Background: Incarcerated individuals are disproportionately affected by sexually transmitted and blood-borne infections (STBBI) and are considered a key population by the World Health Organization and the Government of Canada to the global STBBI response. As Canadian data on this population are lacking, we aimed to determine the prevalence of blood-borne (HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV)) and bacterial sexually transmitted infections (chlamydia, gonorrhea, and syphilis) among people incarcerated in Quebec provincial prisons.

Methods: Convenience sampling of participants from seven representative provincial prisons (where individuals are sentenced for < 2 years) was undertaken. Participants were offered self- or peer-collected dried blood spot (DBS) testing for HIV and HCV antibodies, anti-treponemal antibodies for syphilis, hepatitis B surface antigen (HBsAg), and HIV and HCV viral loads. PCR testing was conducted on urine samples collected in participants’ cells for Chlamydia trachomatis and Neisseria gonorrhoea. While recruitment is ongoing (desired sample size: 1,176), preliminary results are presented.

Results: From October 7 – December 11, 2024, 259 participants were recruited from L’Établissement de Détention de Montréal - Bordeaux (100% male; median age: 35 years; 43 (17%) ever injected drugs). Among these, 41 (16%) chose a self-collected DBS method. Prevalence estimates were 0.4% (1/259) for anti-HIV antibodies (0/1 with a detectable viral load), 1.2% (3/259) for HBsAg, 4.6% (12/259) for anti-HCV antibodies (1/12 with a detectable viral load), and 5.8% (15/259) for anti-treponemal antibodies. Urine prevalence estimates were 1.6% (4/257) and 0.4% (1/257) for Chlamydia trachomatis and Neisseria gonorrhoea, respectively.

Conclusion: Preliminary results among people in Quebec provincial prisons demonstrate high hepatitis B, C, and syphilis prevalence estimates compared to the general population, underscoring significant public health concerns and unmet needs. Enhanced testing and treatment for STBBI both within and beyond carceral settings is imperative to curb transmission and meet Canada’s elimination goals.

Background: HIV/AIDS knowledge has been identified as a determinant of preventative or self-protective sexual behaviour. The HIV Knowledge questionnaire (HIV-KQ-18) is one of the most widely used HIV knowledge scales.
Objective: The objective of this study was to test the psychometric properties of the HIV-KQ-18 in Black people in Ontario. The psychometric properties of interest are construct validity and internal consistency.

Methods: We analyzed the data from 1,302 participants who completed the HIV-KQ-18 in a cross-sectional study conducted among Black people in Ontario. We estimated the internal consistency of this scale using Cronbach’s alpha. We analyzed the construct validity of the scale, testing hypotheses about HIV knowledge and age, education, employment status, gender, language and city using one-way ANOVA and independent sample t-tests. We hypothesized that older age groups, those with higher levels of education and those with full-time employment would have higher scores.

Results: Cronbach’s alpha for the scale was 0.82 (95% CI: 0.80-0.84) suggesting good internal consistency. One-way ANOVA tests revealed significant differences in mean HIV knowledge scores between at least two subgroups when considering the following characteristics: age (F(5, 1286) =[30.30]; p <0.001); employment status (F(2, 1299) = [39.93]; p <0.001); education (F(3, 1276) =[75.76]; p <0.001) and gender (F(2, 1292) = [6.76]; p= 0.001). Independent two sample t-tests revealed higher HIV knowledge scores among those in Toronto compared to Ottawa (MD=1.13, 95% CI: 0.68-1.58; p <0.001) and higher scores among those who completed the questionnaire in English compared to French (MD =1.08, 95% CI: 0.24-1.94; p = 0.012)

Conclusion: The HIV-KQ-18 is a valid instrument to assess the level of HIV/AIDS knowledge among Black Ontarians, with robust internal consistency and construct validity. The HIV-KQ-18 identified important differences in HIV knowledge based on the characteristics examined, indicating the need for targeted initiatives focused on increasing HIV-related knowledge.

Introduction: HIV care and related costs are expected to evolve over time. However, Canadian studies on healthcare costs over time are scarce. Our study quantified trends in annual mean healthcare costs per person living with HIV (PLWH) in Ontario (2003-2018) from a publicly funded healthcare system perspective.

Methods: We conducted a population-based study of PLWH in Ontario health administrative databases diagnosed from 1992-2018 (merged ICES-HIV and ICES-Ontario HIV Treatment Network Cohort Study [OCS] cohorts [merged: n=25842; ICES-OCS only: n=3516]). We examined three time-periods: 2003-2009; 2009-2015 (following guidelines for HIV treatment as prevention); and 2015-2018 with the expansion of generic ART regimens. Costs were estimated using a previously validated algorithm and inflated to 2018 Canadian dollars. Descriptive analyses were performed, and cost estimates were stratified by sociodemographic factors (age, sex, rurality, neighbourhood-level income, immigration status), year of entry into HIV care, and HIV-related characteristics (nadir CD4 count, ART use; ICES-OCS cohort only).

Results: Among the merged cohorts, the mean age at entry into HIV care was 38 years (SD:15) and 78% were male. The annual mean cost per PLWH increased from $9726 (2003) to $13594 (2018), rising by 46% from 2003 to 2009, 2% from 2009 to 2015, and declining by 7% from 2015 to 2018; trends were consistent across populations. Medications accounted for the largest share of annual healthcare costs (47-62%), increasing from $4749 in 2003 to $8974 in 2015, and declining to $7867 in 2018. Stratified analyses revealed that healthcare costs were higher among PLWH diagnosed at an older age, long-term residents, resided in low-income neighbourhoods, or had a nadir CD4 count less than 200copies/mL.

Discussion: Healthcare cost trends for PLWH in Ontario have fluctuated over time, primarily reflecting changes in medication costs. Differential healthcare costs across populations warrants further study, including the role of delayed diagnoses and care.

Introduction:

African, Caribbean, and Black (ACB) communities in Canada continue to experience disproportionately high rates of HIV alongside systemic barriers that hinder equitable care and research participation. This project applies the EGAP framework—Engagement, Governance, Access, and Protection—to establish ethical, community-driven data governance practices. Building on the foundational work of Black Canadian scholars, the principles of racial equity, health equity and social justice are prioritized in HIV-related data management.

Methods:

Using the CHIWOS ACB Data Access Initiative as a case study, this research employed community-based participatory research (CBPR) to co-create a data governance framework tailored to ACB women’s HIV research. Two key groups guided the process: The National ACB Program Expert Steering Committee and the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS) ACB Sub-hub. Together, they developed data access protocols, Community Governance Tables, and strategies for transparent, co-led decision-making. The approach focused on dismantling systemic barriers by embedding EGAP principles into every stage of the collaboration process.

Results:

The initiative produced a robust framework that aligns data management practices with the priorities of ACB communities. Key achievements included:
1) Development of standardized protocols for ethical data access and usage.
2) Creation of culturally responsive governance structures informed by lived experiences.
3) Mechanisms to translate research findings into actionable policy recommendations.

Feedback from interest-holders has showed strengthened trust and engagement within the community, alongside increased demand to access CHIWOS ACB data.

Discussion:

This study highlights the transformative potential of applying EGAP principles to HIV research by centering ACB voices and needs. The findings affirm the critical role of equitable partnerships and transparent governance in advancing health equity and dismantling systemic barriers. Future research should examine how this framework can be scaled to be integrated into public data holdings across Ontario and nationally to ensure broader impact.

Objective: Introduction of short-course, pan-genotypic, oral direct-acting antivirals (DAA) improved hepatitis C (HCV) therapeutic outcomes with clearance rates exceeding 95% in clinical trials, but assessing treatment success among key populations using real-world observational evidence remains critical. This study describes early era DAA treatment outcomes among a population-based cohort of people living with HIV (PLWH) in British Columbia (BC).

Methods: We included all PLWH aged ≥ 19 years in BC’s Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) cohort linkage. We identified index DAA treatment episodes using PharmaNet from January 2015 until March 2019, with one-year of follow-up to assess therapeutic outcomes (sustained virologic response [SVR] 10-52 weeks post-treatment). SVR was sourced from laboratory results from the Drug Treatment Program registry at the BC Centre for Excellence in HIV/AIDS. Logistic regression modeled associations of demographic, behavioral and clinical characteristics with not achieving SVR.

Results: The study included 754 PLWH initiating HCV treatment, of which 637 (84.5%) achieved SVR. Problematic alcohol use (OR 1.53, 95% confidence interval (CI): 1.02-2.31) and methadone dispensation (OR 2.02, 95% CI: 1.34-3.05) (both measured [ever] from HCV treatment start up to one year after treatment end) were associated with higher odds of not achieving SVR. Only methadone dispensation remained significant when adjusting for confounders in a multivariable model. Gender, age, gbMSM, race and HIV viral suppression were not significantly associated with odds of not achieving SVR in univariable models.

Discussion: Demographic and clinical characteristics among PLWH did not significantly impact DAA treatment success in a real-world setting. Factors related to substance use show mixed results. Findings suggest high effectiveness of DAAs observed for HCV treatment among PLWH. While demographic and clinical factors should still be considered, future research on HCV treatment should focus on people who use drugs as a key population.

Background: In many lower-resourced settings, comprehensive surveillance systems for HIV/STBBI are sub-optimal. Countries often depend upon resource-intensive population-based surveys that are implemented sporadically, leaving them reliant on outdated data to support epidemic responses. To better inform (sub-)national policy/programming, lower-cost, rapid, and flexible methods that retain methodological rigour are needed to maintain up-to-date HIV/STBBI estimates. Our team pioneered the expanded polling booth survey (ePBS) method with female sex workers (FSW) and men who have sex with men (MSM) in Nairobi County, Kenya to rapidly generate relevant data for programmatic refinement.

Methods: The ePBS is a nimble, community-engaged method comprising three modules—polling booth surveys (anonymous, ballot-based group surveys); individual questionnaires linked to biological samples; and focus group discussions—that uses population- and location-based random sampling to generate representative samples. Descriptive equity analyses of ePBS data presented examine programmatically relevant outcomes—e.g., HIV prevalence, service coverage—by sub-county.

Findings: Over 30-days in 2023, ePBS data were collected from 759 FSW and 398 MSM across 15 and 9 sub-counties of Nairobi, respectively. Crude inequalities by sub-county were stark. HIV prevalence: FSW=13.4% (range:0-24.2%) and MSM=17.6% (range:0-36.3%); contact with outreach (last quarter): FSW=67.3% (range:47.2-100%) and MSM=68.3% (range:52.1-91.7%); consistently taken PrEP (last 12-months): HIV-negative FSW=14.0% (range:0-28.6%) and HIV-negative MSM=13.5% (range:2.9-40.0%). Additional, ongoing analyses will be presented to examine inequalities by other key variables (age, typology, years identifying as FSW/MSM); equiplots and choropleth maps will illustrate heterogeneity in inequalities.

Implications: ePBS is a rapid, rigorous, and lower-cost tool that can be regularly implemented to supplement routine program data. Coupled with community engagement, ePBS enhances program monitoring and response to changes in local HIV/STBBI epidemiology, and service users’ needs over time and space. The flexibility, adaptability, and modular nature of ePBS is conducive to incorporating new surveillance and biomedical technologies and tracking emerging epidemiological trends rapidly, at relatively low cost.

Background: Hepatitis C virus (HCV) infection disproportionately affects people who inject drugs (PWID). In October 2020, Alberta expanded access to HCV treatment by allowing family physicians, in addition to specialists, to supervise treatment with direct-acting antivirals. This simplified the treatment pathway for patients, and could be particularly impactful for populations facing social barriers to care, including PWID.

Objectives: 1) Describe patients treated for HCV in Alberta, 2) evaluate the effect of the October 2020 policy change on successful treatment completion, defined as achievement of sustained virologic response (SVR).

Methods: This study used linked hospitalization, emergency department, pharmacy, and laboratory data from Alberta Health Services. A cohort of adults treated for HCV with direct-acting antivirals between fiscal years 2017 and 2021 were identified and followed for 1 year. We described cohort demographics, acute care utilization, and substance use. PWID were identified using a validated case definition. Interrupted time series analysis using a quasi-Poisson model was used to model the effect of the policy change.

Results: We identified 5,545 adults treated for HCV in Alberta during the study period (36% female, 20% rural). 1169 (21%) were identified as PWID. Among those eligible, 66% of PWID and 85% of non-PWID achieved SVR. The interrupted time series analysis found a 39% (95% CI 16-66%) immediate increase in treatment completion among PWID following the policy change, but no lasting effect was observed (IRR 0.97; 95% CI 0.89-1.04). No immediate (IRR 0.97; 95% CI 0.84-1.12) nor lasting (1.01; 95% CI 0.98-1.05) change was observed non-PWID.

Conclusion: The main benefit of allowing family physicians to supervise HCV treatment was for PWID, despite the change not being targeted at them directly. Simplifying treatment pathways for all patients may be an important step toward health equity through removing barriers to care that most affect underserved patients.

Introduction: The Public Health Agency of Canada (PHAC) Tracks surveillance system monitors trends in HIV, sexually transmitted and blood-borne infections (STBBI), and associated factors among key populations, including gay, bisexual and other men who have sex with men (GBMSM).
Methods: We used a community-based participatory approach to implement a cross-sectional bio-behavioural survey (Sex Now 2024) as Tracks GBMSM Phase 3. We recruited in all provinces in 19 cities at 43 events (e.g., Two-Spirit powwows, Pride festivals) between June-September 2024. Eligibility criteria were expanded beyond GBMSM to include all Two-Spirit people, trans men, and nonbinary people. Participants had to be aged 15+, live in Canada, and be able to consent to and self-complete the questionnaire in English, French or Spanish. Participants aged 18+ could opt-in to provide dried blood spots (DBS). Participants received $10 cash for survey participation and a tote bag for providing DBS. Data analyses determined prevalences for HIV/STBBI indicators.
Results: Of 4,881 eligible participants, 64% identified as white, 11% as Indigenous (of whom 64% were Two-Spirit), 10% East/Southeast Asian, 8% Black, and 7% Latin. The majority identified as gay (52%) and men (62%), with 28% as trans, 27% queer, and 24% bisexual. Half (47%) were aged <30. DBS were provided by 42% (n=1712/4103) of eligible participants. Self-reported HIV prevalence was 4.3% (n=198/4614). For 95-95-95 targets, 91.9% (182/198) who self-reported living with HIV reported currently taking antiretroviral drugs, and 92.3% (168/182) of those reported viral suppression. Half (48.8%) of HIV-negative participants reported past-year HIV testing; 24.4% were never tested for HIV. Among those STBBI-tested, self-reported past-year prevalence: 7.0% gonorrhea, 6.5% chlamydia, 2.9% syphilis, 0.6% hepatitis C, and 0.5% mpox.
Discussion: Results provide a descriptive snapshot of HIV/STBBIs among this population in Canada. Data use at local, provincial and federal levels should inform and guide public health interventions.