking and Substance Involvement Screening Test(ASSIST). Cannabis-related ASSIST scores ≥27 indicate a high risk of dependence/actual dependence (termed “problematic use”, hereafter). The analysis was restricted to participants recruited before November 2018 with ≥1 follow-up visits. We examined trends in cannabis-use in the previous six months (P6M) and problematic-use in six-month periods using logistic regression and frequency-of-use using ordinal regression. We conducted sub-analyses with time-periods further divided into before COVID-19(February 2017-March 2020) and after (June 2020-August 2022).
Results: 950 participants in Montreal, 258 in Toronto, and 387 in Vancouver met our inclusion criteria. P6M cannabis-use at enrollment was 47.9% in Montreal, 61.6% in Toronto, and 55.7% in Vancouver (p<0.001). Problematic-use ranged between 8.5-11.6% of users (p=0.187). Across all cities, any cannabis-use P6M was unchanged from February 2017-March 2020 (Odds Ratio [OR] 1.03; 95% CI 0.98-1.09), but declined after March 2020 (OR=0.82; 95% CI 0.74- 0.91). More frequent consumption increased from February 2017-March 2020 (OR= 1.07; 95% CI 1.01 - 1.14), but remained unchanged thereafter (OR= 0.99; 95% CI 0.89- 1.11). Problematic-use was unchanged (OR= 0.94; 95% CI 0.88-1.01) over the entire study period, as well as before and after COVID-19.
Conclusion: We found limited impact of cannabis legalization in terms of cannabis-use and use decreased after COVID-19. Neither legalization nor COVID-19 appeared to have any impact on problematic-use.

Introduction: Racial discrimination - unequal treatment because of race/ethnicity - can have deleterious effects on the health of those who experience it. A large proportion of women living with HIV (WLWH) in Canada are Indigenous; African, Caribbean and/or Black (ACB); or otherwise racialized. However, scarce literature has assessed the prevalence of racial discrimination among WLWH. Here, we estimated the prevalence of experiencing racial discrimination among women of different ethno-racial backgrounds, comparing WLWH and people without HIV (comparators).

Methods: WLWH and comparators (cis/trans inclusive) aged ≥16 years in BC and spoke English were included. Racial discrimination was measured using the 9-item Everyday Discrimination Scale-Racism (EDS-R) (Cronbach’s α=0.96) which captures self-reported frequency of racially discriminatory experiences in various everyday situations. Participants responded to each item from ‘never’=1 to ‘almost every day’=6, with higher scores representing more discrimination. Comparisons of EDS-R scores by HIV-status and ethno-racial group used t-tests and ANOVA.

Results: We included 153 (40.3%) WLWH and 225 (59.7%) comparators, (mean age 46.9, SD =14.0 years). Among them, 157 (41.3%) identified as White, 33 (8.7%) as ACB, 110 (28.9%) as Indigenous, 78 (20.5%) as mixed/other racialized. Prevalence of ever experiencing racial discrimination (EDS-R>9) was 97.0%, 90.0%, 88.5% and 47.1% among ACB, Indigenous, other racialized and White women respectively. These rates are much higher compared to findings from the 2019 Canadian Community Health Survey. ACB and Indigenous women reported the highest mean scores [SD] (30.0 [11.2] and 29.4 [13.4] respectively) followed by other racialized (22.4 [11.0]) and White (15.2 [9.1]) women, F(3, 374)=41.91, p<0.001. Mean scores among WLWH and comparators were similar (21.60 [13.0] and 22.67 [12.6]).

Conclusion: Experiences of racial discrimination are high among racialized WLWH, particularly ACB and Indigenous. Future analyses with larger samples are warranted to investigate the impact such racial discrimination may have on priority health areas for WLWH

An estimated 18.2% of men who have sex with men (MSM) in Kenya are living with HIV, among whom, an estimated 62.2% remain undiagnosed. To help prioritize and tailor access to HIV testing, we developed a screening tool that could be applied by programs during outreach activities to identify MSM at greatest risk of undiagnosed HIV.

We analyzed data from two rounds of a community-led, bio-behavioural survey of MSM from three counties in Kenya (Kisumu, Kiambu, Mombasa). We defined undiagnosed HIV using self-reported HIV status and dried blood spot HIV antibody test. We selected candidate predictor variables based on established association with HIV prevalence and which could be easily determined in the field. Then we derived a risk score from coefficients of individual key predictor variables retained in a logistic regression model, following stepwise variable selection. We then developed the screening tool using data from Kisumu and Kiambu, and validated tool performance using data from Mombasa.

Four variables associated with undiagnosed HIV were included in the final tool: ever registered with an MSM-focused HIV service program [odds ratio (95% confidence interval): 2.49 (1.60-4.05)]; meeting sex partners via virtual or both virtual and physical venues [2.60(1.56-4.61)], any experience of verbal/physical assault/abuse in the past year [1.82(1.30-2.55)]; and sexual positioning as predominantly receptive or both receptive and insertive [2.13 (1.51 - 3.06)]. The tool achieved 75.6% sensitivity and 53.4% specificity on the validation dataset. Having a risk score cut off of at least 1 was associated with sensitivity of 96%. Based on the estimated population size (32,600), HIV prevalence (16.8%), and undiagnosed fraction among MSM in Kenya (62.2%), the tool has the potential to help reach 2,311 MSM with undiagnosed HIV.

We developed a 4-question screening tool that could help in prioritize MSM for tailored HIV testing and related services.

Background
Ottawa implemented a PrEP clinic and referral process by public health nurses (PrEP-RN) in 2018 in Ottawa, Canada. These efforts contributed to an increase in the number of persons using PrEP from 110 in 2016 to over 1000 persons in 2021, and a 6-fold increase in the PrEP-to-need ratio since 2017. This study examines if the increase of PrEP uptake in Ottawa is coincident with a decrease in new HIV diagnoses.


Methods
The following variables were extracted from HIV cases reported in Ottawa from January 1, 2017-December 31, 2022: demographics (age, ethnicity, sex, country of birth), risk factors (sex of partners, drug use, STIs) and prior HIV diagnosis and entered data into a RedCap database Test positivity is calculated by dividing the number of diagnoses by the number of HIV tests in Ottawa (excluding prenatal tests). We analyzed trends in test positivity over time using a Cochran-Armitage test.

Results
Between PrEP-RN launch, August 5, 2018 and the end of this study period, 1901 persons were offered a PrEP referral, of which 44% (n=845) accepted and 96% (n=812) were MSM. Over the study time period, first-time HIV diagnoses in Ottawa (n=154) decreased across HIV risk categories, but was significant only among MSM (p<0.05). Analysis of test positivity showed a significant decreases for males (p<0.05) and MSM (p<0.01). While diagnoses by race, age and sex demographics were stable over time, there was an increase in the number of diagnoses among people born outside of Canada (p<0.05).


Conclusions
PrEP-RN implementation and broader PrEP uptake in Ottawa, Canada coincided with decreases in new HIV diagnoses among MSM, but no other groups. While these findings cannot causally link PrEP-RN or PrEP with this outcome, these changes in HIV epidemiology in Ottawa are coincident with PrEP uptake among MSM.

Introduction: In response to increased HIV prevention efforts (PEP and PrEP), HIV rates in Ontario have decreased among gay and bisexmen. By extension, the proportion of first-time HIV diagnoses in females has increased, prompting concern for ongoing HIV transmissions. Presently, uptake of HIV prevention services among persons who identify as women* is limited, largely due to variability of HIV-specific risk factors.

Methods: To explore HIV prevention use among women*, a retrospective review was completed of participants in a nurse-led HIV prevention service (PrEP-RN) in Ottawa, Canada.

Results: Findings showed 10.5% uptake for PEP and 3.3% uptake for PrEP among women*. For PEP, 32 women* presented for assessment and 25 were initiated. Most PEP initiations were made following a potential sexual exposure to HIV, 36% involved a partner who was HIV-positive and not virally suppressed. For PrEP, offers for referral were made to 59 women*; 28 declined and 31 accepted. Among women* who declined PrEP, 32% were HIV contacts and among those who accepted, 80% were due to reported sexual or substance use practices. The highest PrEP engagement occurred among women* receiving services in a safer opiate supply program.

Conclusions: The high uptake of PEP suggests this could be a useful first-line approach to reducing HIV transmission rates in women*. In addition, women* receiving PrEP could benefit from a more supportive approach to care, including assistance with mediation use and regular contact with nurses. In using a more collaborative approach to HIV prevention care, progress can be made in addressing ongoing HIV inequities among women*.

Introduction: Current clinical guidelines and research tends to focus on indications, recommendations, and uptake of HIV PrEP among groups known to be at increased risk for HIV acquisition, such as gbtMSM. Less, however, is known about the outcomes of PrEP offers, including patients’ rationale for declining PrEP referrals or the effectiveness of multiple PrEP offers to persons at elevated risk for HIV. This study presents on the responses of gbMSM to multiple offers for PrEP referrals.

Methods: In Ottawa, Canada, we instituted Canada’s first nurse-led PrEP program, known as PrEP-RN. As part of this service, public health nurses specializing in sexual health offered PrEP referrals to persons with indicators for HIV. Responses to these offers (as accepted, declined, or ineligible) were logged in a database and assessed for multiple occurrences based on chart number. We also recorded the number of recorded HIV diagnoses among participants who were offered PrEP. Data was analyzed using descriptive statistics.

Results: Data from August 2018 to August 2022 yielded 636 instances of multiple PrEP offers made to 263 unique patients, of whom, 99% percent identified as male and gbtMSM. Of the 223 eligible patients, 48% accepted after multiple offers and 52% declined after multiple offers. Seven unique trajectories for accepting or declining were identified. We noted 5 HIV diagnoses during the study period: 2 were among patients who declined PrEP more than once and 3 were identified at PrEP intake among patients who accepted after a single offer, yielding an overall diagnosis rate of 1 in 156 for the sample.

Conclusions: Using a similar approach to smoking cessation, providers can ask patients about PrEP, advise on its risks/benefits, and assist in making referrals where indicated. Repeating these at every clinical encounter could help to increase PrEP uptake and reduce HIV diagnoses among at-risk gbtMSM.

Background: While new HIV diagnoses occur unabated, in Canada an estimated 11% of persons living with HIV remain unaware of their status. Moreover, there are social and economic challenges to accessing in-person HIV testing services, particularly among marginalized and at-risk population groups. These barriers were made more prominent as a result of COVID-19, where access to STI/HIV screening was greatly reduced. In response to the foregoing issues, we implemented Canada’s first at-home HIV self-testing service, GetaKit.

Methods: GetaKit is a prospective cohort study, led by nurse researchers with the University of Ottawa in collaboration with the Ontario HIV Treatment Network. The research operates through a web-based platform (GetaKit.ca), which uses a unique algorithm developed by the team to assess HIV specific risk factors and indications for HIV testing. Self-test kits are available for free to eligible participants. In addition, GetaKit has partnered with several AIDS Service Organizations throughout Ontario who distribute kits locally and provide supports/resources to participants.

Results: GetaKit launched in July 2020 in Ottawa and expanded to Ontario in April 2021. To date, we have distributed over 5000 self-testing kits. Of those who ordered a kit, 81% identified as belonging to an HIV priority population group and 26% reported having never completed HIV testing in their lifetime. Results were reported by 59% of participants who completed testing of which, 70% reported a negative HIV test. Eighteen participants were found to be HIV-positive through GetaKit, all of whom were linked to HIV treatment/care.

Conclusions: Our findings from the GetaKit study to date shows high uptake among persons from priority groups and first-time testers, suggesting that self-testing may be a useful to identify HIV infection among persons who are unaware of their status and to provide linkage to HIV prevention or treatment/care.

Background: Many gay, bisexual and other men who have sex with men (GBM) who may benefit from better HIV prevention strategies are unwilling to use PrEP. At the same time, some health care providers do not feel confident counseling about PrEP. Our aim is to develop a tool to assist health care providers in counseling about PrEP.

Methods: We compiled findings from the PrEP implementation project (PRIMP) and drew from relevant literature on theories of change including: the information-motivation-behavioral skills model; the social cognitive model; the theory of planned behavior; and Fishbein’s integrative model. Using those elements, we proposed a framework to guide the development of a counseling tool to assist clinicians in discussing PrEP with potential users.

Results: Our framework consists of four sections. In the first two sections, we address (a) values and (b) information about risk, which together determine whether individuals perceive the need for changing their strategies to stay HIV-negative, including using PrEP. In the second section, information about side effects and cost of PrEP influence the transition from perceived need to intention to use PrEP. In section three, we consider common concerns among GBM: mental health and substance use. In section four, we propose that the ability to seek/start PrEP is influenced by (a) self-efficacy skills and (b) external facilitators, including specific information and organizational features.

Discussion and Conclusion: Interventions to increase PrEP uptake should be theory informed. This framework will be discussed with healthcare partners and community members, and tested among providers and users.

Introduction: Pre-exposure prophylaxis (PrEP) effectively prevents HIV acquisition; measuring trends in uptake is important to inform planning for HIV prevention programs and policies. The PrEP-to-need ratio (PnR) is a construct used by public health organizations such as the US Centers for Disease Control to explore disparities in provision across geographic areas and demographic categories (e.g. age/sex). We aimed to estimate PrEP-use prevalence and PnR for nine Canadian provinces by year (2018-2021), sex, age group and province.  

Methods: Annual estimates of persons taking PrEP were generated using IQVIA’s geographical prescription monitor dataset for eight provinces. PrEP use in British Columbia (BC) was provided by the BC Centre for Excellence in HIV/AIDS. The PnR was defined as the number of PrEP users divided by new HIV diagnoses. Data on new HIV diagnoses was obtained from the national HIV Surveillance System.

Results: The estimated number of PrEP users increased steadily over the study period, with an annual percentage change of +19.7%. The estimated PrEP-use prevalence was 69.9 per 100,000 persons (range across provinces: 15.9/100,000 in Manitoba (MB) –107.6/100,000 in BC) and the PnR in 2021 was 16.8 (range across provinces: 1.5/100,000 in MB –37.7/100,000 in BC). The number of people taking PrEP, PrEP-use prevalence and PnR were the highest among aged 30-39 years, and higher among males compared to females (approximately 98.0% of people on PrEP).

Conclusion: The use of PrEP increased steadily from 2018 to 2021, and uptake varied across age groups, sex and geography.  As PrEP use increases, the PnR increases, however there is no known threshold for PnR and its impact on HIV incidence. PnR may be a useful measure to assess PrEP as a prevention strategy; however, it may not always provide the detail needed to inform prevention programs and policies, especially when information on key populations is unavailable.

Background: Canada legalized cannabis for medical purposes in 2001 and for recreational purposes in 2018. Our aim was to produce a comprehensive profile of Ontarians living with HIV who use cannabis for medical or recreational purposes to document their post-legalization needs.

Methods: Participants were recruited from the Ontario HIV Treatment Network Cohort Study, a multi-site clinical cohort. At their annual interview, those who reported using cannabis in the past year were invited to self-complete the Ontario Cannabis and HIV Survey. Items included patterns of cannabis use in the past year, since legalization, and since the COVID pandemic. We present descriptive statistics for the first survey respondents (2022/08/17 to 2023/03/17); recruitment is ongoing.

Results: Among 117 respondents, 81% were male, 73% were white, and 40% were employed full-time. Respondents reported cannabis use in the past year for: recreational purposes only (51%), medical purposes only (11%), or both (38%) (Table). When asked how legalization impacted use, 34% used more frequently (11% less) and 28% used greater amounts (9% less) due to easier access to safer products and greater social acceptability. When asked how the COVID pandemic impacted use, 30% used more frequently (4% less) due to stress/anxiety, pleasure, boredom, and loneliness.

Conclusions: These preliminary findings provide a rare documentation of cannabis use among people living with HIV. Use patterns were broadly similar for medical and recreational purposes, although daily use was reported more for medical use and edibles and beverages were reported more for recreational purposes.

Background: GetCheckedOnline, BC’s online sexually-transmitted and blood-borne infection (STBBI) testing service, has been shown effective in improving testing access and is being scaled up in the province, with two waves of expansion from Vancouver to seven urban, suburban and rural communities. We assessed post-expansion implementation outcomes (awareness, use, and intention to use) in these communities.

Methods: Between July-Sept 2022, we conducted a cross-sectional survey in each community, recruiting in-person and online with oversampling among populations affected by STBBI. Eligible participants were ≥16 years old, sexually active, and BC residents. Questions evaluated awareness, use, and intention to use GetCheckedOnline; these outcomes and key sample characteristics are described.

Results: 1657 eligible individuals were recruited, of whom 67.0% (1099/1641) identified as White, 10.2% (151/1477) identified as trans and 53.0% (793/1496) as non-heterosexual, 39.1% (566/1447) had used illegal/non-prescribed drugs (past year), and 21.5% (315/1466) had ever been homeless. A fifth (20.7%, 319/1543) had never tested for STBBIs, and 66.8% (990/1483) reported experiencing barriers accessing provider-based testing in the past year (e.g., long wait times, not knowing where to access testing). Overall, 35.8% (584/1633) were aware of GetCheckedOnline, of whom 56.3% had used the service (324/576). These outcomes varied by wave of expansion: in Wave 1 communities (2016), awareness was 39.6% and use 60.1% among aware, versus 18.1% and 38.3% in Wave 2 communities (2019-2020), respectively. For 91.1% of participants (1334/1465), it was very easy/easy to go online when they needed to, and 63.1% (1020/1616) were very likely/likely to use GetCheckedOnline in the future.

Conclusion: Our study suggests GetCheckedOnline is improving access to STBBI testing in these communities, as half of people aware of the service had used it in a sample where barriers to accessing provider-based testing were common. Given high intention to use, further promotion of GetCheckedOnline to increase awareness may be beneficial.

Background: Two-Spirit, gay, bisexual, queer and other men who have sex with men, including trans men (2SGBQM) are disproportionately affected by HIV, representing half of newly diagnosed infections in Canada. New long-acting pre-exposure prophylaxis (LA-PrEP) options, including injectable cabotegravir (CAB-LA) hold substantial promise in addressing ongoing HIV transmission.

Methods: The Future of PrEP is Now aims to prepare for the approval of “long-acting” (LA) PrEP in Canada by better understanding 2SGBQM community needs and preferences for accessing and taking LA-PrEP. As the first component, we conducted focus groups and interviews to understand 2SGBQM community perspectives regarding LA-PrEP. We prioritized 2SGBQM who are: Indigenous and Two-Spirit, African, Caribbean, and Black, persons of colour, transgender, non-binary, people living in remote/rural areas, and/or people who use substances. Participants were recruited via our and partner organizations’ social media channels and prior study participants. We conducted a thematic analysis of focus group and interview transcripts.

Results: Participants (n=50) of focus groups and interviews faced barriers in accessing and taking oral PrEP, such as a lack of access to culturally-sensitive healthcare providers, adherence, cost, stigma, and insufficient information about PrEP. Most participants expressed their interest in CAB-LA and thought having the option would be beneficial for addressing some of these barriers such as adherence and stigma. However, many participants wanted to learn more about LA-PrEP such as price, how to take it, efficacy and safety, and mentioned that LA-PrEP would need to be accessible and affordable for everyone.

Conclusions: Our results were consistent with past studies regarding barriers to oral PrEP, particularly among marginalized populations within 2SGBQM communities, and suggested CAB-LA may help address some of these barriers. However, to maximize the benefits of CAB-LA, current fundamental access barriers for PrEP such as accessibility and affordability must not be recreated in the implementation of CAB-LA.

Background: Two-Spirit, gay, bisexual, queer and other men who have sex with men, including trans men (2SGBQM), are disproportionately affected by HIV, representing half of newly diagnosed infections in Canada. Long-acting pre-exposure prophylaxis (LA-PrEP) options, including injectable cabotegravir (CAB-LA) hold substantial promise in addressing ongoing HIV transmission. However, there is a need to increase awareness among 2SGBQM communities.

Methods: We conducted three, free 1.5-hour webinars on PrEP between DEC 2021-JUN 2022 as part of launching ‘The Future of PrEP is Now’, a community-based study that aims to prepare Canada for the arrival of LA-PrEP. The first webinar described current PrEP options and regimens, barriers to access, and gaps in HIV prevention work. The second and third webinars (one in English, one in French) described future PrEP options, particularly CAB-LA for people not currently reached by oral PrEP. The webinars included presenters from clinical, academic, and community settings. We examined the post-webinar evaluation surveys, which asked about the overall effectiveness of the webinars.

Results: The three webinars were attended by 105, 244 and 25 participants, respectively. Of those who completed an evaluation (n=76), 100% thought the webinars were well presented and appropriate for them. Additionally, 99% indicated that the webinar presenter(s) was knowledgeable about the topic discussed and an equal proportion (99%) reported an increased knowledge of PrEP. The vast majority of participants also indicated intending to use the knowledge gained from the webinars.

Conclusion: A lack of knowledge about PrEP among 2SGBQM is a common PrEP access barrier. Results of this evaluation demonstrate the effectiveness of community-oriented didactic webinars as a way to increase health literacy among 2SGBQM. Our results show the value of incorporating community education webinars in community-based research and how knowledge translation and exchange can be enhanced by integrating KTE throughout a project’s lifespan.

Introduction : Les recommandations canadiennes pour l’alimentation des nourrissons nés d’une FVVIH privilégient l’utilisation de la préparation commerciale (PC) et appuient sa gratuité. Ainsi, le P3CN a vu le jour au Québec en avril 2021 pour rendre disponible gratuitement cette PC aux familles éligibles.

Objectifs: Évaluer l’implantation du P3CN pour nourrissons nés de FVVIH au Québec.

Méthodes: Etude mixte convergente s'appuyant sur le cadre écologique d’implantation des programmes décrit par Joseph A Durlak et l’analyse comparative fondée sur le sexe et le genre Plus de l’Agence de santé publique du Canada. Les données quantitatives ont été extraites du registre périnatal du VIH au Québec (CIME-Q) et du registre du P3CN. Les données qualitatives ont été collectées via des entrevues semi-dirigées de vingt bénéficiaires et neuf acteurs (coordinatrices et pharmaciens) et les verbatims analysés par thèmes en utilisant une approche inductive et déductive.

Résultats: En considérant l’éligibilité des FVVIH ayant donné naissance à partir d’avril 2019, le P3CN a rejoint 173 familles sur 204 naissances au Québec, dont dix qui ont bénéficié conjointement du P3CN et d’un autre programme, et cinq bénéficiaires d'un autre programme. L’implantation du programme est influencée par des facteurs contextuels notamment les systèmes d’informations et les relations sociales, le soutien financier qu’offre le P3CN aux bénéficiaires malgré les délais de remboursement. Plusieurs adaptations ont été nécessaires soit le choix du mode de remboursement, les moyens de communications à privilégier, la possibilité de récupérer la préparation commerciale dans le centre affilié. La disponibilité des ressources, la cohésion de l’équipe sont des éléments facilitants soulignés par les coordinatrices. Les pharmaciens optent pour une entente simple permettant l’atteinte des objectifs du programme.

Conclusion: Le P3CN est accessible aux familles éligibles qui ont en général une expérience positive. La documentation de l’expérience des bénéficiaires et des acteurs permettra d’améliorer le P3CN.

Introduction:
People who inject drugs (PWID) are disproportionately affected by HIV and Hepatitis C infections. Estimating the size and distribution of this population is essential in monitoring infectious disease rates and progress towards elimination targets.

Methods:
We estimated numbers of people with 1) a lifetime history of injection drug use (IDU) stratified by sex, and region and 2) IDU within the past 12 months, stratified by sex, using combined weighted Canadian Community Health Survey (CCHS) cycles (2019-2021). We applied the weighted prevalence of IDU to the 2021 Statistics Canada national population size estimate of individuals aged 15yrs+. Further adjustments were made using external data to account for populations not included in the CCHS sample frame (Indigenous Peoples living in a First Nation (on-reserve) community, active military personnel, people experiencing unstable housing, and people who are incarcerated), and to account for false-negative self-reporting of IDU on surveys.

Results:
In 2021, the estimated number of PWID (lifetime) was 373,820, representing 1.15% of the Canadian population 15yrs+. Among these 69% were male, and 31% were female. The estimated number of PWID (past 12 months) was 76,500 or 0.24% of the population, of which 56% were male, and 44% were female. The highest prevalence of lifetime PWID was estimated in British Columbia at 1.59% (72,090), followed by the Prairie provinces at 1.21% (70,010), Quebec at 1.12% (81,950), Ontario at 0.86% (109,380), and the Atlantic provinces at 0.84% (18,150).

Conclusion:
Estimates of PWID at the national and regional levels can be used to inform policy and programming to reduce the impact of HIV and Hepatitis C among PWID. Further work is necessary to refine the methodology and to validate these estimates.

Introduction
Memory and other cognitive problems can persist in persons with HIV despite antiretroviral treatment. One of the most common comorbidities in PWH is depression, which itself has known effects on memory functions. Our objective was to conduct an up-to-date systematic review on memory functions in treated HIV, comparing PWH with or without comorbid depression. We also examined relationships between memory and depressive symptoms in cross-sectional and longitudinal HIV-studies. Our working hypothesis was that comorbid depression should be associated with lower memory performance in PWH.
Methods
The review was conducted following the PRISMA guidelines, with searches in eight databases. Outcomes were a) differences in memory performance in group designs (PWH vs. PWH and depression), b) relationships between depression severity and memory in PWH, c) longitudinal memory performance by ongoing or acute depressive symptoms in PWH. If reported, we also extracted normative memory performance.
Results
We identified 1611 papers. After removal of duplicates, title/abstract screening (996) and full text review (85), 27 studies were included. Of studies that compared memory between depressed and non-depressed PWH, 28% (4 of 14 studies) showed lower memory in depressed PWH. Correlations between depression severity and memory were negative in 37.5% (6 of 16) of the examined relationships. Of the longitudinal findings, 50% (3 of 6) showed worse memory over time with concurrent or ongoing depression in PWH. Interestingly, in 76.9% of the 13 studies reporting normative memory scores, memory was normal regardless of depression status.
Conclusion
About a quarter of cross-sectional findings point to memory reductions in PWH with, compared to without comorbid depressive symptoms. Longitudinal findings were scarce and extracted from partially overlapping cohorts, but thus far point to more a definitive role of depressive comorbidity in memory functions over time. Longitudinal studies from more diverse cohorts are required to solidify these findings.

Objective: The illicit drug toxicity crisis in British Columbia (BC) has reduced the survival gains among people living with HIV (PLWH) achieved by antiretroviral therapy. We examined opioid agonist therapy (OAT) uptake and correlates of retention in OAT among a cohort of PLWH over a 21-year observation period.
Methods: We analyzed data from the Seek and Treat for Optimal Prevention of HIV/AIDS database between April 1996 and March 2017. PLWH with known gender, age of ≥19 years old, ≥12 months of follow-up, and at least one OAT dispensation were included. OAT treatment episodes with no interruptions in the prescribed doses lasting ≥ 3 days for methadone (the first line of treatment in BC until July 2017), or ≥ 6 days for buprenorphine/naloxone (introduced to BC in 2008) were constructed. Retention in treatment was calculated as no interruption in the prescribed doses for ≥12 months. We examined annual trends in retention. Correlates of retention were modeled using the generalized estimating equation method.
Results: Among 13,433 PLWH in the cohort, 2,151 (16.0%) had at least one OAT dispensation. Retention declined by 1.34 units per year (p<0.0001). In the overall sample, during the first OAT episode, 42.9% (n=923) reached the therapeutic dose (≥ 60 mg for methadone [n=904], ≥ 12 mg for Buprenorphine/Naloxone [n=19]). Correlates of 12-month retention are presented in table 1.
Conclusion: We found a decline in OAT retention among PLWH. Optimal management of opioid use disorder among PLWH aimed at maximized retention and reaching a therapeutic dose is necessary.

Background: Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) is a program conceptualized by the BC Centre for Excellence in HIV/AIDS (BC-CfE) that aims to expand HIV testing, care, and treatment in British Columbia (BC), Canada. In 2013, a process monitoring strategy was implemented to assess the benefits of this initiative. The original monitoring report included 13 HIV-related surveillance and treatment indicators, which have been published quarterly in all BC health authorities ever since. However, due to changes in the clinical and demographic characteristics of people living with HIV (PLWH), and to the standards of care for HIV in BC, this report needs to be updated.
Methods: A working group of representatives from the BC-CfE, BC Centre for Disease Control (BCCDC), First Nations Health Authority, and each of the five regional health authorities collaborated on an updated monitoring report. A total of 31 indicators were proposed and assessed based on the following criteria: data quality, validity, scientific evidence, relevance for current clinical care and public health, feasibility, confidentiality, accuracy, and administrative requirement. Once these indicators were finalized, a draft report was created using patient data from the BC-CfE, BC Ministry of Health, and BCCDC.
Results: Of the 31 proposed indicators, 16 were chosen to monitor the results of the STOP HIV/AIDS program. The new report includes modified indicators of HIV testing, disease progression, and the cascade of care, as well as new indicators of the standard of care, viral load levels, and opioid agonist therapy among PLWH. The draft report of these indicators reflects the positive impact of HIV interventions in BC.
Conclusions: We have adapted the STOP HIV/AIDS monitoring strategy to reflect the current landscape of HIV in BC. The continued monitoring of the STOP HIV/AIDS program is essential for optimizing health outcomes and program efficiencies.

Background: Pre-exposure prophylaxis (PrEP) is safe and effective at reducing the risk of HIV acquisition;
however, its success has been hindered by several factors, including inadequate drug access. We sought
to describe the variability in eligibility criteria and reimbursement policies across Canada's public drug insurance programs for tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) for PrEP and in potential
projected out-of-pocket costs for individuals accessing these programs.
Methods: In January 2022, we reviewed restrictions for prescribing TDF/FTC for PrEP and subsidies to
offset its costs across Canada’s provincial and territorial drug insurance programs. To illustrate the economic effects of different programs, we considered 2 hypothetical scenarios: a 23 and a 35-year old person from different households, earning a yearly income of $40,000 and $80,000, respectively. We applied the cost-sharing rules of each jurisdiction to calculate each person’s estimated annual expenditure for daily PrEP.
Results: The scope of coverage for PrEP varied greatly depending on geography, age, and income. Of the 13 jurisdictions, British Columbia, Alberta, Saskatchewan, Prince Edward Island, and the three territories offered universal coverage with no co-pays or deductibles, although in three regions, PrEP was restricted to individuals meeting specified criteria. In the remaining provinces, there were inter- and intra-jurisdiction variations in eligibility and out-of-pocket expenses ranged from 0 to 100% of drug costs. Despite the existence of a drug program, our higher income case would be required to pay the full cost of TDF/FTC in Ontario, Manitoba, Nova Scotia, and Newfoundland and Labrador.
Conclusions: There is substantial variation in access to PrEP across Canada, both in eligibility criteria and the subsidies offered by public plans. Providing universal access to PrEP to all individuals living in Canada would remove critical financial barriers to accessing this proven biomedical intervention and
could be an essential component of eliminating new HIV infections in Canada.