Background
Given the ongoing public health crisis of drug poisoning deaths, there is growing interest in measures that would facilitate access to a safe supply of quality-controlled substances for those currently risking their lives — a significant proportion of whom are people living with HIV and/or HCV — because they are compelled to secure potentially fatal street drugs. Law and policy play a central role in enabling the effective implementation of safe supply initiatives, including their integration alongside supervised consumption services (SCS).

Description
We examined legal/policy options to facilitate safe supply via SCS, informed by a synthesis of the available evidence, the expert perspectives of people who use drugs, service providers (including those working in SCS), safe supply prescribers, policymakers, and lawyers, and human rights standards.

Lessons learned
Grey literature and key informant interviews described three main barriers to implementing safe supply at SCS:
1. Prescribed-safe supply is limited by lack of available/willing prescribers, resulting in long waitlists and limited capacity to serve high volumes of participants.
2. There is need for a greater variety of non-medical safe supply through co-ops, compassion clubs, and additional community-based options.
3. The selection of drugs available is inadequate, with no prescribed safe supply options for people who smoke their drugs or use stimulants.

Next steps
A range of legal/policy responses are possible to facilitate safe supply at SCS, requiring efforts from federal and provincial policymakers and colleges overseeing regulated health professionals. These include regulatory college guidance, delegated orders or medical directives, expanding the class of practitioners and prescribers, scaling up other operational models, broadly exempting SCS from federal drug control legislation, and expanding coverage of safe supply options in provincial public drug plans. These options will be shared with policymakers to sustain pressure on them to facilitate the scale-up of this lifesaving intervention.

Introduction: In 2021, approximately 1.3 million pregnant women were living with HIV, of which an estimated 81% received antiretroviral drugs (ARVs) for their health and to prevent perinatal HIV transmission. Although the benefits of ARVs outweigh any risks, several reports show adverse effects of ARV treatment during pregnancy. Previous studies from our group have validated a mouse pregnancy model to investigate the impact of in-utero ARV exposure on fetal-placental development, demonstrating direct parallels with clinical observations. The current model lacks HIV infection, limiting the ability to investigate the impact of both virus and drug on pregnancy outcomes. This study aims to establish a murine model of HIV infection (EcoHIV) in pregnancy.

Methods: EcoHIV-infected pregnant mouse model; 7-week-old female C57BL/6 were divided into two arms: (A) EcoHIV (B) PBS. Treatment group (A) were intraperitoneally (I.P) injected with EcoHIV virus, and control group (B) were I.P injected with PBS only. Mice were mated at 9 weeks of age. Mating was confirmed by presence of plug, and pregnancy was confirmed by weight gain of >1.5g by gestational day (GD) 11.5. Mice were sacrificed at two-time points – GD14.5 and GD18.5. Fetal and placenta weights were recorded as well as fetal viability and number of resorptions. Tissue was collected for further analyses.

Results: Successful induction of infection was confirmed through p24 (viral protein) detection in spleen lysates by western blot analysis. No significant differences in fetal or placental weights were observed at GD14.5 between groups. At GD18.5, significantly lower fetal weights were seen in EcoHIV infected mice as compared to controls.

Significance: Establishing a mouse pregnancy model that incorporates HIV infection in addition to ARV treatment will greatly enhance our abilities to understand the impacts of perinatal HIV and ARV exposure on fetal development and long-term health outcomes of these children.

Background: A few large-scale US-based and Canadian studies have shown that among persons with HIV (PWH), mental health and substance use comorbidities can increase the likelihood of emergency department (ED) and hospital visits. However, there is no information about the reasons for the increases in hospital-based healthcare utilization and the associated costs to the healthcare system. Reasons of those visits are needed to manage the healthcare costs in PWH with mental health/substance use comorbidities (PWH-MH). We hypothesized that PWH-MH will have increased rates of hospital-based treatment utilization compared to PWH without (PWH-only), which will result in higher costs. Reasons for higher healthcare utilization in PWH-MH will include but not be limited to acute mental health-related crises, e.g., suicide attempts.
Methods: Alberta Health Service data (practitioner claims) from April 1, 2002 to March 31, 2020 were consulted to identify PWH-MH and PWH-only. Hospital and ED utilization (discharge and ambulatory care records) were inspected over a three-year follow-up period with respect to visit frequency, duration, reasons, and costs.
Results: PWH-MH visited the ED or hospital (78%) more often than PWH-only (48%; p<0.01). This resulted in an average hospitalization costs of $58190 (98361) in PWH-MH compared to $35031 (64203) in PWH-only (p<0.01). Higher visit rates in PWH-MH compared to PWH-only included increased ED-visits for mental-health-related reasons (28% vs. 4%), physical conditions typically treated in ambulatory care (30% vs. 14%), physical trauma (45% vs. 19%) and medication complications (19% vs. 3%). ED admissions after acute mental-health crises due to self-harm or suicide attempts were rare but if observed, they only occurred in PWH-MH (2%).
Conclusion: Our outcomes highlight the significant burden of healthcare utilization and costs in PWH-MH compared to PWH-only. It emphasizes the need for targeted interventions to manage mental health/substance use comorbidities, potentially reducing healthcare utilization and associated costs among this population.

Introduction: We explore COVID 19 pandemic impacts on safer opioid supply programs (SSPs) to identify structural factors that sustain or impede access to crucial HIV prevention and harm reduction services for people who use drugs during public health emergencies.
Methods: During 2021, we conducted semi-structured interviews and demographic surveys with service providers (n=27) and clients (n=52) from four Ontario SSPs about program implementation. Thematic analysis was conducted.
Results: Quick SSP service adaptations led to reduced: crowding in waiting rooms, appointment wait times, appointment frequency, and public transit trips which in turn reduced COVID-19 exposure. Data show that SSP clients often reduced or stopped injecting drugs, thereby reducing their risk of HIV transmission. Access to harm reduction supplies and HIV medication prescriptions were maintained, but appointments and pickups were less frequent. Clients with stable telephone/computer access and housing were better able to access and enrol in programs with pandemic-related changes in hours of operation and admission processes. Some programs increased outdoor outreach to establish/maintain connections with clients and prioritized those with untreated HIV and pregnancy for enrolment. Advocacy ensured that clients were given priority access to COVID 19 vaccines. Prescribers and staff played important roles in providing up-to-date and accurate information about COVID for clients. Public health restrictions (e.g., indoor capacity, distancing) resulted in reductions in new enrolments, particularly for newer programs. Reduced staffing created stressful situations and burnout.
Discussion: Sustaining access to harm reduction and HIV prevention services during emergencies depended on harm reduction clinician/worker ingenuity, willingness to quickly adapt, flexible service guidelines, and forceful advocacy on behalf of clients. Access to telephones and the internet create barriers for more isolated clients or those newly in need of prevention services. Strategies to avoid staff burnout are especially needed during emergencies to maintain services.

Dried blood spot (DBS) samples can diagnose new HIV and hepatitis C (HCV) infections and screen for syphilis by using blood from a finger-prick onto paper that is dried and mailed to a laboratory for testing. DBS can improve access to testing, particularly for rural and remote communities, as sampling can be performed outside a laboratory. BC, with other provinces, has accepted confirmatory results from DBS samples for HIV and HCV positive case-definition. DBS sampling started in BC in 2019 but the BCCDC launched a pilot DBS process in 2021. A mixed methods evaluation was conducted of implementation processes at pilot sites between 2019-2022 using provincial data, service provider semi-structured interviews and a survey, and a focus group at a community-health agency, including peer workers to explore pilot strengths, limitations, and outcomes. 335 DBS samples submitted, 70% from Northern Health Authority. When comparing DBS and phlebotomy sampling, HIV and HCV antibody positivity rates were ten-times higher with DBS, similar positivity rates for syphilis antibody, but HCV RNA positivity was higher for phlebotomy samples. DBS sampling is a useful, low barrier tool to engage people who are not being served by standard-of-care testing, including people who use substances, have experienced discrimination in healthcare settings, or do not have access to phlebotomists. While an ordering provider is required for DBS to support linkage to care, non-healthcare providers, such as peer workers, can take samples. The biggest challenge was turnaround time for results: average 33-34 days, compared to 3.5-6 days for phlebotomy tests, increasing the risk of losing people for follow-up. The results suggest DBS can reach populations at higher risk for HIV, HCV, and syphilis in less urban areas with a high-level of satisfaction. The evaluation provides recommendations for improving the current DBS process and for a potential future DBS provincial program.

Background: Saskatchewan faces a syndemic involving disproportionately high HIV incidence (more than 4x the national average) and elevated drug toxicity overdose deaths (3rd worst in Canada). From 2010 to 2019, injection drug use accounted for ~65% of new HIV cases in the province. This syndemic underscores the need for harm reduction interventions like Naloxone training. Regina, Saskatchewan's predominantly non-walkable infrastructure creates need for pop-up services.

Methods: Areas with high needle prevalence in Regina were identified using the geospatial platform reportneedles.ca. Four Naloxone trainings were conducted in these areas between October 2023 and November 2023, focusing on fentanyl overdose risks, recognizing overdose symptoms, responding to overdose, and Naloxone administration. A post-training survey was conducted assess training knowledge.

Results: All participants completed the training and post-training survey (n=30). Participants ranged in age (M = 39.6, SD = 13.4), gender (53.3% cisgender women, 30.0% cisgender men, and 6.7% non-binary), and ethnicity (56.7% Indigenous and 36.7% White). The majority of participants (75.6%) lived within a 15-minute walk of the trainings. When assessing participant knowledge after training, 82.8% understood Naloxone's onset time, and 65.6% knew its duration. Nearly all (93.1%) participants could identify Naloxone administration methods. In recognizing opioid overdose risks, most were able to identify factors that increase the risk of opioid overdose. Most could identify overdose indicators, including blue discoloration (93.1%), slow/shallow breathing (86.2%), loss of consciousness (82.8%), and unresponsiveness (82.8%).

Conclusions: This initiative demonstrates preliminary feasibility and promise of geospatial technology with community-based health interventions in Regina. The targeted approach, informed by geospatial data, enhances the accessibility of harm reduction services like Naloxone training. The diverse participant demographics and improved knowledge of overdose prevention indicate this program’s potential community impact. Leveraging geospatial data offers a pragmatic and feasible framework for enhancing service accessibility and addressing public health challenges applicable in various contexts.