Background: Previous research has demonstrated that people living with HIV (PLWH) in rural areas may have suboptimal HIV treatment outcomes. We examined whether rurality impacts treatment interruptions (TIs) and unsuppressed viral load (VL) in a cohort of PLWH after the expansion of the STOP HIV/AIDS program in British Columbia (BC).

Methods: We recruited PLWH aged ≥19 years across BC into the STOP HIV/AIDS Program Evaluation (SHAPE) study from January 2016-September 2018 and conducted surveys online or with the assistance of peer-research associates (in-person or by telephone). We used postal code to classify participants’ degree of rurality and metropolitan influence based on Statistical Area Classification (SAC) categories. We examined 6-month proportions of participants with TIs (>60 days late for medication refills) and yearly proportions of at least one unsuppressed VL (≥200 copies/mL) between 2016-2023. We used univariable generalized estimating equation regression analyses to model TI incidence and unsuppressed VL by SAC category (large, medium-sized/suburb, and rural).

Results: Among 608 PLWH included, the median age was 50 years (Q1-Q3: 43-57) and 21.5% were women. Of 608, 79.8% resided in large, 17.3% in medium-sized/suburban, and 3.0% in rural SAC areas. Overall, 6-month proportions of TIs ranged between 2.9-9.9% and yearly proportions of unsuppressed VL ranged between 10.2-13.9%. There were no statistically significant differences in TI incidence or unsuppressed VL between participants residing in rural (TIs: incidence rate ratio [IRR] = 1.10; 95% CI 0.50-2.40; unsuppressed VL: odds ratio [OR] = 0.89; 95% CI 0.38-2.05) or medium-sized/suburban (TIs: IRR = 1.23; 95% CI 0.88-1.73; unsuppressed VL: OR = 1.38; 95% CI 0.94-2.04) communities compared to large cities.

Conclusion: We did not observe differences in TIs or unsuppressed VL among PLWH residing in smaller or more rural areas relative to large cities, suggesting that disparities based on residence may be lessening over time.

Objective:To assess the implementation fidelity of a community-based exercise (CBE) tele-coaching (online) intervention seeking to improve health outcomes among adults living with HIV.

Methods:The online 6-month CBE intervention included thrice-weekly 60-minute exercise sessions combining aerobic, resistance, balance, and flexibility exercises, supervised biweekly by a personal trainer (13 sessions); group exercise classes; and monthly group educational sessions. We assessed fidelity from participant and fitness trainer perspectives through structured interviews at months 2 and 6 (assessing 20 fidelity intervention criteria on fitness providers’ performance, participant engagement, and exercise experiences) and coaching logs from personal training sessions (frequency, intensity, time, and type of physical activity during supervised sessions and self-reported physical activity the prior week). We defined fidelity to be met if at least 80% of participants reported meeting "complete criteria" for ≥80% of the criteria (16/20) assessed through structured interviews, and completed ≥80% of the intervention criteria (5/6) reported in coaching logs.

Results:Twenty-nine of 30 participants (age 33-71 years, 69% male) participated in a fidelity interview. According to the interviews and coaching logs, fidelity was not achieved for ≥80% of criteria at month 2 or 6. Fidelity was achieved for personal training sessions but not for independent exercise and attendance at exercise classes (29% completed) and monthly group educational sessions (45% completed). At month 2, ≥80% of participants reported 70% of the criteria as "completely met" and 30% at month 6. Scheduling issues, disinterest, and technology problems hindered online group exercise class attendance. Disability and disinterest hindered engagement in aerobic, resistance, balance, and flexibility exercise. In supervised sessions, highest exercise adherence was for strength and flexibility exercises (≥80% completion in 57% of participants).

Conclusion:Fidelity of implementation was achieved for supervised components of the intervention, and less for independent exercise. Future research should tailor interventions to personal preferences to improve engagement.

Background: Sexual Orientation, Gender Identity, and Expression (SOGIE) diverse communities (SDCs) face notable health inequities, including increased incidence and prevalence of HIV/AIDS within community-specific subgroups (i.e., gay, bisexual, transgender, and other men who have sex with men, GBTMSM). These inequities highlight the need for explicit consideration, whether directly in health service provision and via policies and programming. Prior research on SDCs' representation in health policy bodies in Ontario has highlighted exclusion in policy and programming.
Objectives: This study reviews: 1) Ontario Public Health Standards (OPHS) documents to assess consideration of SDCs; 2) Ontario's public health unit (PHU) websites to explore how SDCs are defined and represented; and 3) publicly available surveillance data and reports for inclusion of SDCs, in measurement and in context.
Methods: OPHS documents, PHU websites, and surveillance data (2013-2024) were collated and analyzed. Overarching themes were gleaned from content reviews.
Results: Preliminary findings suggest that, while most PHUs' websites address SOGIE diversity in sexual health and mental health, representation is inconsistent and often vague. Salient issues such as PrEP for HIV prevention tended to be underemphasized or absent. MPOX vaccination for GBTMSM is disproportionately highlighted compared to broader SOGIE health issues, likely due to the recentness of the issue. OPHS documents lack detailed guidance on SOGIE inclusion, often using generic terms such as "diversity" without actionable directives. Protocols fail to address intersectional needs, particularly for marginalized subgroups. SOGIE-specific identity metrics in surveillance reports, in mental health or sexual health indicators, are largely absent. Reports do not include actionable recommendations or involve community consultations with SDCs, further limiting relevance for health equity.
Conclusion: These findings highlight fragmented and inadequate representation of SOGIE diversity in Ontario’s public health systems. Standardized, inclusive policies and targeted data collection are essential to address structural barriers and to foster equitable outcomes.

Background: Rates of HIV and HCV are disproportionately high among incarcerated populations, yet testing in correctional facilities remains inadequate. Accessible and acceptable testing strategies are critical to address these gaps. Pharmacist-led point-of-care (POC) testing in correctional settings is a novel approach with the potential to normalize testing and overcome barriers associated with traditional methods. This study evaluated the acceptability of pharmacist-led testing for HIV and HCV in correctional facilities.

Methods: Between January and February 2024, two pharmacists visited three rural correctional facilities in Newfoundland and Labrador to offer voluntary HIV and/or HCV POC testing. Eligible participants completed pre- and post-test surveys to share their perceptions and experiences with the testing process. Survey items were based on the Theoretical Framework of Acceptability (TFA) to assess domains of Affective Attitude (AA), Burden (B), Ethicality (E), Intervention Coherence (IC), Opportunity Costs (OC), Perceived Effectiveness (PE), and Self-efficacy (SE). Surveys included multiple-choice questions and Likert-type scales. Descriptive statistics were used to analyze the results.

Results: Among 103 incarcerated individuals, 75 participants expressed interest in testing. A total of 73 HIV tests and 57 HCV tests were administered. The highest positivity ratings (>93%) were observed in domains AA, PE, SE, IC, and OC. All participants (100%) reported comfort in testing by pharmacists and supported its implementation in correctional facilities. A total of 91.1% of participants denied feelings of stigma throughout testing visits, and 97.9% of participants reported an understanding of pharmacist-provided education. Additionally, 52% preferred testing by pharmacists over other healthcare providers, while 38% expressed no strong preference.

Conclusions: Pharmacist POC testing in corrections is associated with high participant acceptability. This highlights its potential as a solution to low testing rates, improving access to essential HIV and HCV testing in underserved populations.

Introduction: Pre-exposure prophylaxis (PrEP) is a highly effective HIV-risk reduction strategy and critical part of a comprehensive public health approach to HIV prevention. Recent progress has improved access to PrEP in Ontario, but no provincial-level monitoring system currently exists. This creates a poor understanding of the landscape of PrEP in Canada’s largest province.

Method: PrEP uptake was estimated using a published algorithm together with branded/generic TDF/FTC and branded TAF/FTC dispensation data extrapolated from more than 70% of retail pharmacies in Ontario, provided by a private company, IQVIA. PrEP counts (estimated number of unique PrEP users), and PrEP-to-need ratios (P2N: PrEP users to first-time HIV diagnoses, as determined by the Ontario HIV Epidemiology Surveillance Initiative) are described in yearly (2019 to 2023) and quarterly bases (Jan-Mar 2022 to Oct-Dec 2023) to assess PrEP uptake over time in Ontario.

Results: An estimated of 21,180 individuals were dispensed PrEP at least once in Ontario in 2023, the largest number ever recorded. This is compared to 9,957 in 2019, 10,687 in 2020, 13,104 in 2021, and 16,635 in 2022, an increase of 112% compared to 2019 and 27.3% to 2022. 97.1% of the PrEP users were male (P2N:31.24); however, females have seen a steady increase from 306 to 618 between 2019 and 2022 (102% relative increase, P2N:2.24). Furthermore, most of the PrEP users in Ontario were below the age of 40. Toronto and Ottawa continue to account for the largest number of PrEP users. While PrEP programs have been in place, 76% of the users pay for this medication with private insurance. Full geographical analysis pending.

Conclusion: PrEP usage is mainly male driven; however, PrEP use changes show a rise of females on PrEP. This analysis allows for the better understanding of PrEP use and to identify implementation gaps to guide future work.

Background:
Rates of syphilis, a sexually transmitted blood-born infection (STBBI), have surged over the last decade. This increase is driven by cases among gbMSM, individuals living with HIV (lwHIV) and females. There has been a fifteen-fold increase of cases in females from 2017 to 2022, with over 90% of childbearing age, raising concerns about vertical transmission.

Cool Aid Community Health Centre in Victoria, BC serves 7,000 clients experiencing homelessness and mental health and substance use challenges. The weekly nurse-led STBBI clinic, Prism Wellness, partners with AVI Health and Community Services and is staffed by STI certified practice nurses and offers STBBI education, screening, treatment, pre-exposure prophylaxis (PrEP) and doxycycline post-exposure prophylaxis (doxyPEP). STBBI testing is also offered during regular client encounters.

Methods:
A retrospective chart review was conducted to identify and include all clients tested for syphilis between January 1, 2021, to December 31, 2024. Client demographic variables included age, gender, gbMSM, lwHIV, and PrEP.

Results:
7828 syphilis tests were completed with 2994 unique individuals in the last 3 years (2725 non-reactive, 269 reactive). Of the reactive tests (n=269, mean age=46), 111 (41%) were determined to have a current infection (149 previously treated, 9 false positive). For those with current infection, 106 (95%) were fully treated. Females, particularly those under 40, are disproportionately affected by recent syphilis infections. While females account for 25% of all reactive syphilis tests, they represent 41% of current infections.

Conclusions:
Evolving syphilis trends require targeted interventions as rates shift from gbMSM and plHIV to females.

BACKGROUND
Syphilis notifications have increased among women and heterosexual men in Canada and people who inject drugs (PWID) are an emerging group at risk. However, there is a limited understanding of syphilis specifically among PWID. We examined syphilis prevalence and how this varied by intersecting population groups and environmental factors.

METHODS
Data were from HEPCO, a cohort study of PWID in Montreal. Syphilis testing via venipuncture was added in November 2022 with treponemal testing reflexed to non-treponemal testing if positive. We included the result at each person’s first test and Fisher’s exact test was used to examine differences in the prevalence of any syphilis exposure, inclusive of current or past infection.

RESULTS
As of March 2024, 386 people (16.1% women, 2.6% non-binary/transgender/two-spirit) had a syphilis test. Two people (0.52% [95%CI 0.1-2.1]), one man and one woman had current syphilis and 33 (8.6% [95%CI 6.1-11.8] had any syphilis exposure. Men and women both had a prevalence of 8.1%. Among men, prevalence was higher among those identifying as gay, bisexual and other MSM (gbMSM), those with HIV, and those who reported recent sex work (all p <0.001). All women with syphilis identified as heterosexual and none were living with HIV. Prevalence was higher among women reporting recent sex work and recent unstable housing; however, this was not statistically significant.

CONCLUSION
Current syphilis infection was uncommon among this cohort of PWID; however, any syphilis exposure was higher than anticipated. Among men, there is an intersection and overlap among those who identify as gbMSM and are living with HIV. Among women, there was a possible link to sex work and unstable housing however caution is needed due to the small sample size. Periodic syphilis testing among PWID may be justified alongside testing for other STBBIs.

Background
HHV-8 is a gammaherpesvirus associated with Kaposi sarcoma, some B lymphoproliferative disorders and inflammatory cytokine syndrome, mostly in older and immunosuppressed men. Lack of validated serological tests has hampered the assessment of its seroprevalence. Using our in-house serology assay, we assessed demographic and sexual behaviour factors linked with HHV-8 seropositivity in men.
Methods
802 Cis and transgender gay, bisexual and other men who have sex with men (GBM) from the Engage study in Montreal were included. 33 HIV-negative heterosexual men from the McGill HIV cohort were included. HHV-8 serology was assessed by flow cytometry quantifying IgG binding to HHV-8 infected BCBL1 cells. Comparisons of demographics and sexual behaviours in GBM were performed using Kruskal Wallis’, t- and binomial tests.
Results
From a total of 802 participants, 157 (19.6%) were living with HIV. HHV-8 seropositivity was elevated in GBM with HIV as compared to GBM without HIV (67.5% vs. 41.8%, p<0.001), independently of ethnicity. Conversely, HHV-8 seropositivity was low at 9.1% in heterosexual men compared to GBM, regardless of HIV (p<0.001).
HHV-8 seropositive HIV-negative GBM were older (median age 35 vs. 32, p<0.001), and had more lifetime (8 vs. 5, p<0.001) and recent (<6 months) sexual partners (6 vs. 3, p<0.01) than their HHV-8 seronegative counterparts. HHV-8 seropositive GBM living with HIV had similar age (52 vs 50, p>0.99), but tended to have more sexual partners in their lifetime (10 vs. 4, p=0.054) than their HHV-8 seronegative counterparts. Irrespective of HIV, HHV-8 seropositive GBM had more often been diagnosed with an STI in their lifetime (HIV-: 70 vs. 56%, HIV+: 94 vs. 82%, p<0.001).
Conclusion
HHV-8 seropositivity appears elevated among this large sample of Montreal GBM compared to heterosexuals. Older HIV-negative GBM and those living with HIV may be more at risk for the development of HHV-8-induced diseases.

Background: Long-acting HIV treatment (LA-treatment) can improve quality of life and address key adherence challenges with daily oral treatments among people living with HIV (PLHIV). Currently, one complete LA-treatment regimen is approved in Canada, but access remains limited across different provinces and territories.

Methods: We assessed Two-Spirit, gay, bisexual, trans, and queer men and non-binary (2S/GBTQ) people’s preferences for LA-treatment in Canada through CBRC’s 2024 online Sex Now survey. Participants were 2S/GBTQ PLHIV who were aged 15+, living in Canada, and self-completed a questionnaire in English, French, or Spanish. Recruitment occurred through social media, community-based organizations, and sociosexual websites/apps. Pearson’s chi-square and Fisher exact tests were used to assess statistically significant differences (p<0.1) in preference for LA-treatment across explanatory variables.

Results: Overall, 42% of participants (n=232) reported preferring LA-treatment over daily pills. Preference for LA-treatment was higher among participants reporting financial strain (53%, p=0.033), sexualized substance use in the past 6 months (57%, p=0.007), and lower satisfaction with their connection to 2SLGBTQQIA+ communities (46%, p=0.091). The most frequently reported benefits of LA-treatment included not needing to take a daily pill (75%) and not worrying about forgetting to take daily meds (63%), while drawbacks included more frequent visits to healthcare providers (54%) and concern that LA-treatment was less effective than daily pills (50%). Participants preferred receiving LA-treatment at a clinic (76%), home (53%), or a pharmacy (46%) and from a primary care provider (79%), themselves (50%), or infectious disease specialist (48%).

Conclusion: Our findings can inform improvements in the rollout of LA-treatment among 2S/GBTQ people in Canada, including across diverse healthcare settings and within key sub-populations who would most benefit. Given the potential quality of life benefits of LA-treatment, access must be expanded and awareness about treatment efficacy must be enhanced among healthcare providers and PLHIV.

BACKGROUND
Previously, we presented rates of overdose hospitalizations among people living with HIV (PLWH) in Canada. We examine the sex differences in the occurrence overdose-related hospitalizations among PLWH across Canada.

METHODS
Using standardized hospitalization data from the Canadian HIV healthcare use study (CHESS), we examined hospitalization records for adult (≥20 years) PLWH who had at least one HIV-related inpatient acute hospitalization in Canada between April 2006 and March 2020. We identified overdose-related hospitalizations using International Classifications of Diseases 10, Canada revision (ICD-10-CA) diagnostic codes, distinguishing opioid, stimulant, and other overdoses. We used logistic regression models with generalized estimating equations to assess whether sex was associated with the odds of a hospitalization being (1) overdose-related, and (2) opioid overdose-related, adjusting for province and territories, area-level income, rurality, and fiscal year.

RESULTS
Among a total of 117,436 hospitalizations in 28,320 PLWH (25% females) between 2006 and 2020, we identified 2,230 overdose-related and 1,201 opioid overdose-related hospitalizations. Compared to males, females had a significantly higher proportion of overdose-related hospitalizations (4.8% vs 8.6%, p<0.0001) and opioid overdose -related hospitalizations (2.6% vs 5.6%, p<0.0001). After adjusting for confounders, the odds of a hospitalization being overdose-related was higher among females than males (adjusted OR [aOR] = 1.20, 95% Confidence Interval [CI]= 1.06 –1.35). Similarly, the odds of a hospitalization being opioid overdose-related was higher in females than in males (aOR = 1.38, 95% CI= 1.18–1.61).

CONCLUSION
Our findings highlight a significant sex-based disparity in the overdose and opioid-overdose related hospitalizations among PLWH. These results suggest a disproportionate burden of substance-use related harms among females with HIV and indicate a need for further research and action.

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

Methods: Participants were recruited from the Ontario HIV Treatment Network Cohort Study, a multi-site clinical cohort. Those reporting past-year cannabis use were invited to complete the Ontario Cannabis and HIV Survey assessing patterns of past-year cannabis use, since legalization, and since COVID-19. Data were collected between August 2022 and December 2023. We used descriptive statistics to describe the sample.

Results: Among 292 respondents, 84% were male and 72% were White, with a mean age of 50 (SD=13). Post-legalization, 34% of participants used cannabis more frequently (versus 9% less frequently) due to easier access, pleasure, safer products, more product variety, and less stigma. Post-COVID-19, 36% used more frequently versus 4% less frequently. Reasons included stress/anxiety, pleasure, more opportunities to consume, boredom, and loneliness. Common products for recreational and medicinal users, respectively, were smoked flower (77%; 69%), edibles (62%; 43%) and vaped flower (28%; 23%). Some did not know the THC content of their products (17-19% medicinal; 13-23% recreational). Only 36% of medicinal users had healthcare provider authorization and fewer still (7%) had insurance coverage; also, 17% used cannabis to manage symptoms of insomnia, 15% anxiety, and 13% depression. Screening for problematic use indicated 71% had a moderate risk for health and other problems while only 3% reported high risk of dependence and severe problems.

Conclusions: Our findings provide a rare documentation of cannabis use among people living with HIV. Use patterns were broadly similar for recreational and medical purposes and across product types, except edibles and beverages. More consumer education is needed regarding cannabinoid levels and lower-risk cannabis use.

Objectifs
En 2024, le Canada a établi un plan pour atteindre les objectifs mondiaux en matière de soins du VIH d’ici 2030, visant à atteindre 95 % des personnes vivant avec le VIH diagnostiquées, sous thérapie antirétrovirale et avec une charge virale supprimée. Les taux actuels de 90 %, 85 % et 95 % au Québec, et une recrudescence récente du nombre de nouvelles infections, suggèrent que des efforts supplémentaires sont nécessaires. Ce travail explore les conséquences financières d’instaurer la gratuité des antirétroviraux (ARV) au Québec.

Méthode
Une revue des données démographiques, épidémiologiques et financières a été effectuée. Trois scénarios ont été explorés :
scénario 1 : la modification de la Loi sur l’assurance médicaments pour exclure la participation financière,
scénario 2 : l’intégration au Programme de gratuité des médicaments pour les infections transmises sexuellement et par le sang, et
scénario 3 : la création d’un réseau de distribution parallèle aux pharmacies communautaires.

Résultats
Il est estimé que 17 851 personnes seraient touchées par la gratuité. Le scénario 1 représente le scénario le moins coûteux avec un supplément de 6,2 et 6 millions de dollars pour les régimes public et privés. Les scénarios 2 et 3 entraîneraient une dépense annuelle supplémentaire de fonds publics de 71,9 à 85,9 millions de dollars.

Conclusion
Bien que coûteuse pour le régime public, les bénéfices anticipés attribuables à la gratuité des ARV méritent la considération des décideurs afin d’atteindre les objectifs de lutte contre le VIH pour 2030.

Background: HIV-1 drug resistance mutations (DRMs) compromise the effectiveness of antiretroviral therapy (ART) and lead to treatment failure. While DRMs have been extensively studied in many parts of the world, data from African countries, including Nigeria, remains limited.
Methods: A cross-sectional integrated biological and behavioural surveillance survey was conducted across 12 states, representing two states from each of Nigeria’s geo-political zones, among female sex workers, men who have sex with men, people who inject drugs (PWID), and transgender individuals. Dried blood spot specimens were collected from 2,309 participants, of whom 719 (31.1%) were HIV-1 viremic (>1,000 copies/mL). Partial HIV-1 pol genes were sequenced from viremic specimens using an in-house DRM genotyping assay. DRMs were identified from MiSeq reads with HyDRA Web and resistance levels were interpreted using the Stanford HIVdb program. Pearson chi-square tests assessed associations between sociodemographic factors and DRMs.
Results: Of the 414 HIV-1 genotyped specimens, 16.7% contained at least one DRM. The most common DRMs were K103N, M41L, and M184V, with 9.2% showing high-level resistance to both efavirenz and nevirapine. DRMs were most prevalent among PWID (21.6%) and in the North Central zone (25.8%). Older age was significantly associated with the presence of DRMs (p<.001). Notably, over half (58.7%) of participants reported being unaware of their HIV-positive status and having never received ART.
Conclusion: Our findings suggest the presence of transmitted drug resistance, given most participants reported never receiving ART. The association between older age and DRMs may be indicative of HIV-1 chronicity and/or sub-optimal ART adherence. While the high-level resistance to efavirenz supports the transition to dolutegravir-based regimens in Nigeria, parallel efforts should be made to improve adherence and ensure sustained ART access to prevent the emergence and spread of drug-resistant strains. Ongoing surveillance remains essential to address these challenges and guide effective interventions.

Background
In 2018, publicly-funded, oral tenofovir-based HIV Pre-Exposure Prophylaxis (PrEP) became available to individuals at elevated HIV risk in British Columbia (BC). We describe new HIV diagnoses, evaluate factors associated with HIV diagnosis, and estimate the diagnosis rate amongst BC PrEP program participants.

Methods
Participants with ≥1 PrEP dispensing between 1-Jan-2018 and 31-Dec-2023 (follow-up to 30-Jun-2024) were included. We described baseline characteristics and compared participants with and without subsequent HIV diagnosis, using Chi-square or Fisher’s exact tests and Wilcoxon rank sum test. We identified factors associated with HIV diagnosis using a multivariable model, and reported the diagnosis rate per 100 person-years (PY).

Results
Overall, 12,389 PrEP participants were included (98.1% men who have sex with men [MSM]) and followed for median (Q1-Q3) 31 (15-58) months. 73/12,389 (0.6%) participants were subsequently diagnosed with HIV at median 32 (13-50) months after enrolment, and median 13 (6-28) months after PrEP prescription run out. All were MSM, and were younger (median 31 [25-37] vs. 32 [27-41] years; p=0.044) with higher HIRI-MSM scores (median 22 [18-29] vs. 18 [14-22]; p<0.001) than participants without new HIV diagnosis. Substance use, syphilis infection, and <3 PrEP prescription fills were associated with increased odds of HIV infection (Table). The HIV diagnosis rate was 0.19 per 100 PY (95%CI, 0.14, 0.23) over 39,313 PY of follow-up.

Conclusions
New HIV diagnoses were low amongst BC’s PrEP program, occurring almost exclusively among participants disengaged from PrEP medication. Our results suggest focused follow-up may be warranted for such participants with ongoing risk factors.

OBJECTIVES
This study provides an overview of area-based measures of socioeconomic status (SES) used in Canada and the United States (US), the domains captured, and their associations with health outcomes among people living with HIV (PLWH).

METHODS
A scoping review of studies published in English between 2012 and 2023 was conducted using PubMed and Web of Science. The search combined ‘HIV’ with terms related to area-based SES measures. Eligible studies included PLWH, were based in Canada or the US, used area-based SES measures, and assessed health outcomes.

RESULTS
We identified 1,995 studies for title/abstract screening; 104 underwent full-text review; 48 met the inclusion criteria. Of these, 33 have been reviewed to date (31 US, 2 Canada). Most studies focused on PLWH only (29/33). Area-based SES was assessed using composite measures (21/33), single measures (10/33), or both (2/33) – all sourced from census data. The most common area-units used were census tract (12/33), and ZIP code tabulation area (12/33). Area-based SES domains assessed are shown in Figure 1. Common health outcomes assessed included viral load/suppression (19/33), care linkage/retention (6/33), and mortality (5/33). Most studies found that lower area-based SES was associated with poorer health outcomes.

CONCLUSIONS
Most area-based SES measures used in studies among PLWH in the US and Canada were composite scores, with area-level income/poverty, education, and employment/occupation being the most frequently captured domains. The associations between lower SES, assessed by area-level measures, and poorer health outcomes, underscore the utility of such measures in research addressing health disparities among PLWH.

Background: Educational materials on PrEP safety and effectiveness are privately and publicly available online for people prescribed PrEP. We assessed Canadian PrEP users’ knowledge, attitudes, and behaviors regarding PrEP.

Methods: People aged ≥18 years who were currently taking or had previously taken (≤30 days) oral PrEP were invited to participate in Wave 2 (September–November 2024) of an online, self-reported, cross-sectional survey. Proportional sampling based on PrEP user location was utilized to recruit respondents. Primary outcome was knowledge of PrEP use and risks; adequate knowledge was defined as ≥75% correct responses to 12 questions. Secondary outcomes included 5-point Likert scale questions on attitudes and behaviors towards PrEP. Wave 1 results were previously presented.

Results: Sixty-nine PrEP users completed the survey; most identified as male (98.6%), had a college education or higher (92.8%), and lived in Ontario (56.5%) or Quebec (26.1%). Overall, 47.8% demonstrated adequate knowledge, with 70.3% correct answers on average; only four respondents scored <50%. Most users were aware of testing HIV-1 negative before initiating PrEP (97.1%), regularly testing for HIV-1 while using PrEP (94.2%), and that missing doses increases HIV-1 risk (95.7%). Some users understood the need for hepatitis B testing (49.3%) and informing their provider about recent (<1 month) flu-like symptoms (55.1%) before initiating PrEP. A minority of respondents (27.5%) knew that they should talk to their provider before stopping PrEP if hepatitis B positive. Most respondents initiated PrEP ≥1 year ago (94.2%) and tested for HIV-1 ≥3 times per year (91.3%). Condoms were used by 8.7% during their last sexual encounter and ‘sometimes’ (53.6%) or ‘never’ (39.1%) generally. Respondents ‘somewhat agreed’ (17.4%) or ‘agreed’ (75.4%) they were more likely to have condomless sex while using PrEP.

Conclusions: Respondents demonstrated adequate knowledge about HIV-1 testing and adherence. Opportunities exist regarding hepatitis B and acute HIV-1 infection symptoms.

Background: In November 2020, emtricitabine/tenofovir alafenamide was granted indication expansion to include pre-exposure prophylaxis (PrEP) for HIV-1 infection. Updated educational materials on the safety and effectiveness of PrEP were made available to healthcare providers (HCPs). We assessed oral PrEP knowledge, attitudes, and prescribing behaviors of Canadian HCPs.

Methods: HCPs who had ever prescribed oral PrEP anywhere in Canada were eligible for a dual-wave, cross-sectional survey (December 2022–September 2024). Proportional sampling based on the practice location of PrEP prescribers was utilized to recruit HCPs via email/mail. Primary outcome was overall knowledge of PrEP use and risks; adequate knowledge level was defined as ≥80% correct responses to 14 questions. Secondary outcomes included 5-point Likert scale questions on attitudes and behaviors towards PrEP. Results from both waves were aggregated.

Results: Among 1257 HCPs invited, 109 completed the survey. Respondents were primarily physicians (96.3%) specializing in family medicine (73.4%) and practicing in Ontario (51.4%). Most respondents (71.6%) demonstrated adequate knowledge, with 86.4% of questions answered correctly on average. Three HCPs achieved the lowest score of 57.1%. HCPs were aware that PrEP should be stopped (64.2%) and converted to an HIV-1 treatment regimen (50.5%) for PrEP users with signs/symptoms of acute HIV-1 infection. They understood the importance of verifying creatinine clearance (99.1%) and the link between adherence to PrEP and effectiveness (99.1%). Respondents reported always testing for creatinine clearance (94.5%) and counseling on adherence (85.3%). Most HCPs ‘somewhat agreed’ (22.9%) or ‘agreed’ (60.6%) with the attitude that the role of PrEP in HIV-1 prevention is distinct from condoms, abstinence, and testing. A minority of HCPs (16.5%) ‘agreed’ that PrEP use contributes to an increase in sex partners.

Conclusions: Most PrEP-prescribing Canadian HCPs were knowledgeable about PrEP but could benefit from education on treating people with signs/symptoms of HIV-1 and PrEP research on sex partners.

Background
Accurate and timely cause of death information is important for public health monitoring. In recent years, deaths with an unknown/ill-defined underlying cause have increased in Canada, particularly in British Columbia (BC), among people with HIV (PWH). Delays/missingness in cause of death data coincide with BC’s drug toxicity crisis, suggesting the complexity of classifying drug poisoning deaths may have contributed to these delays. To help classify some of these deaths, we adapted a published method to presume unknown deaths as drug-related.

Methods
From the STOP HIV/AIDS study (a linkage of administrative healthcare and clinical data for PWH in BC), we examined deaths occurring 2015/16– 2019/20. Unknown deaths were defined using the International Classification of Diseases 10 code: R99. Drug-related death classification criteria were: a) died aged 20-64, b) a “pending”, “accident”, or “undetermined” manner of death; and c) history of drug use ascertained via drug-related healthcare contact (practitioner encounters, hospitalizations, opioid agonist therapy dispensations, urine drug screening), and injection use history from clinical forms.

Results
Of the 79 unknown deaths, 70.9% (56/79) were men. Median age at death was 49 (Q1:42, Q3: 58). In total, 88.6% (70/79) met the presumed drug-related death criteria. In the 12 months before death, 78.5% (62/79) recorded a drug-related healthcare interaction, with 21.5% (17/79) hospitalized in the 30 days prior (Figure 1).

Conclusion
Our method suggested almost 90% of unknown deaths among PWH in BC between April 2015 - March 2020 may be drug-related. Future work may further validate such classifications using updated mortality data.

Background: Men who have sex with men (MSM) account for a disproportionate number of bacterial STIs (bac-STIs). A new tool, “doxy-PEP,” is used after condomless oral or anal sex. We reviewed surveillance data to understand the potential public health impact of offering doxy-PEP to MSM diagnosed with 0, 1 or ≥ 2 bac-STI diagnoses.

Description: We analyzed episodes during 2022 –2024 in which a bac-STI was confirmed in MSM to determine the number of individuals with ≥1 positive bac-STIs testing episodes (PTEs) within 12 months of another diagnosis. We calculated the number of PTEs and bac-STIs that might be prevented, and the number needed to treat (NNT), using either 0, ≥1 or ≥ 2 PTEs in a 12-month period as a threshold for doxy-PEP.

Findings: We found that ~3% of MSM had ≥1 PTEs within 12 months, 26% with one PTE had a second PTE within 12 months; and 32% with two PTEs, a third. Based on this analysis, the NNT for doxy-PEP taken by all MSM to prevent a first PTE is 50; by MSM following a first PTE to prevent a second, 7; and following a second PTE to prevent a third, 6. Taking doxy-PEP following one PTE would avert one-third of subsequent PTEs and one-fifth of bac-STIs.

Conclusion: This analysis informed decisions about prescribing doxy-PEP to achieve the best prevention outcomes while minimizing antibiotic overuse. Doxy-PEP use in MSM with ≥1 bac-STI diagnoses within 12 months would yield a high population-level prevention outcome with a low NNT.

Background: In Canada, HIV incidence increased 24.9% between 2021 and 2022. Cabotegravir long-acting (CAB-LA), the first long-acting injectable, administered every two months was approved in Canada (05/2024) as pre-exposure prophylaxis (PrEP) for adults and adolescents, including men who have sex with men, transgender women, and cisgender women. The HIV Prevention Trials Network (HPTN) 083 and HPTN 084 studies demonstrated superiority of every-two-month CAB-LA vs. daily oral TDF/FTC for PrEP.

Methods: A decision-analytic Markov model was used to estimate lifetime clinical and economic impact of CAB-LA compared with oral TDF/FTC and no PrEP from a Canadian public payer perspective. Modelled individuals initiated PrEP (CAB-LA, TDF/FTC, or no PrEP) upon model entry and continued to receive their initially assigned PrEP until discontinuation, HIV acquisition, or death. Secondary HIV seroconversions related to onward transmission were also estimated. An indirect treatment comparison including HPTN 083 and 084 provided an estimate of effectiveness of CAB-LA vs. no PrEP based on observed effectiveness of CAB-LA vs. TDF/FTC and predicted effectiveness of TDF/FTC vs. no PrEP.

Results: Number needed to treat (NNT) to prevent one primary HIV acquisition over the modelled lifetime was 13 for CAB-LA and 19 for TDF/FTC compared with no PrEP; compared with TDF/FTC, NNT was 37 with CAB-LA. CAB-LA was less costly ($174,847) and more effective (36.86 QALYs) than TDF/FTC ($192,328; 36.67 QALYs) and no PrEP ($261,682; 36.29 QALYs), resulting in incremental cost savings of $17,481 and QALY gains of 0.20 vs. TDF/FTC, and $86,835 and 0.57 vs. no PrEP. CAB-LA would be the dominant PrEP option based on the $50,000 willingness-to-pay threshold in Canada.

Conclusions: Compared to TDF/FTC and no PrEP, results indicate introduction of CAB-LA as PrEP in Canada would result in substantial public health and monetary benefits by preventing additional HIV acquisitions and reducing clinical and economic burden of HIV.

HIV pre-exposure prophylaxis (PrEP) is over 99% effective in preventing HIV infection when medication adherence is high. Despite this, uptake and retention in PrEP care remains less than optimal. We investigated here whether men who have sex with men (MSM) who presented with objective risk factors for HIV acquisition and were automatically offered a referral to a PrEP provider would have a higher acceptance, initiation and retention in PrEP. Through our PrEP-RN program, MSM with clinical evidence of HIV risk received from a reflexive offer for PrEP by a nurse. Number of offers, referral acceptance, presentation to first appointment, PrEP initiation, and retention in care at 6 months were examined between August 2018 and November 2022. Data were further analyzed to look at trends based on age and referral clinic setting. Of 1181 MSM identified with objective risk factors for HIV acquisition who automatically received an offer for PrEP referral, only 50% accepted the offer, 28% initiated PrEP and 16% remained on PrEP at 6 months. Loss across the cascade was more pronounced for youth. We found a notable disconnect between the presence of objective risk factors for HIV acquisition such as a diagnosis of rectal gonorrhea or Chlamydia or syphilis and acceptance, initiation and retention in PrEP. This notwithstanding, 137 at risk individuals were retained in care because of an active offer of PrEP. Nurse-led PrEP was as effective in terms of initiation and retention as that delivered by infectious diseases physicians. While an active offer of PrEP successfully brought at risk individuals into care, more work is required to understand how individuals perceive HIV risk, how they weigh the benefits and challenges of PrEP, how stigma and structural barriers affect PrEP retention and how these factors vary between the diverse groups affected by HIV.

Background: Despite growing numbers of new HIV diagnoses in Canada, including among women, HIV Community-Based Organizations (CBOs) remain critically underfunded with limited resources to provide programming, services, and support. Given limited research, this study investigated social-structural factors associated with: (1) HIV CBO service use and (2) community participation among women living with HIV.

Methods: Data were drawn from the Sexual Health and HIV/AIDS: Women’s Longitudinal Needs Assessment (SHAWNA) Project, a longitudinal community-based study with women living with HIV in Metro Vancouver (September/2014-February/2025). Bivariate and multivariable logistic regression with generalized estimating equations were employed to investigate the associations between social-structural factors and HIV CBO service use (‘used the services of HIV CBOs’) and HIV CBO community participation (‘volunteered, worked and/or participated in HIV CBOs’), both measured in the last six months. Adjusted odds ratios (aOR) and 95% confidence intervals are reported. Missing data from covariates was addressed using multiple imputation.

Results: The study sample of the first outcome included 270 participants with 1445 observations (2019-2023) and 227 participants with 984 observations for the second (2020-2023). In multivariable analysis, women who were older (aOR:1.03 [1.01-1.05] (per year)), Indigenous (aOR:1.58 [1.01-2.45]), Black and otherwise racialized (aOR: 2.37 [1.25-4.50]) (vs White), and reported food insecurity (vs food secure) (aOR:1.39 [1.11-1.75]) had higher odds of HIV CBO service use. Women who were older (aOR:1.05 [1.01-1.09] (per year)) and had graduated high school (vs less than high school education) (aOR:1.91 [1.02-3.60]) had higher odds of HIV CBO community participation, while women who used criminalized substances (vs none) had lower odds of community participation (aOR:0.55 [0.36-0.86]).

Discussion: Increased support is needed to expand youth-focused services and reduce barriers for structurally marginalized women living with HIV (e.g., criminalized substance use, education) to engage with HIV CBOs. HIV CBOs need bolstered funding to sustain anti-oppressive and culturally safe services.

Background: HIV diagnoses in Canada increased by 35.2% from 2022-2023, challenging the UNAIDS 95-95-95 targets. Scaling access to pre-exposure prophylaxis (PrEP) is critical, yet uptake remains low in suburban and rural areas. Since 2018, Kingston, Frontenac, Lennox, and Addington Public Health has offered PrEP services through its sexual health clinic (SHC) to address these gaps. This study aims to evaluate the clinic’s reach and effectiveness in reducing HIV risk.
Methods: The SHC possesses an interdisciplinary team, initially focused on gay, bisexual, and other men who have sex with men (gbMSM), before expanding to serve all populations at risk for HIV. Clients are referred by healthcare providers or self-initiate care. The clinic offers in-person and remote services for appointments and prescriptions within the first 30-days and every 3 months thereafter, including SMS reminders and phone appointments. In consultation with SHC staff, we used the RE-AIM Framework to analyze client characteristics (reach) and evaluate implementation effectiveness across the continuum of care, leveraging client electronic medical records.
Results: Between October 1, 2018, to December 15, 2024, 171 clients consulted the PrEP clinic, with 71.8% initiating PrEP. Most clients were male (97.8%), ages 29-40 (35.5.%), living locally (74.5%), with primary care attachment (57.4%). Data on heterosexual clients and those using injection drugs are not reported due to small sample sizes. The median duration of PrEP use was 8 months (IQR: 3-21 months), with no new HIV diagnoses reported. Overall, 52.4% of clients discontinued, with the highest rates occurring in the first 3 months (30.2%). Reasons for discontinuation included transferring care (28.4%), moving (18.9%), and changes in sexual activity (13.2%).
Conclusion: While the SHC effectively reaches gbMSM and reduces HIV risk, other populations remain underserved. Addressing these gaps requires tailored outreach strategies and inclusive screening practices to optimize HIV prevention.

Background: Gender-based violence (GBV) shapes HIV risk among adolescent girls and young women (AGYW). Transactional sex (TS) and sex work (SW) often occur within structural contexts that heighten exposure to both violence and HIV. This descriptive cross-sectional analysis explored the prevalence of GBV among cisgender AGYW engaged in casual sex (CS), TS, and SW in Dnipro, Ukraine, examining whether associations between sex activity typology and GBV persisted after controlling for key confounders.

Methods: Participants included AGYW aged 14–24 years (n = 1,818) engaged in CS (n = 899), TS (n = 469), or SW (n = 450), sampled within a 2015 HIV prevention study. The prevalence of GBV was calculated for each group, and associations between sex activity typology (CS/TS/SW) and outcomes of lifetime or recent GBV were assessed using separate multivariable logistic regression models; adjusted odds ratios (AORs) and 95% confidence intervals (95% CI) are reported.

Results: Lifetime GBV was reported by 47.8% (95% CI: 43.1–52.5) of AGYW engaged in SW, 23.0% (19.3–27.1) in TS, and 13.1% (11.0–15.5) in CS (p<0.001). Recent GBV followed similar patterns: 23.1% (19.3–27.3) (SW), 8.5% (6.2–11.4) (TS), and 4.0% (2.8–5.5) (CS) (p<0.001). AORs of lifetime and recent GBV were 3.9 (2.9–5.3, p<0.001) and 3.9 (2.5–6.0, p<0.001) for SW, and 1.8 (1.3–2.5, p<0.001) and 1.7 (1.0–2.7, p = 0.042) for TS, compared to CS. Only 24.7% (20.8–28.9) of AGYW in SW reported ever accessing an HIV prevention clinic, with little use among the TS or CS groups. Recent use of embedded violence prevention services was negligible.

Conclusion: These findings underscore the urgent need for integrated and increased awareness of HIV and GBV prevention services, particularly those tailored to address both the overlapping and distinct risks faced by AGYW engaged in TS and SW.

Introduction:
HIV pre-exposure prophylaxis (PrEP) use is increasing in Canada, but barriers to uptake persist. We described the PrEP cascade among gay, bisexual, and other men who have sex with men (GBM) in Ontario and British Columbia (BC), and identified predictors of cascade outcomes.

Methods:
Using cross-sectional 2022 PRIMP survey data from GBM within five urban centers across Ontario and BC, we constructed a PrEP cascade defined as being: 1) aware of, 2) willing to use, and 3) currently using PrEP. For outcomes 2) and 3), we used a Change-In-Estimate approach with stepwise variable selection to produce adjusted odds ratios (aORs) with 95% confidence intervals (CIs) comparing BC to ON. Subsequently, multivariable logistic regression was used to identify predictors for each outcome.

Results:
Among the denominators of 1,193 eligible respondents, PrEP awareness, willingness, and current use were reported by 96.5%, 84.1%, and 55.2%, respectively. Predictors of willingness included residing in BC, younger age, higher HIRI-MSM score, identifying as gay, full-time employment, prior post-exposure prophylaxis (PEP) use, and knowing PrEP users. Predictors of current PrEP use included older age, higher HIRI-MSM score, income >$40,000/year, private drug insurance, prior PEP use, and knowing PrEP users (Table 1).

Conclusions:
Current PrEP use among eligible GBM in BC and Ontario is moderate. Willingness and use were higher among those who knew others’ using PrEP, had taken PEP themselves, and had greater socioeconomic resources, suggesting that promotion of access pathways, PEP use, and expanded public funding models could be leveraged to improve the PrEP cascade.

Background
Long-acting PrEP formulations offer opportunities to re-imagine PrEP delivery. We pilot-tested a questionnaire about PrEP preferences using Best Worst Scaling (BWS) among Two-Spirit, gay, bisexual, queer and other men who have sex with men (2SGBQM).

Methods
HIV-negative 2SGBQM recruited from a Toronto PrEP clinic and community-based organizations (CBOs) completed a 49-item electronic questionnaire, assisted by trained research staff over Zoom. The questionnaire included 12 BWS questions, each presenting 4 hypothetical PrEP care scenarios characterized by PrEP product (daily pill, on-demand pill, intramuscular injection, subcutaneous injection, intravenous infusion, implant), care setting (clinic, pharmacy, CBO, home), healthcare provider (physician, nurse, pharmacist, community worker), and assessment format (in-person, telephone, video-link, online). For each scenario, participants ranked the relative importance of each attribute for decision-making. We used ranked order logistic regression to estimate the relative importance of attributes/levels. We derived preference scores from coefficient values for levels and corresponding attributes, rescaled from 0-100 (least to most important).

Results
Of 39 participants, 35 (90%) were recruited from clinic, 38 (97%) had post-secondary education, 14 (36%) were racialized, and median age was 38 years. The Figure shows the relative importance of each attribute/level combination (bar height) and the variability in response (vertical lines). The most important attribute in determining willingness to use PrEP was the product itself, and there was greater variability in how participants viewed individual PrEP products compared with other aspects of care.

Conclusions
These pilot results suggest that diverse PrEP products, care settings and provider types warrant study for enhancing PrEP delivery for 2SGBQM in Canada.

Introduction
Antiretroviral treatment (ART) is provided at no cost to persons living with HIV in BC. HIV/AIDS-related morbidity, mortality, and new infections have declined >90% from their respective peaks after generalized Treatment as Prevention (TasP) and targeted Pre-Exposure Prophylaxis implementation; however, new HIV Drug Treatment Program (DTP) enrollments are rising. Here, we describe evolving socio-demographic characteristics of newly-enrolled DTP participants.

Methods
Demographics, clinical characteristics and prior ART experience were assessed for DTP participants newly enrolled between 2017-2023. Enrollee characteristics (2018 vs 2023) were compared using Chi-square, Fisher’s exact, and Wilcoxon rank-sum tests.

Results
ART-naïve enrollees have decreased, while ART-experienced enrollees from outside BC increased (Figure). The proportion of total new enrollees with non-BC healthcare coverage doubled [18% in 2018 to 40% in 2023 (p<0.001)]. Ethnicity distribution shifted for ART-experienced (p=0.002) and ART-naïve (p=0.003) enrollees (2018 vs 2023), so that within each group, self-identified White participants declined by >10%, with a compensatory increase among Latin and Black enrollees. Similarly, new ART-naïve enrollees with non-subtype B HIV increased from 14% to 31% (p=0.002). Reassuringly, median[Q1-Q3] time from HIV diagnosis to enrolment declined from 23.5 [9-52] to 10 [5-21.5] days (p<0.001) for ART-naïve enrollees.

Conclusion
Observed changes in ART experience, healthcare coverage, ethnicity, and HIV-1 subtype amongst new DTP enrollees are consistent with a shift from predominantly local transmission towards more migratory cases. Further national and international efforts are needed to ensure HIV/AIDS control in BC. Continued support for newcomers is essential to reach “End of AIDS as an Epidemic Concern by 2030”.

Objective:
Primary healthcare is an effective way to reach individuals with complex conditions, including HIV, hepatitis C (HCV), and substance use disorder (SUD). Despite these conditions being public health priorities, relatively little research leverages primary care data, including electronic medical records (EMRs), to monitor and evaluate care for these conditions. As an initial step in informing primary care research on these conditions and potential comorbidities, we conducted a targeted literature review of studies validating case-finding algorithms, including those for HIV, HCV, and SUD, using Canadian EMRs.

Methodology:
A targeted search was conducted using PubMed, Ovid MEDLINE, and publication lists from the Canadian Primary Care Sentinel Surveillance Network (Canada’s largest EMR-based research network). Studies were included if they validated a case-finding algorithm for any condition using Canadian EMR data. Additionally, studies had to be written in English and published between 2010-2024 in a peer-reviewed journal.

Results:
Of 377 unique articles identified, 25 met eligibility criteria. Most studies validated chronic conditions (92%), with 8% validating algorithms for acute conditions. No validation studies were found for ascertaining HIV or HCV infection, or any type of SUD. All studies included International Classification of Diseases diagnostic codes in their algorithm, with 72% additionally using medications, 36% using lab results, and 52% using diagnosis descriptions. Chart review was the most common validation reference standard (85%), with a few studies using disease registries or lab results. The mean sensitivity and specificity of EMR case-finding algorithms was 81% (ranging 18% - 100%) and 95% (ranging 79% - 100%), respectively.

Conclusion:
Although validity evidence generally supports ascertainment of numerous conditions using Canadian EMRs, no algorithms aimed to identify HIV, HCV, or SUD. The results of this search will inform our efforts to develop valid and reliable algorithms for these conditions and ultimately open opportunities to expand primary care research.

Background: While Canada has made significant progress in reaching the UNAIDS’ 95-95-95 targets, there are signs that progress is plateauing. This suggests the need for greater commitment and public investment to address HIV-AIDS as a public health threat. To support policymakers faced with competing priorities and limited budgets, we provide updated estimates of the economic burden of HIV in Canada, which was last estimated in 2011.

Methods: A burden analysis was conducted to estimate the lifetime economic cost among people diagnosed with HIV in 2021. An annual cohort approach was used. The economic burden includes healthcare costs, individual costs incurred from productivity losses, and the value of diminished quality of life. This burden analysis was compared to previous evaluations to assess the impact over time and to forecast the cost of HIV investment remains status quo.

Results: We estimate that the current lifetime cost of HIV for all newly diagnosed persons in 2021 to be over $2.1 billion, including $454 million (22%) due to healthcare costs, $1.2 billion (57%) due to productivity losses and $453 million (21%) due to diminished quality of life. Adjusted for inflation, this represents a modest decline in the total economic burden from a decade ago. However, the healthcare costs have risen over that time, meaning the direct financial pressure on Canada’s healthcare system from HIV has grown.

Conclusion: Despite Canada’s progress in addressing HIV over the last decade, the economic burden of HIV remains substantial. These costs represent a fraction of the total costs incurred and are likely an underestimation due to underreporting. Further, with 2023 surveillance data showing a significant increase in incident cases compared to 2021 (approximately 66%), the economic burden is unlikely to diminish, leaving significant headroom for further investments to reach the 95-95-95 targets in a short timeframe.

Introduction:
HIV Pre-Exposure Prophylaxis (PrEP) is critical to HIV prevention. Understanding PrEP use, prescribing, and dispensing patterns is crucial for optimizing HIV prevention strategies in Nova Scotia. This study assesses PrEP access from 2019-2023.
Methods:
We conducted a descriptive analysis tracking PrEP clients (2019-2023) using unique person identifiers. Prescribing providers and dispensing pharmacies were identified by license numbers. Client-prescriber/pharmacy and prescriber/pharmacy distances were calculated using the linear distance between Nova Scotian postal code centroids.
Results:
PrEP dispensation doubled (2019-2023) particularly among males, with a rising male-to-female ratio (7:1 to 15:1). Most dispensations were to those aged 30-34 in the Central Zone. Prescriptions increased 139.9% (primarily in the Central Zone), with a 116% increase in prescribers (mostly family physicians). 47.5% of provincial pharmacies dispensed PrEP (n=236), located in the central zone Median client travel distance to providers and pharmacies was 7.8 km and 2.7 km, respectively, with most traveling 20 km or less. The maximum distance a client traveled to access a prescriber was 370 km, while the maximum distance to reach a pharmacy was 407 km. Approximately, 28.7% of clients traveled over 20 km to obtain a prescription, while 13.8% traveled the same distance to have it dispensed. 1.1% (mainly clients from the Eastern Zone) traveled more than 300 km to access a prescriber and 0.8% (mostly from the same zone) commuted a similar distance to dispense it.
Conclusions and implications:
These findings will inform targeted actions to increase PrEP access in Nova Scotia. More work is needed to address the lack of increased uptake by females and to expand PrEP access outside of the Halifax Regional Municipality. By ensuring that more individuals at high risk have access to this effective prevention method, we can help curb the spread of HIV in the province.

Background: Indigenous Women Living with HIV have distinct experiences with health and wellness. Understanding how socioeconomic status and cultural experiences impacts their wellness is vital for developing appropriate policy and health supports.
Methods: Frequencies were used to describe categorical variables. Medians and interquartile ranges were used for continuous variables. Associations between sociodemographic and cultural variables with health characteristics were assessed using Chi-square tests for self-rated health (Excellent/Very good Vs. Good/Fair/Poor) and linear regression models for mental and physical health (SF-12). Associations were then stratified by sexual orientation (heterosexual or 2SLGBTTQ+).
Results: Of the 318 Indigenous women who participated in CHIWOS, 40% had ever lived in a First Nations (FN) community, 80% identified as heterosexual, and 20% identified as 2SLGBTTQ+. The women had levels of physical health (median=47.7 [IQR=35.5, 54.5]) and mental health (median=44.6 [IQR=30.3, 52.3]) that are similar to values reported among other people living with HIV. Food security, paid employment and younger age were associated with better physical and mental health. Women who never lived in a FN community had higher mental (45.6 Vs. 39.9, p<0.01) and physical health (45.5 Vs. 42.1, p=0.04) than women who had. However, women currently living in a FN community had higher mental (45.8 Vs. 38.7, p=0.06) and physical health (44.8 Vs. 41.5, p=0.39) than women who were not. The effects of lower socioeconomic status on mental health were more pronounced for 2SLGBTTQ+.
Conclusions: Employment status and food security are important for the wellbeing of Indigenous Women Living with HIV. These results underscore the need for tailored interventions and support systems for 2SLGBTTQ+ women living in poverty. More work is needed to understand how heterosexism/homophobia may shape the relation between socioeconomic status and mental wellness, and to determine what role sex-related inequities play in shaping the relation between wellbeing and FN community living.