Background: Street-connected and homeless youth face barriers to HIV testing in both Kenya and Canada, including discrimination, stigma, and lack of health insurance. To address these barriers, we adapted and scaled a peer navigator program to five sites in Kenya and Canada. The purpose of this analysis is to describe the first two years of program uptake and factors associated with HIV testing.

Methods: Six peer navigators with lived experience of being street-connected or homeless were hired and trained in Kenya (Eldoret, Kitale, Huruma) and Canada (Toronto, London). Beginning in 2021, the peer navigators enrolled youth aged 16-29 and completed encounter forms at enrolment and each follow-up. Descriptive statistics were used to characterize the participants and the factors associated with HIV testing.

Results: The peer navigators enrolled 583 youth in Kenya (42% cisgender women) and 40 youth in Canada (63% cisgender women). In Canada, 73% of participants identified as 2SLGBTQ+. The median age of Canadian participants was 24 (IQR: 21-27); in Kenya it was 22 (IQR: 19-27). At enrolment, 65% of Kenyan and 75% of Canadian participants had previously been tested for HIV and 11% and 13%, respectively, were living with HIV. After two years, 95% of Kenyan participants and 80% of Canadian participants had been tested. In both countries, the median age of participants tested for HIV was higher than among those not tested (p-values <0.02). In Kenya, participants at the Eldoret site (p<0.01) and women (p<0.001) were most likely to get tested.

Conclusions: The peer navigators were successful at connecting youth to HIV testing despite ongoing external factors such as the COVID-19 pandemic and an HIV test kit shortage in Kenya. Peer navigators play an important role in increasing youth access to sexual health services, though more attention is needed to ensure equitable access for all youth.

Canada faces an ongoing drug poisoning crisis, yet research on overdose among women living with HIV (WLWH) remains limited. Previous studies highlight how social-structural factors including gender-based violence (GBV) and criminalization, highly overrepresented among WLWH, increase women's vulnerability to overdose. This study therefore examined the prevalence and social-structural correlates of overdose among WLWH.

The analysis drew on data (2015-2022) from a cohort of cis and trans WLWH in Metro Vancouver as part of the SHAWNA (Sexual Health and HIV/AIDS: Women's Longitudinal Needs Assessment) Project. Bivariate and multivariable logistic regression with generalized estimating equations (GEE) were performed to identify social-structural correlates of recent (last six months) unintentional overdose among WLWH who reported using criminalized substances (last six months). Adjusted odds ratios (AOR) and 95% confidence intervals are presented.

This study included 248 participants with 1303 observations over 7 years. At baseline, close to one third (31.9%) reported experiencing an unintentional overdose at least once in their lifetime, while one in ten (11.7%) reported overdose in the last six months (first available observation). In multivariable logistic regression with GEE, increased odds of overdose was associated with: previous unintended overdose (AOR:1.76 [1.09-2.83]), less than daily opioid use (AOR:2.64 [1.38-5.05]), suicidal ideations and/or attempts (AOR:1.95 [1.18-3.24]), and heightened GBV (two or more instances of physical, sexual and/or verbal violence) (AOR:1.94 [1.10-3.41]).

Findings underscore the need for HIV providers to screen for social-structural risk factors, namely overdose history, opioid use frequency, suicidality, and GBV. Comprehensive support is essential to reducing unintended drug poisoning, prioritizing trauma-informed care in harm reduction, mental health, and housing services. Urgent policy changes, like substance de-criminalization, are vital. Additionally, developing gender-specific harm reduction, such as supervised injection sites tailored for women and gender-diverse individuals within male-dominated spaces, is crucial to addressing intersections of power dynamics, violence, mental health, and substance use.

Introduction: The illicit drug toxicity crisis in British Columbia (BC) has worsened since the onset of the COVID-19 pandemic, significantly impacting high-risk populations who are vulnerable to comorbidities such as hepatitis C virus (HCV). Using a syndemics lens, our analysis aims to understand the potential impact of COVID-19 on drug use and harm reduction services, and to characterize patterns of unregulated substance use among people recently treated for HCV.

Methods: Data from the Preservation of Sustained Virologic Response (Per-SVR) study, a prospective cohort in BC characterizing healthcare engagement and outcomes among people recently treated for HCV, was used for this analysis. Study participants completed an interviewer-administered questionnaire at regular intervals for up to four years. For this analysis, participants who reported unregulated substance use and/or had a positive urine drug screening test result at baseline were included. Preliminary descriptive analysis and generalized trend estimating models were used to describe unregulated substance use patterns over time.

Results: Of 272 participants, 179 (65.8%) were men, 32 (12%) were recently homeless, and 128 (47.1%) lived in Vancouver’s Downtown Eastside neighbourhood. Amongst opioid and stimulant polysubstance users 89 (68.4%) self-reported frequent daily use. At baseline, 122 (70.9%) opioid users were engaged in opioid agonist therapy, but stimulant users did not access any stimulant therapies. In 2020, the majority of people injecting fentanyl or heroin transitioned from infrequent use to frequent daily use, which remained true over time.

Conclusions: We observed an overall increase over time on frequency of drug use, especially at the start of COVID-19, similar to other studies which have shown an increase in fentanyl and other unregulated drug use due to COVID-19. These results highlight the impact of COVID-19 on substance use and the importance of harm reduction services especially among populations affected by HCV.

BACKGROUND
We examined overdose-related hospitalizations among people living with HIV (PLWH) across Canadian provinces.

METHODS
We used data from the Canadian HIV healthcare use study (CHESS). This study contains hospitalization records for adults (≥20 years) with HIV in Canada who had at least one hospitalization between 2006-2020 during which HIV was documented in any of the discharge diagnosis fields. A hospitalization was classified as overdose-related if any of the following fields in a hospitalization record—most responsible diagnosis, pre-admission comorbidity, post-admission comorbidity, or service transfer diagnosis—contained an ICD-10-CA code indicative of drug poisoning. We estimated the rates of opioid, stimulant, and total overdose hospitalizations, using publicly available population estimates of PLWH by province to calculate person-years of follow-up between 01/04/2015-31/03/2020. Rate ratios were calculated using the hospitalization rates for Canada as the denominator.

RESULTS
We identified 855 overdose-related hospitalizations, of which 61.5% (526) were opioid-related and 29.4% (251) were stimulant-related. The highest rates of opioid, stimulant, and overall overdose hospitalizations among PWH were observed in Saskatchewan (Table 1). Higher rates of opioid, stimulant, and total overdose hospitalizations were also seen in the western-most provinces (British Columbia, Alberta, and Saskatchewan) compared to the national averages.

CONCLUSION
Our findings demonstrated that rates of opioid, stimulant, and overall overdose hospitalizations among PWH were highest in the western-most provinces. The rates may even be higher because our study did not account for hospitalizations of PWH who never had at least one HIV-related record in any of their previous hospitalizations throughout the study period.

Background: In Canada, PWLLE-I are disproportionately affected by STBBIs and are recognized as a key population in the Pan-Canadian STBBI Framework for Action, which highlights the need for evidence to guide action. We conducted a scoping review to explore the evidence on STBBI prevalence, risk exposure, prevention, testing and treatment among PWLLE-I in Canada.

Methods: We searched 6 databases for articles published between January 1, 2013 and September 13, 2023 reporting on STBBIs among PWLLE-I in Canada. For published abstracts, a search for full texts was conducted and, if not found, authors were contacted.

Results: 52 out of 426 screened records were included, of which the majority contained quantitative data only. Studies were largely conducted with one of three specific populations: people living with HIV (PLHIV), people who use injection drugs, and people who are currently incarcerated. Most studies focused on HIV and HCV, with few mentioning other STBBIs. Studies point to a higher prevalence of HCV and HIV among PWLLE-I than among the general Canadian population. Several studies with PLHIV found that the odds of optimal antiretroviral therapy adherence and the odds of HIV viral suppression were lower among PWLLE-I compared to those with no incarceration experience. Qualitative and quantitative data highlight challenges with continuity of STBBI care post-release. Limited data were found on the experiences of youth in correctional facilities, and PWLLE-I in the territories and Atlantic provinces. Trends in the past decade toward greater Ministry of Health responsibility for health service provision at provincial correctional facilities show promise in improving STBBI care.

Conclusions: Research published over the last ten years highlights the inequitable impact of STBBIs on PWLLE-I in Canada. Focused efforts are required to support PWLLE-I in accessing necessary prevention, testing, treatment and care for STBBIs both inside and outside of the corrections system.

Background: ‘Know Your Status’ (KYS) is a community-led program designed to improve education, testing, and treatment of HIV and STBBIs for on-reserve Indigenous communities. Wellness Wheel clinic (WW) delivers the program through a culturally responsive mobile medical model in remote and on-reserve communities across Saskatchewan.
Objective: To report the patient reported outcome measures (PROMs) to determine patient characteristics and experiences of the KYS program.

Methods: The PROMs were comprised of 6 validated survey tools. The tools surveyed demographics, alcohol dependency (AUDIT-C), substance use dependency (DUDIT-C), quality of life (EQ-5D-5L), personal agency questionnaire (PASI), Nature Connectedness Scale, Personal and Interpersonal Agency (PIAS – PASI & IASI), Quality of Life Questionnaire (QoL), Connectedness scale, and the post traumatic growth inventory questionnaire (PTGI). Survey tools were distributed with a letter of introduction and consent form by site nurses and returned to WW for data entry and analysis. Participation was voluntary and participants were remunerated.

Results: Surveys were completed by n=37 participants (female=19; male=18), mean age 45 (female=41; male=49), across three on-reserve communities. Analysis indicated similar responses between males and females, with divergence in four areas: 1. substance use dependency - females reported higher incidence of substance use dependency (14/19) compared to men (11/18); 2. self-reported health score – females scored higher (females=67; males=59); 3. personal agency - females scored higher at 3.24 compared to 3.19; 4. PTGI questionnaire - males scored lower than females in every category except Appreciation of Life. Nature Connectedness Scale was removed from analysis for low response rate.

Conclusion: Despite higher rates of substance use and poly-substance use, females reported greater positive change and better overall health. Reported alcohol use was low across the sample. Despite small honorariums, recruitment was difficult. The number of tools required to complete in one sitting may have contributed to the low response rate.

Introduction:
The postpartum phase represents a fragile period for the HIV care—a sequence encompassing linkage to care, retention in care, initiation of antiretroviral therapy (ART), and maintenance of an undetectable viral load. Unfortunately, no comprehensive exploration of these stages in the Canadian context exists to date. This study aims to describe the HIV cascade of care during the initial postpartum year in Ontario.

Methods:
A retrospective cohort study was performed by combining data from various administrative databases provided by the Institute for Clinical Evaluative Sciences (ICES). The study encompassed all adult women (≥18 years) with HIV who underwent live births in Ontario from 2013 to 2021. We assessed the proportions of women in the first three stages of the cascade and employed univariate and multivariate logistic regression analyses to identify factors influencing each stage.

Results:
Our cohort comprised 705 pregnancies from 527 women. Within this cohort, 42.0% of pregnancies achieved linkage to care, 28.1% were retained in care, and 82.1% were on ART. Notably, younger age (<25 years) correlated with a heightened risk of taking ART, whereas women with existing children demonstrated a protective effect (adjusted odds ratio [aOR]: 1.61). Residing in neighborhoods with a high ethnic concentration emerged as a protective factor for both linkage to care (aOR: 2.71) and retention in care (aOR: 3.32).

Conclusions:
Our results indicate low percentages for linkage to care (42%) and retention in care (28%) in the HIV care cascade. The ART uptake of 82% falls short of the international goal of 95%. Numerous sociodemographic factors, identified as barriers, warrant in-depth exploration through qualitative research. This nuanced understanding can inform targeted interventions to address the unique needs of those facing the most substantial challenges within the HIV care continuum.

Background: HIV viral load (VL) is a key predictor of long-term health for women living with HIV (WLWH). Here, we investigate how self-reported HIV VL in a cohort of WLWH in the BCC3 Study relates to women’s knowledge of their own key HIV-related health parameters, and whether it is associated with selected socio-demographic characteristics.
Methods: For women enrolled between March 2021-August 2023 (n=219), self-reported HIV VL (undetectable≤40 or detectable>40copies/ml) was compared to VL obtained from chart review closest to but before the date of self-reported VL. Sensitivity, specificity, predictive values and likelihood ratios were calculated overall and for socio-demographically defined subgroups.
Results: Ninety-five percent of WLWH (208/219) in the study estimated their most recent HIV VL via self-report, and 189/219 (86%) estimated it correctly. Among women who self-reported HIV VL, 200/208 (96%) were on antiretroviral therapy, half reported history of homelessness and 30% reported current substance use. Knowledge about “Undetectable=Untransmittable” was lower (4/10; 40%) among women who didn’t report their most recent VL than for those who did, 153/208 (74%). Importantly, self-reported undetectable HIV VL performed similarly across socio-demographic subgroups and showed high sensitivity (Table 1). Enacted, internalized, and disclosure concerns-related HIV stigma scores did not differ between women who estimated their HIV VL correctly or incorrectly.
Conclusions: Our findings replicate previous reports of high awareness about HIV VL by women in BC, despite high prevalence of adverse socio-demographic experiences in our cohort. Our data further suggest that despite highly stigmatized life experiences, WLWH in BC self-report their VL detectability reliably.

Introduction: The COVID-19 pandemic has significantly disrupted Canadian healthcare services, potentially compromising the management and prevention of infectious diseases like HIV. The study aimed to explore the impact of COVID-19 on the HIV incidence in on-reserve First Nations communities in northern Saskatchewan.

Methods: A retrospective analysis was conducted, utilizing healthcare information from northern Saskatchewan First Nations on-reserve communities between January 2019 and December 2020. HIV incidence rates one year before the pandemic (January to December 2019) were contrasted with the rates observed in the initial year of the pandemic (from January to December 2020). Demographic data, testing rates, and HIV diagnoses were analyzed descriptively to assess any substantial changes or trends. Furthermore, HIV-diagnosed cases in both periods were stratified by quarter, sex, and age and compared to detect differences.

Results: HIV testing fell by 28.6% during the COVID-19 pandemic. In addition, there was a 25% decline in the identification of new HIV cases among the northern Saskatchewan First Nations on-reserve communities, notably in the second quarter of 2020, when COVID-19 precautions and restrictions were intensive. In comparison to the pre-COVID-19 era, males had a 36% decrease in new HIV diagnoses, but females had no change. The number of new HIV cases among those aged 30 to 39 years and 40 to 49 years was reduced by 38% and 33%, respectively, compared to the pre-COVID-19 era. During the pandemic, the total number of new HIV cases detected in northern Saskatchewan's Far North Central, Far North West, and North Central areas decreased, while the Far North East region experienced an increase.

Conclusion: The COVID-19 pandemic has impacted HIV testing and diagnosis rates in First Nations on-reserve communities in northern Saskatchewan, emphasizing the need for sustained public health services during crises.

Introduction: Hospitalizations are a major component of healthcare utilization, particularly among people with chronic conditions, including people with HIV (PWH). In the Canadian Discharge Abstract Database (DAD), interhospital transfers appear as separate records – yet misclassifying transfers as independent hospitalizations can bias metrics such as readmissions. We examined approaches of combining sequential, related records into hospitalization episodes of care (HEoCs) among PWH and people without HIV (PWoH) in British Columbia (BC), Canada. Methods:Hospitalization records (1992 to 2020) were sourced from the Comparative Outcomes and Service Utilization Trends (COAST) study, a population-based BC data linkage including PWH and PWoH cohorts. We constructed eight HeoC definitions (see table 1). Comparison was informed by the proportion of multi-record HEoCs (mHEoCs; HEoCs spanning multiple hospitalization records) generated, and feasibility given data quality. Results: We analyzed 98,553 hospitalization records from 13,498 PWH, and 1,874,507 records from 385,011 PWoH. Across the definitions, proportion of mHEoCs varied from 2.5% to 5.3% for PWH (2.7% to 4.2% for PWoH). Definitions yielding the highest proportion of mHEoCs were the least stringent, requiring no transfer indication. Definitions yielding the lowest proportion of mHEoCs were the most stringent, requiring two-way agreement of hospital identifiers. Patterns were comparable among PWH and PWoH. We selected a pragmatic general use approach to defining HEoCs – requiring one-way population of hospital transfer identifiers and a <48 hour gap. Discussion: Various definitions can be employed to combine related hospitalization records into episodes, to yield less biased estimates of hospitalization-related metrics for PWH, and comparisons with PWoH.

Background: In High-Income Countries (HICs) HIV/AIDS has been continuing to disproportionally affect racialized communities such as Black Women of African Descent (BWAD). Despite the multiple efforts, evidence is limited on the effectiveness of HIV interventions to address the HIV outcomes inequalities among BWAD. This paper seeks to examine determinants of effective HIV related interventions to improve HIV outcomes among BWAD in HICs.
Methods: A systematic review of eligible articles was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A comprehensive search of the literature was made in MEDLINE(R) ALL (Ovid), Embase (Ovid), CINAHL (EBSCO Host), and Global Health (Ovid). We searched studies in English from 1980‒2023. The study team independently reviewed the illegibility criteria of the articles. Articles reported on determinants of effective interventions for HIV prevention, treatment, and care among BWAD in HICs were included. Articles that met the inclusion criteria were appraised using the Joanna Briggs Instrument.
Result: Using socio-ecological framework (SEF), and the thematic mapping process, we identified the determinants of effective interventions to improve HIV outcomes among BWAD in HICs at 4 levels: individual/BWAD, interpersonal, community and systemic/health system. Themes are currently being finalized and will be ready for CAHR conference presentation in April. These will address the multilevel effectiveness factors of HIV prevention, treatment, and care including HIV-knowledge and testing, critical health and racial literacy through innovative ACB community-based health promoters.
Conclusion and policy implications: Tailored interventions are needed to address inequities in HIV outcomes that disproportionally impact BWAD in HICs. Tackling the multilevel determinants of the effectiveness of BWAD-focused HIV interventions using SEF is critical to reducing the burden of the HIV disease and low health outcomes among BWAD.
The SEF can provide a lens of understanding diverse context and equity-driven policy and practice to address inequitable HIV outcomes.

Background
Clinicians who perceive a potential risk of HIV exposure in their work environment may experience feelings of fear, anxiety, and concern regarding their health and safety. In this study, we aimed to investigate the percentage of healthcare providers who present this concern at the workplace, and the associated sociodemographic variables to inform policymakers regarding this critical issue.

The survey
Data for this study came from the project titled ‘Optimizing HIV and health services for Canadians of African Descent (CAD) women: A multi-sectoral and innovative approach to capacity building’. Sample population included Physicians (n=429), Nurses (n=331), Social workers (n=173) and Others (n=120).

Results
Overall, about 15% of the participants reported the level of risk of HIV exposure as high, while more than half reported the risk of exposure as moderate (54%). Compared to women, men had 0.65 times lower odds of perceiving their HIV exposure risk as high at work (OR=0.65, 95% CI=0.46-0.93). Healthcare professionals who identified as Black Canadian (OR=2.09, 95% CI=1.53-2.84) and Caribbean (OR=2.68, 95% CI 1.69-4.24) had approximately 2 times higher odds of perceiving high risk compared to those who identified as African. Nurses (OR=2.13, 95% CI=1.30-3.48) and physicians (OR=1.91, 95% CI=1.18-3.10) had around 2 times higher odds of perceiving risk as high compared to other professions. Healthcare professionals who felt somewhat prepared (OR=1.90, 95% CI 1.27-2.84) or not prepared (OR=8.69, 95% CI 2.57-29.37) to provide HIV care had higher odds of perceiving high risk compared to those who felt very prepared.

Conclusion
Current findings indicate that racial background, profession, and perceived preparedness to provide HIV care are significant predictors of healthcare professionals' perceptions of their HIV exposure risk at work. Targeted interventions based on these factors may help improve provider awareness and safety practices related to infection control in the workplace.

Early diagnosis and treatment of HIV is important to reduce the risk of transmission and adverse HIV-related health outcomes. The Public Health Agency of Canada recommends all sexually active individuals be tested at least once in their lifetime and those engaging in high risk activities be tested at least annually. Transgender and non-binary individuals face high levels of stigma and discrimination, which contribute to a disproportionately high burden of HIV and have been highlighted as barriers to accessing HIV testing among these populations.

This study aimed to estimate the uptake of HIV testing and to identify predictors of past-year testing among transgender and non-binary individuals at sexual risk of HIV acquisition. The analytic sample included 679 participants of the 2019 Trans PULSE Canada survey who reported past-year condomless vaginal or anal sex with a partner’s flesh genitals. Block-wise modified Poisson regression models were used to identify predictors of past-year testing.

Of the analytic sample, 62% had ever been tested for HIV and 33% had been tested in the past year. The likelihood of past-year testing was similar across most sociodemographic groups and appeared to follow need appropriately. Participants who were single or in a nonmonogamous relationship were more likely to report past-year testing than those in a monogamous relationship and those who reported past-year sex work were more likely to have been tested than those who did not. Overall, HIV testing levels were low among transgender and non-binary individuals at sexual risk of HIV acquisition relative to Canadian guidelines and estimates among similar U.S. samples. Future research is needed to assess the impact of self-testing initiatives and to identify potential testing facilitators in this population.

Aim: The housing crisis in British Columbia (BC), Canada, is characterized by a shortage of accessible, safe, and affordable housing. We explore the impact of housing instability on substance-involved mortality among a cohort of people with HIV (PWH) in BC.

Methods: Data are from the Longitudinal Investigation into Supportive and Ancillary Health Services (LISA) study, a cross-sectional survey (2007-2010). Survey data were linked with prospective administrative health data from the BC Centre for Excellence in HIV/AIDS Drug Treatment Program (DTP) and Population Data BC until March 31, 2020. This linkage includes information on cause-specific mortality, allowing us to investigate the relationship between housing instability and substance-involved mortality (Table 1). Selection bias into LISA was potentially introduced through oversampling PWH marginalized by sociostructural inequities, which we addressed through inverse probability of participation weighting (IPPW). We constructed participation weights using information from the DTP database, which includes all known PWH in BC accessing HIV-treatment via the DTP (including respondents and non-respondents to the LISA survey). We estimated the hazards of substance-involved mortality associated with housing instability, adjusting for confounders, in an IPPW-weighted Cox model.

Results: Of 998 respondents (74% male, 63% white), 302 people (30%) died from any cause between the completion of the LISA survey until March 31, 2020; 111 (37%) died from substance-involved mortality. Of those people, 56 (50%) experienced housing instability. Experiences of housing instability were associated with increased hazards of substance-involved mortality (aHR: 1.80; 95%CI:1.01-3.19).

Conclusion: PWH experiencing housing instability may have a greater risk of substance-involved mortality.

Introduction: Despite the overall decrease in Canadian HIV incidence from 10.0 people newly diagnosed per 100,000 population in 1995 to 4.7 in 2022, a noteworthy surge in HIV cases within the prairie provinces of Manitoba, Saskatchewan, and Alberta underscore the necessity for region-specific interventions and tailored public health strategies. This study aims to investigate the evolution of the HIV epidemiology in the Canadian prairie provinces since 1985.
Methods: We conducted an ecological study using publicly available data released by the Governments of Manitoba, Saskatchewan, and Alberta, spanning the timeline from the first reported cases of HIV diagnosis up to the latest available information. We observed the general HIV incidence, as well as the proportion of people diagnosed according to sex.
Results: Despite an overall reduction in Canadian HIV incidence over time the prairie provinces exhibited alarming increases, with HIV incidence rates up to four times higher than the national average in 2022 Newly reported cases rose from 0.3 people per 100,000 population in 1985 to 18.9 in 2022 in Manitoba, 1.7 in 1985 to 20.1 in 2021 in Saskatchewan, and 4.9 to 6.3 in 2022 in Alberta. A notable increase over time was seen among women in Manitoba (5.7% in 1987 to 44.3% in 2021) and Saskatchewan (30.2% in 1997 to 47.2% in 2021), compare to Canada (17.7% in 1995 to 28.6% in 2020).
Conclusion: This study highlights key differences in the rates of HIV and affected populations in the Canadian prairie provinces when compared to the rest of Canada. To stem the rapid rise in cases, urgent and targeted strategies are required from policymakers, public health, and healthcare professionals.

Sub-Saharan Africa contains an estimated 67% of the HIV-1 positive population. Integrase strand transfer inhibitors (INSTIs), comprised of Raltegravir, Elvitegravir, Dolutegravir, Bictegravir, and Cabotegravir, are recommended as part of first-line treatments against HIV-1 infection. There have been growing concerns surrounding HIV-1 pre-treatment drug resistance to various antiretrovirals. Although mutations associated with INSTI resistance are generally rare, the prevalence of pre-treatment INSTI resistance in sub-Saharan Africa is unknown. In this study, we compared the frequency and potency of resistance mutations across time and region of sub-Saharan Africa. INSTI resistance mutations from individual HIV-1 sequences were collected from the Stanford HIV-1 Drug Resistance Database. The inclusion criteria was that the virus have no exposure to INSTIs, be collected from patients in sub-Saharan Africa, and be collected between 2001-2018. Each sample was organized by region and isolate date. We found that the frequency of pre-treatment resistance mutations were low, ranging from 0% to 1.31%. During most time periods, the West region experienced the greatest frequency of both major and minor INSTI resistance mutations. Pre-treatment resistance, which considers both the frequency and potency of major resistance mutations, was greatest against Elvitegravir across all regions and times. Similarly, the least pre-treatment resistance was detected against Dolutegravir and Bictegravir. However, pre-treatment Dolutegravir and Bictegravir resistance is greater in the South than in other regions, where it demonstrates a prolonged peak between 2013-2018. Interestingly, high resistance against Elvitegravir is primarily caused by the potency rather than frequency of major resistance mutations. Low pre-treatment resistance against Dolutegravir and Bictegravir corresponds to both a low frequency and potency of major resistance mutations. This study provides support for Dolutegravir scale-up efforts in sub-Saharan Africa. However, it also demonstrates the regional heterogeneity in pretreatment resistance and the importance of monitoring on a regional or national basis.

Background
Bacterial STBBI rates disproportionately impact sexually active Two-Spirit, gay, bisexual, trans, and queer men and non-binary people (2S/GBTQ). Among 2S/GBTQ, the use of doxycycline as post-exposure or pre-exposure prophylaxis (doxyPEP/PrEP) reduces acquisition of chlamydia and syphilis, and to a lesser extent gonorrhea.

Methods
We assessed 2S/GBTQ community members’ knowledge, uptake, and interest in doxyPEP/PrEP via the Community-Based Research Centre’s Sex Now 2022 survey. Recruitment was conducted in-person at 41 Pride festivals and community events across 21 cities in Canada. Eligible participants were at least 15 years old, 2S/GBTQ, living in Canada, and able to complete the electronic survey in English, French, or Spanish. Statistical differences in awareness, uptake, and interest were computed using chi-square tests (p<0.05 significant)

Results
Participants (n=3284) had moderate awareness of doxyPEP/PrEP (25.4%). Lifetime uptake was low (6.3%), with half (54.3%) reporting use in the past 6 months. Among those not currently using doxyPEP/PrEP, one-third (36.0%) were interested in the intervention and one-third (31.3%) were unsure. Awareness, uptake, and interest were consistently higher among participants 30-39 years old, with more sexual partners, who have sex partners who were HIV undetectable, with recent STBBI acquisition, and concurrent HIV PrEP use. Participants who were less out about their sexuality and who reported recent front hole/vaginal sex had lower doxyPEP/PrEP awareness, uptake, and interest. Interest was lower amongst Indigenous and Black participants and higher amongst other People of Colour.

Conclusion
2S/GBTQ community interest in doxyPEP/PrEP is high, and reflects alignment with key indicators for this intervention. However, there is a significant disparity in access/uptake of doxyPEP/PrEP. This work can inform equity-oriented health promotion and health service provision of doxyPEP/PrEP.

Background
Leaving the emergency department (ED) without being seen by a physician or against medical advice, referred to as leaving without completing care, is associated with adverse outcomes. Leaving without completing care is more common in substance use related ED-presentations, but this pattern is unclear among people with HIV (PWH). We assessed incidence and determinants of leaving without completing care among PWH and people without HIV (PWoH) attending an ED with a suspected overdose.

Methods
Using linked administrative data of all PWH and a 10% random sample of PWoH in British Columbia between 2012-2020, we identified ED-presentations with a suspected overdose: symptoms and/or complaints classified by a triage nurse as “overdose ingestion”. Leaving without completing care was defined using diagnosis code and/or discharge disposition. Using a multivariable log-linked regression model with binomial distribution and generalized estimating equations, stratified by HIV-status, we identified determinants of leaving without completing care compared to being discharged or admitted, using backward selection.

Results
We identified 1,160 and 4,581 ED-presentations with a suspected overdose among 632 PWH and 3,057 PWoH, respectively. Overall, 13.9% of PWH visits and 9.0% of PWoH visits resulted in leaving without completing care (p<0.05). Older age (50+) and higher triage level were associated with lower risk for leaving without completing care (Table 1).

Conclusions
Leaving without completing care was more common among PWH than PWoH attending the ED with a suspected overdose. Addressing risk factors for leaving without completing care may improve linkage to care among people attending EDs with an overdose.

Background: The vast majority of mpox cases in Canada have occurred among MSM (men who have sex with men). Community-led responses to this health threat included education and vaccination efforts in partnership with public health.

Methods: We examined self-reported mpox diagnosis and vaccination among Two-Spirit, Gay, Bisexual, Trans, and Queer men and Non-Binary (2S/GBTQ) participants in Sex Now 2022. Data were collected in-person at Pride festivals and community events across Canada between 06-09/2022. Participants were aged 15+, 2S/GBTQ-identified, living in Canada, and able to self-complete the survey in English, French, or Spanish. Vaccination analyses were restricted to MSM aged 18+ who reported at least one of: past-year STI diagnosis, multiple recent sex partners, or recent transactional sex. Data were analyzed descriptively, with attention to calendar time and geographic location given the rapid evolution of the mpox outbreak and response, and chi-square tests were conducted to assess statistical significance (p<0.05 significant). All results reported are significant, except where noted explicitly.

Results: Self-reported mpox diagnosis was 0.8% (n=24/2891), with higher prevalence among HIV-negative PrEP users compared with HIV-negative PrEP-naive participants (1.9% versus 0.4%). Self-reported mpox vaccination uptake was 41.3% (n=475/1150), which increased over time (i.e., 12.6% at the end of June to 76.0% at the start of September). Vaccination was lower among trans versus cis men (24.3% versus 42.5%), people without a university degree (29.1% versus 50.9%), those experiencing financial strain (30.9% versus 44.1%), and HIV-negative PrEP-naive men compared to lifetime PrEP users (26.5% versus 56.6%). Although not statistically significant, participants living with HIV had descriptively higher prevalence of mpox diagnosis (1.4% versus 0.7%) and vaccination (48.1% versus 40.8%).

Discussion: Canada’s spatial-temporal experience with mpox diagnosis and rapid vaccination scale-up among 2S/GBTQ communities during summer 2022 was shaped by entrenched social determinants of health and varied based on HIV PrEP experience.

Background: Housing instability is a social determinant of health that influences the wellbeing of women living with HIV(WLWH), who may be particularly at risk due to gendered disparities in housing equity. Eviction is an extreme form of housing instability; however, there is little research on eviction among WLWH, despite high prevalence of housing instability. Our study therefore examined the associations between social-structural factors and eviction amongst WLWH in Metro Vancouver.
Methods: Data was drawn from the Sexual Health & HIV/AIDS Longitudinal Women’s Needs Assessment (SHAWNA), a longitudinal community-based cohort study of women living with and accessing HIV care in Metro Vancouver (2014-2022). Bivariate and multivariable logistic regression models, with generalized estimating equations for repeated measures over time, were used to identify associations between social-structural factors and eviction, all self-reported in the last six months. Backwards model selection using AIC was used to select the final model. Adjusted odds ratios (AOR) and 95% confidence intervals are reported.
Results: Overall, 344 women contributed 2309 observations over the study period; 12.5% reported a minoritized gender; 55.9% reported being Indigenous, 34.6% White, and 9.9% otherwise racialized/women of colour. During the study, 13.7% reported eviction (n=47) and of these, 38% reported >one eviction in the study period (n=18). In the final multivariable logistic regression with GEE, gender minority identities [AOR:2.24[1.11-4.51], removal from parents as a child [AOR:2.06[1.05-4.03], and heightened HIV stigma [AOR:1.07[1.03-1.10], were significantly associated with eviction.
Conclusion: Our study identified key social-structural factors associated with greater odds of eviction, including gender minority identity, removal from parents as a child, and HIV stigma. Interventions are needed to address eviction, including short-term approaches such as free legal advice for those facing unfair notices, and longer-term policies for the creation of low-barrier, affordable housing tailored for and with WLWH who may be at elevated eviction risk.

Background: In March 2023, the INSTI® Multiplex HIV-1 / HIV-2 / Syphilis Antibody Test, a rapid point-of-care test (POCT) was licensed by Health Canada. In June 2023, the Kingston, Frontenac and Lennox & Addington Public Health Unit implemented the “rapid POCT and treat” outreach model of care, which incorporates POCT and treatment with existing public health outreach services, bringing services to the population at highest risk including those facing housing instability, mental health concerns, or injection drug use. In September 2023 this model of care was expanded to included four additional PHUs.

Methods: We developed a survey targeting participating health care providers including outreach nurses, managers, nursing leads, and other health/social service professionals to understand the barriers and facilitators of implementing this intervention within public health units. Data collection will continue until at least September 2024, with the aim of having ~30 respondents by April 2024.

Results: While all survey respondents (n=6) indicated that the “POCT and treat” intervention should continue to be offered during outreach services, challenges were also identified. Notably, 66% reported issues with pipettes, and 33% faced difficulties obtaining sufficient blood from clients, sometimes necessitating multiple pricks. Concerns specific to outdoor settings included maintaining product temperature within recommended ranges during extreme weather and addressing challenges posed by windy conditions when using the lightweight kits. Additionally, 83% expressed apprehension about the test's sensitivity for syphilis in clients with low RPR levels, as it occasionally yields negative POCT results. Only half of the respondents believed that POCT is more acceptable to outreach clients than routine serology.

Outcomes: Preliminary results from survey responses have already provided valuable insight into professional’s perception of the feasibility of POCT in a community setting. This research will inform improvements for future implementation of POCT, a vital low-barrier method to reach undiagnosed and underserved populations.

Background:
Public health units (PHUs) in Ontario have experienced a dramatic spike of infectious syphilis. Underserved populations, such as people who are experiencing homelessness or use drugs, are at increased risk for syphilis and other sexually transmitted and bloodborne infections. Using point-of-care tests (POCTs) outside a clinical setting represents a low-barrier method to reach undiagnosed and underserved populations.

Methods
The SPRITE study includes five Ontario PHUs (Kingston, Frontenac and Lennox & Addington Public Health (KFL&A PH), Hastings Prince Edward Public Health (HPEPH), Leeds, Grenville and Lanark District Health Unit (LGLDHU), Thunder Bay District Health Unit (TBDHU) and Ottawa Public Health (OPH)). As part of existing public health outreach programs and scheduled blitz events at community-based organizations the implementation and accuracy of INSTI® Multiplex HIV1/2 & Syphilis Antibody POCTs is being evaluated. The target sample size of 380 is expected to be obtained by April 2024.

Results:
From June to mid-December 2023, 110 POCT were administered across 3 PHUs (KFL&A PH n=85, HPEPH n=23, LGLDHU n=2); 63.6% at outreach events, 27.3% at community service hubs, and 7.3% through general outreach. Of these 110 POCT tests, six were positive, 100 negative, and four invalid. Overall, INSTI had a 54.5% sensitivity, 100% specificity, 100% positive predictive value, and 94.6% negative predictive value. Of the five false negatives, four were previously treated for syphilis (three were non-reactive) and the one new positive infection had an RPR of 1:2. All six POCT positive cases were treated - four in the field and two in the clinic after reinfection was confirmed. No HIV infections were identified.

Conclusions:
These are preliminary results in a population experiencing a high (yet heterogeneous) incidence of infectious syphilis. Evaluating the accuracy of low-barrier interventions in community settings is vital to inform future decision-making.

Introduction
Women living with HIV have a 20-fold higher risk of anal cancer than the general population, and are considered a high priority for screening. We aimed to characterize knowledge of anal cancer risk and willingness to undergo anal screening among women living with HIV in Ontario.

Methods
A cross-sectional questionnaire was administered from 2017 to 2020 among women living with HIV in the Ontario HIV Treatment Network Cohort Study. Items assessed knowledge of anal cancer risk and willingness to undergo screening with anal Pap tests or digital/anal rectal exams (DARE). We restricted our analysis to those aged ≥45 years in keeping with forthcoming international guidelines. We assessed associations with demographics and HPV screening and prevention measures using chi-square tests.

Results
Among the 325/579 women aged 45 years and over, the median age was 55 years (IQR: 10 years). 56% of women believed that they had “no chance” of developing anal cancer and 17% did not know their risk. Most women responded that they were “likely’’ or “very likely” to undergo anal screening if it was offered (anal Pap: 72%; DARE: 69%), with 93% reporting consistent answers for both modalities. There were no statistically significant differences in willingness to screen by age, sexual orientation, race, immigrant status, or HPV vaccination history. However, women who underwent cervical screening in the past 3 years were more willing to also undergo anal screening than those who had not (DARE: 73% vs 51%, p=0.01; anal Pap: 76% vs 55%, p=0.02).

Conclusions
Education on elevated anal cancer risk among women living with HIV is important for the implementation of anal cancer prevention and screening in Ontario. Our findings suggest that future uptake of anal screening may reproduce inequities observed for cervical screening without careful attention to barriers and facilitators to both.

Background: We previously reported that uptake of COVID-19 vaccine was similar by sex and gender identity in an online survey of PLWH in Canada during winter 2022 (AIDS and Behav 2023). Here, we examined vaccine attitudes and beliefs based on biological sex.
Methods: Between February-May 2022, PLWH across Canada were recruited via social media and community-based organizations to complete an online survey consisting of a modified Vaccine Hesitancy Scale questionnaire with items from the National Advisory Committee on Immunization Acceptability Matrix. Unadjusted proportions were used to summarize attitudes and beliefs, stratified by sex.
Results: Of 259 PWH, 27% were females and 73% males. Median age (SD) was 47 ±14 years and 53% had HIV ≥ 15 years. More males than females believed that COVID-19 vaccination was: 1) important for his/her own health (86 vs 70%, *p<0.05); 2) a good way to protect themselves from infection (86 vs 67%, **p=0.01; 3) that getting the COVID-19 vaccine was important for the health of others in his/her community (90 male vs 78% female, *p<0.05); 4) believed recommendations by their doctor/health care provider about COVID-19 vaccines (88 vs 78%, *p<0.05); 5) that information about COVID-19 vaccines from public health officials was reliable and trustworthy (75 vs 55%, *p<0.05); and 6) that all COVID-19 vaccines offered by government programs in their communities were important for good health (87 vs 69%, **p=0.01).
Conclusions: Among PLWH, males more often than females believed that COVID-19 vaccines had health benefits at both the personal and societal level and that recommendations made by their doctor/health care provider and public health officials is reliable and trustworthy. These sex differences may be confounded by other factors (e.g., race/ethnicity, sexual orientation and other social determinants of health). Educational interventions targeted toward females living with HIV are especially needed to increase confidence towards vaccination.

Problem: Community-based research (CBR) is a useful method for understanding hepatitis C (HCV) care needs among people who inject drugs (PWID). Involving community-based organizations (CBOs) in research is paramount to enhance its impact on the community. How do we implement CBR in practice? Herein, we describe strategies used to carry out the HCV virtual cascade of care cohort (VCCC) study, a study conducted in community-based and harm-reduction organizations serving PWID in Canada.

Description: In our application of CBR to the VCCC study, research questions were developed by the researchers. CBOs were responsible for recruiting the target population, collecting data with funding support, and were involved in knowledge dissemination. Over 40 CBOs were approached either by email, telephone, or in person. The recruitment process comprised 3 steps: an initial call with 14 CBOs who expressed interest, a face-to-face meeting (including a visit to their premises), and the signing of a collaboration agreement. Afterwards, the CBO is trained to conduct all research activities. To date, our study was implemented in 4 CBOs.

Lessons learned: We encountered various challenges to successfully integrate CBOs, including a lack of space and staff to execute study procedures; and staff turnover, resulting in multiple training periods. Adaptations were needed to meet ethical considerations and procedures required by our protocol. For instance, the training placed a particular emphasis on the informed consent process. Realistic recruitment goals were set for each CBO, and data was collected onsite with them. On average, the whole recruitment process took roughly 8 months, demonstrating that the process of engaging CBOs in research takes time.

Conclusions: The study protocol states what and how. However, we can be creative in how we implement it. Hence the importance of anchoring research activities in local contexts. Building on each other strengths is key to successfully engaging CBOs.

Background: There remains a gap in understanding the patterns of CVD recurrence among people with HIV (PWH). Our community-led team adopted a strengths-based approach and examined the incidence of acute index and recurrent CVD events among PWH compared to people without HIV (PWoH) in British Columbia (BC).

Methods: From 01-Apr-1992 to 31-Mar-2020, PWH and a 10% random sample of all PWoH in BC aged ≥19 years were followed using linked administrative health data from the Comparative Outcomes and Service Utilization Trends (COAST) study. CVD events were identified using ICD-codes from emergency department visits and inpatient hospitalizations. Age-adjusted incidence rates were expressed per 1,000 person-years, and median time between events, as well as the distribution of potential CVD risk factors were reported.

Results: The age-adjusted incidence rate for index CVD events was 25.24 (95% CI: 21.81, 28.67) for PWH, and 12.58 (95% CI: 12.49, 12.67) for PWoH. Among the 1,466 PWH and 66,274 PWoH who had an index event (the main cohort), the age-adjusted incidence rate for recurrent CVD events was 123.73 (95% CI: 85.75, 161.7) for PWH and 73.96 (95% CI: 72, 75.92) for PWoH. Time to recurrent CVD events was less, and recurrent events occurred at a younger age among PWH vs. controls (see Table).

Conclusion: Our community-led study indicates that PWH experience higher incidence of index and recurrent CVD events; however, PWoH had more hypertension and diabetes mellitus. PWH may have access to greater care and earlier CVD diagnoses at a younger age which may affect rates.

Objectives:
We assessed sex differences in hospitalization rates among people with HIV (PWH) and people without HIV (PWoH) in British Columbia (BC).

Methods:
PWH and a 10% random sample of PWoH in BC aged ≥19 were followed from 04/01/2002 to 03/31/2020, using linked administrative data from the Comparative Outcomes and Service Utilization Trends (COAST) study. All-cause hospitalizations were identified using ICD-codes. Using Poisson regression, we modelled the association between sex, HIV-status, their interaction, and hospitalization rates adjusting for confounders.

Results:
We analyzed 12,635 PWH (17.81% females) and 548,992 PwoH (49.34% females) with 462,627 hospitalizations. Age-adjusted hospitalization rates per 100 person-years were highest among females (incidence rate [IR] 34.25, 95% CI:33.02-35.49), followed by males with HIV (IR 21.49, 95% CI:21.04-21.94), and females and males without HIV (IR 7.10, 95% CI:7.07-7.13 and 7.06, 95% CI:7.03-7.09, respectively). Adjusted for socio-structural factors, being male (RR 1.92) or female with HIV (RR 2.66) was significantly associated with a higher hospitalization rate compared to males without HIV (Table, Model 1). Among PWH, additionally adjusting for HIV- and disease-related factors, female sex remained significantly associated with a higher hospitalization rate (Table, Model 2a-c).

Conclusion:
We found a higher hospitalization rate among PWH than PWoH in BC, with the highest rate among females with HIV. This could, in part, be explained by socio-structural and health-related factors. These findings underscore the necessity for further investigation into the factors contributing to disparities and emphasize the importance of addressing social determinants of health to enhance health outcomes for women with HIV.

A genetic cluster is a group of sequences that are more similar to each other than to other sequences in the dataset. When applied to HIV epidemiology, genetic clusters are used to characterize the transmission risk structure of a population. Most clustering methods require the user to select one or more criteria to define groups. These decisions are often based on default settings of the software, or recommendations from public health agencies, e.g., the US Centers for Disease Control and Prevention. However, the makeup and interpretation of clusters can vary substantially from one setting to the next, due to differences in HIV prevalence, sampling rates, and access to HIV testing. Instead, we propose that the optimal clustering of sequences in a given setting should maximize one's ability to predict the distribution of new infections among existing clusters.

We have developed a suite of methods in an R package, called clustuneR. First, the sequences are partitioned into "known" and "new" cases based on their dates of sample collection. Next, clustuneR provides methods for generating clusters using either pairwise distance (e.g., TN93) or phylogenetic methods, yielding sets of clusters under varying criteria. The distribution of new cases among clusters is modelled as a count outcome, i.e., by Poisson regression. We fit a null model where cluster growth is predicted only by cluster size, and an alternate model that incorporates additional metadata, such as the sample collection dates.

clustuneR is distributed under a GNU General Public License at https://github.com/PoonLab/clustuneR with package binaries for Linux and macOS platforms. It includes a comprehensive unit test suite and example data including anonymized HIV sequences from published studies, which we have randomly scrambled to prevent comparison to any other data.

Background
The imminent arrival of injectable long-acting HIV-PrEP (LA-PrEP) in Canada necessitates re-imagining how new PrEP modalities are delivered. ‘The Future of PrEP is Now’ is a mixed-methods study including a survey of Two-Spirit, gay, bisexual, queer and other men who have sex with men (2SGBQM) needs and preferences for PrEP.

Methods
Individuals of any gender other than cis-woman who identify as 2SGBQM and report being HIV negative are eligible to complete the survey. Recruitment is through sexual health clinics and community-based organizations, and prioritizes Indigenous and/or Two-Spirit, Black, People of colour, Remote/rural, substance-using, and transgender and non-binary individuals. The survey contains 49 questions, including 12 ranked stated preference (SP) questions about preferred PrEP formulations, settings, healthcare provider types, and modalities of assessments (online, in-person, etc.). We report on the survey pilot-testing, which entailed a Research Assistant (RA) asking 8 verbal questions on Zoom to assess survey length and understandability.

Results
In the first 18 days, we enrolled 7 ethnically diverse cisgender gay men with median (IQR) age of 33 (33,38) years. Participants spent a median of 28 minutes (21.5,35.5) completing the survey. 57% of participants (n=4) self-rated as having medium knowledge of LA-PrEP, with 29% and 14% reporting low and high self-rated knowledge, respectively. All participants correctly observed and comprehended the structure and content of the SP questions. Participants rated the difficulty of the SP questions at a median of 3 (2,4.5) on a scale from 1 (easiest) to 10 (most difficult). In open-ended questions, participants reported preferences for PrEP modalities with longer dosing intervals and for virtual appointments, and a dislike of implants, but still considered a daily pill acceptable.

Conclusions
Pilot results will inform a self-administered survey format for completion by a large sample of 500 2SGBQM, to inform the equitable implementation of LA-PrEP in Canada.

Background:
Publicly-funded, centrally-distributed HIV PrEP with emtricitabine-tenofovir has been available in British Columbia (BC) since 1-Jan-2018. We utilized longitudinal prescription data to evaluate PrEP persistence amongst provincial PrEP program participants.

Methods:
PrEP participants dispensed ≥1 PrEP prescription between 1-Jan-2018 and 30-Jun-2022 with ≥1 year follow-up opportunity were included. Baseline demographics were described, and PrEP persistence characterized by 1, 2 or ≥3 prescriptions. Between-group comparisons were made using Chi-square and Kruskal-Wallis Tests. A multinomial logistic model was used to obtain the adjusted odds ratio (aOR) comparing demographic and clinical variables amongst PrEP persistence groups (2 and ≥3 prescriptions vs. 1).

Results:
Of 9375 participants, 80% persisted with ≥3 PrEP prescriptions, 11% received 2, and 9% had only 1. Groups differed in baseline characteristics (Table). Significant differences in the odds of PrEP persisting ≥3 vs. 1 prescription was observed for several subgroups: age category ≤28 years (Ref. >48 years) (aOR 0.67 [95% CI, 0.53-0.83]); gender cis-women (Ref. cis-men) (aOR 0.22 [0.12-0.40]); trans-women (aOR 0.30 [0.19-0.46]); trans-men (aOR 0.41 [0.19-0.86]); no prior PrEP (Ref. prior PrEP) (aOR 0.72 [0.56-0.92]); PrEP mailed (Ref. central pharmacy pick-up) (aOR 0.64 [0.54-0.75]); prescribed on-demand PrEP (Ref. daily PrEP) (aOR 3.30 [1.99-5.47]); and HIRI-MSM score ≥25 (Ref.10-24) (aOR 1.41 [1.15-1.73]).

Conclusions:
In BC’s PrEP program, 80% of participants demonstrated high PrEP prescription persistence. Persistence was associated with a higher HIRI-MSM score, and being prescribed on-demand PrEP. Support may be warranted for younger, non-cis-men starting PrEP, and those receiving PrEP medication remotely.

Background:
Infection rates for bacterial sexually transmitted infections (STBBIs) like syphilis, chlamydia and gonorrhea are increasing, and gay, bisexual, and other men who have sex with men (gbMSM) and transgender women are disproportionately affected in British Columbia (BC). Recent studies have demonstrated efficacy of doxy-PEP for STBBI prevention in this population.

The Cool Aid Community Health Centre (CACHC), an inner-city, interdisciplinary primary health care centre in Victoria, BC, serves over 7,300 clients who experience severe mental health challenges, substance use and homelessness. The bi-monthly drop in nurse-led low barrier STBBI clinic (Prism Wellness) at CACHC, staffed by STI certified practice nurses and run in partnership with AVI Health and Community Services, provides STBBI education, screening and treatment as well as pre-exposure prophylaxis (PrEP) initiation and monitoring.

In December 2022, CACHC implemented doxy-PEP for eligible individuals: people who are living with HIV, accessing PrEP, identify as gbMSM, transgender women, and with an increased risk of bacterial STI by either having a history of syphilis, chlamydia or gonorrhea in the past year, or being clinically assessed at increased risk.

Methods:
A retrospective chart review was conducted to identify clients offered doxy-PEP. All gbMSM and transgender clients who initiated doxy-PEP from December 27, 2022, to December 31, 2023, were included.

Results:
A total of 94 clients were offered doxy-pep: 91 gbMSM, 1 woman (on PrEP), 2 transwomen, 9 plwHIV, 82 on PrEP, 22 with previous syphilis, 16 with rectal chlamydia/gonorrhea (within the last year). 86 clients were provided with 10 doses of doxy-PEP and 56 clients have refilled prescriptions. To date, 8 clients have documented STBBI’s (1 syphilis, 1 rectal chlamydia, 3 rectal gonorrhea, 6 throat gonorrhea) since receiving doxy-PEP.

Conclusions:
This innovative nurse-led program at a community health centre facilitated access to doxy-PEP for people at high risk of contracting STBBI’s.

Background: The importance of public health surveillance data in reducing the health impacts of HIV, viral hepatitis, and other Sexually Transmitted and Blood-Borne Infections (STBBIs) is well established. However, the accessibility and utilization of this information is limited for community, including people with lived and living experiences of STBBIs and community-based organizations. Additionally, community are infrequently invovled by public health in interpreting or disseminating this data.

Method: This oral presentation will explore an innovative strategy developed by BCCDC and PAN for involving community in public health surveillance for STBBIs. Developed through the SPARTA project (Sustaining Partnerships to Advance Community Priorities in STBBI Public Health Data Sets), this strategy has fostered a collaborative approach to public health surveillance of STBBIs and made data more accessible to community in BC.

Results: Experts from community and public health will share insights and experiences from the SPARTA project, including:
(1) Describing the SPARTA model for engaging community in the process of accessing, interpreting, and disseminating STBBI public health surveillance data.
(2) Strategies to enhance the understanding of STBBI public health surveillance data among community members to promote data literacy at grassroots levels.
(3) Addressing ethical concerns related to community involvement and accessibility in STBBI public health surveillance data, including how to ensure privacy, security, and equitable access.
(4) Illustrating how increased engagement, expanded access, and utilization of STBBI public health surveillance data by community can lead to more effective interventions and improved public health outcomes related to STBBIs.

Discussion: This presentation aims to prioritize community involvement as a cornerstone and generate actionable insights and recommendations for PWLLE, community leaders, researchers, public health practitioners, and policymakers to foster a more inclusive, informed, and empowered approach to STBBI public health surveillance in Canada.

Background (word count 299/300)
Long-acting cabotegravir/rilpivirine (CAB/RPV-LA) is the first injectable regimen for maintenance of HIV treatment, with benefits over oral antiretroviral therapy (ART) related to adherence, convenience and privacy. New medical technologies are often met with hesitancy in adoption and implementation challenges. As part of a larger study using the RE-AIM implementation framework, we surveyed healthcare professionals at specialized HIV clinics in Ontario to assess CAB/RPV-LA Adoption and Implementation.

Methods
We conducted an 18-question, anonymous, electronic survey of physicians, nurses, and pharmacists at the Ontario HIV Clinics Network (OCN). Targeting at least one participant from each of the 21 clinics, the survey covered three domains: Clinic/Respondent Details, Clinical Practices related to CAB/RPV-LA, and Barriers/Facilitators to CAB/RPV-LA implementation at the patient-, provider-, and settings-levels. The survey was active between 12/2022-12/2023. We averaged clinic-level responses and reported median (interquartile range) for clinic-level variables and weighted averages for patient-level variables.

Results
We received 27 responses from 16/21 clinics. Respondents were 45% nurses (n=12), 22% pharmacists (n=12), and 33% physicians (n=9). Clinics were staffed by a median (IQR) of 4 (2-7) clinicians with 20 (7.5-30) years of HIV experience, and cared for 637 (170-1100) patients. An estimated 63% of clinicians prescribed CAB/RPV-LA. Respondents estimated that 3.2% of patients receive CAB/RPV-LA, of whom 91% followed an 8-weekly dosing schedule and 60% received injections off-site (weighted averages). Most of respondents’ reported CAB/RPV-LA patients (244/329=74%) attended clinics in Toronto and Ottawa, where they accounted for 4% (vs. 2% elsewhere) of patients. Common implementation challenges were related to the logistics of administration, injection hesitancy and concerns about risk of resistance for non-adherent patients.

Conclusion
Initial findings shows concentrated CAB/RPV-LA usage in Toronto and Ottawa, with most users following an 8-weekly schedule and opting for off-site injections. Addressing the systems-level barriers to administration might improve uptake of CAB/RPV-LA, particularly in sub-urban and rural Ontario.