Background: HIV self-testing (HIVST) is an effective way to expand access and increase frequency of HIV testing. This study examined the factors associated with the uptake of HIV self-testing kits and reporting of test results among Black people who participated in the I’m Ready’ – national HIV self-testing implementation study.
Method: We analyzed data of Black participants in the I’m Ready study. Descriptive statistics (frequencies, proportions) were used to describe demographic characteristics and variables of interest. Bivariate and multivariable binary logistic regression were used to examine associations between demographic characteristics and ordering a kit and submitting a test result.
Result: Among Black people who participated in the study from June 2023 – Dec 2025, 44.4% (1864/4194) ordered test kits through the app, and 24.9% (464/1864) of those who ordered test kits reported their test results. In the final multivariate model, participants who are 24 years and older (OR=3.1; CI: 2.1, 4.6) were more likely to order test kits compared to younger participants. In addition, those who identified as non-cisgender (non-binary, Trans man/woman, gender queer and self-described gender) (OR=3.9; CI: 1.3, 11.9) were more likely to order test kits compared to cis-male participants. Employment status, immigration status and sexual behavior were all negatively associated with ordering of test kits. For reporting of test results, Participants with precarious immigration status (OR =0.2; CI: 0.1, 0.4) and those with temporary status (OR=0.6, CI: 0.4, 0.9) were less likely to report test results compared to citizens/permanent residents.
Conclusion: Strategies to increase access to HIVST among Black people must consider factors associated with the uptake of test kits and reporting of test results.

Background
The COVID-19 pandemic significantly disrupted access to HIV care and may have had longstanding impacts. The Canadian Coinfection Cohort (CCC) is a national prospective cohort following individuals with HIV-hepatitis C virus (HCV) coinfection. Study follow-up visits are scheduled every six months. We assessed lost to follow-up (LTFU) from the CCC, before, during, and after the pandemic.

Methods
We included CCC participants enrolled before March 2018, on antiretroviral therapy for at least 6 months and with one or more follow-up visits. The characteristics of those not attending any visits were compared with those having at least three visits in each of the pre-pandemic (March 2018 – February 2020), pandemic (March 2020 – February 2022), and post-pandemic (March 2022 – February 2024) periods.

Results
Among 929 participants, 5% had no visits pre-pandemic, 39% had no visits during the pandemic, and 40% had no visits post-pandemic. Those with no visits post-pandemic were more likely to be Indigenous (32% vs. 19%), report injection drug use (29% vs. 18%), have detectable HIV RNA (21% vs. 7%) and be HCV RNA positive (21% vs. 4%) compared to those who had at least three visits (Table).

Conclusion
Over a third of CCC participants were LTFU during and were not re-engaged after the pandemic. People LTFU were disproportionately from marginalized groups and remain at risk for HIV and HCV transmission and disease progression. Tailored strategies and dedicated resources to re-engage people in care and treat ongoing co-infection are urgently needed if HIV and HCV elimination targets are to be met.

Introduction: Among gay, bisexual, and queer men (GBM), childhood sexual abuse (CSA) is associated with increased condomless anal sex in adulthood and HIV acquisition. HIV-PrEP uptake and discontinuation among GBM CSA survivors remain understudied. We examined whether CSA predicts HIV-PrEP uptake and discontinuation over time among GBM when moderated by social support.

Method: We recruited sexually active GBM aged 16+ from Vancouver, Toronto and Montreal using respondent-driven sampling (02/2017-08/2019). Participants completed STBBI testing and computer-assisted self-interviews every 6-12 months until 08/2023, self-reporting CSA at baseline, and social support (MOS Social Support Survey composite score) and HIV-PrEP use at each visit. We used generalized linear mixed effects models to estimate adjusted odds ratios (aOR) with 95% confidence intervals for HIV-PrEP uptake and discontinuation among HIV-negative and HIV-PrEP indicated participants per 2017 Canadian guidelines or used HIV-PrEP at any timepoint. Analyses excluded GBM who were not HIV-PrEP-indicated at initiation or who discontinued due to sexual inactivity, monogamy, adverse effects, or physician recommendation.

Results: We analyzed data from 1574 HIV-negative GBM over a median of 4.19 years. Of these, 980 (62.3%) reported taking HIV-PrEP at ≥1 study visit(s) and 347 (35.4%) had discontinued HIV-PrEP. 601 participants (39.8%) reported CSA. CSA (aOR=0.95; 95% CI=0.70-1.30), social support (aOR=0.91; 0.61-1.37), and their interaction (aOR=0.95; 0.77-1.21) were not associated with HIV-PrEP uptake. However, CSA survivors had higher odds of discontinuation compared with other GBM (aOR=2.20; 1.49-3.25), and this association was moderated by social support (aOR=0.68; 0.50-0.93); the odds of discontinuation among CSA survivors attenuated as social support increased and were no longer evident at the highest levels of social support.

Discussion: CSA was not associated with HIV-PrEP uptake, but was associated with HIV-PrEP discontinuation especially for those with low social support. Psychosocial interventions that increase perceived social support may help GBM survivors of CSA continue using HIV-PrEP.

Background: Housing stability is a well-established protective social determinant of health for people living with HIV (PLWH), however, temporal correlates of changes in housing stability remain explored. We examined time-updated factors associated with improved housing stability or maintaining stable housing among a cohort of PLWH from 2016-2021 in British Columbia (BC).

Methods: PLWH aged ≥19 years across BC were recruited into the STOP HIV/AIDS Program Evaluation study from January 2016-September 2018 and completed a baseline and two follow-up surveys 18-months apart. Surveys collected recent self-reported information on demographics, housing stability, HIV risk group, substance use, experiences of violence, food security, accessing HIV services, depression, social support, stigma, and resilience. Housing stability was classified at each visit as unstable, neutral, or stable based on a Likert-scale measure. Generalized mixed-effects logistic regression models were used to assess time-updated factors associated with improved or sustained housing stability at follow-up.

Results: Among 525 baseline participants (923 follow-up visits), median age was 51 years (Q1-Q3: 43-57) and 19.4% were women. At baseline, 80.0% rated their housing stability as stable, 7.6% as neutral, and 12.4% as unstable, and 10.1% were homeless in the past year. Of 179 visits where participants reported neutral or unstable housing, 105 (58.7%) reported improved housing stability at the following visit, although there were no independent associations between time-updated factors and improved housing stability. Of 744 visits where participants reported stable housing, 109 (14.7%) reported transitioning to unstable or neutral housing at follow-up. Time-updated food security (adjusted odds ratio [AOR] =4.79; 95% CI 2.84-8.06) and resilience (AOR=1.02; 95% CI 1.00-1.03) were independently associated with maintaining stable housing.

Conclusion: Although no time‑updated factors were associated with improved housing stability, food security and resilience were associated with sustained stable housing. These findings highlight the role of intersecting structural and psychosocial factors in housing stability.

Background: It is important that the healthcare system can address the most pressing current health concerns facing people living with HIV (PLWH). The present study aims to explore self-reported current health priorities within a sample of PLWH across British Columbia (BC).

Methods: PLWH aged ≥19 years across BC were invited to participate in the STOP HIV/AIDS Program Evaluation study from August 2024-September 2025. Eligible participants self-reported sociodemographic characteristics, health behaviours, and psychosocial outcomes on a cross-sectional survey (online, in-person, or via telephone) where they could report and rank any current health priorities. We characterized health priorities and compared gender and age groups for ranking a given priority using descriptive statistics (Chi-square and Fisher’s exact tests).

Results: Among 972 PLWH who completed the survey, the median age was 53 years (Q1-Q3: 41-62), 189 (19.4%) were women, 352 (36%) reported excellent or very good health status, and 916 (94.2%) were on antiretroviral therapy. Among the overall sample, the most commonly reported health priorities were HIV (72.3%), mental health (48.2%), and effects of aging (32.6%). There were no statistically significant differences in the proportion of individuals selecting HIV, mental health or aging as a top-three priority across genders. However, 59.9% of those aged ≥60 years who selected HIV as a priority ranked it as a top-three priority versus 69.0% of 40-59-year-olds and 81.9% of those aged <40 years (p<0.001). Aging was selected as a top-three priority by 55.5% of those aged ≥60 years versus 39.8% of 40-59-year-olds and 53.3% of those aged <40 years (p=0.028). Age groups did not differ significantly in selecting mental health as a top-three priority.

Conclusion: HIV, mental health, and aging were the top health priorities in this sample of PLWH in BC. Understanding the diverse health priorities of PLWH is instrumental for delivering optimal and tailored HIV care.

Background: Children HIV-exposed but uninfected (CHEU) now greatly outnumber children living with HIV globally and in Canada. We describe the epidemiology and clinical characteristics of Canadian CHEU.

Methods: We reviewed Canadian Perinatal HIV Surveillance Program data from 01/1990–12/2024.

Results: 5878 CHEU were born in Canada in the 35-year period. Annual numbers of HIV-exposed infants rose from 1990-2007 and have since remained at ~250/year, with 1-7 infants infected/year (0.4-2.9% vertical transmission). Ontario (33%) and Quebec (23%) have had the highest proportion of cases over time, with Alberta (15%) and Saskatchewan (10%) increasing and BC (12%) decreasing over time. In 2023 the provincial proportion of cases was Ontario 31%, Quebec 24%, Alberta 15%, Saskatchewan 17%, and BC 5%. Birth parent demographics differ between Eastern (ON/QC/Atlantic) and Western (MN/SK/AB/BC) Canada. Overall 51% were African/Caribbean/Black (ACB), 21% White, and 21% Indigenous, but in Eastern 68% were ACB, 23% White, and 2% Indigenous versus in Western 47% Indigenous, 28% ACB and 17% White. Birth parent HIV transmission risk factor also differed geographically: overall 66% sexual, 20% injection drug use (IDU), 2% perinatal; Eastern primarily sexual (82%) whereas Western sexual (43%) and IDU (37%) predominated. Birth parent treatment anchor drug changed over time, with protease inhibitors most common (45% total, peaking at 82% in 2011) but integrase inhibitors predominating in the past 7 years (23% total, peaking at 89% in 2024). Preterm delivery occurred in 17% overall, peaking at 25% in 2008 (when 58% were treated with lopinavir/ritonavir) but down to 14% in 2024. Breastfeeding amongst CHEU is increasing, with 58 infants breastfed between 2021-2024.

Conclusions: Since 1990, nearly 6000 CHEU have been born in Canada, with changes in demographics and birth parent treatment over time. As evidence grows of the impacts of HIV and ART exposure on child health, monitoring this population remains increasingly important.

BACKGROUND
Acute complications arising during hospitalized nonfatal overdose (NFOD), including acute kidney failure, respiratory and cardiac complications, and brain injury, are unequally distributed by sex and HIV status. People with HIV (PWH) may experience elevated risk due to structural inequities and a greater burden of multimorbidity relative to people without HIV (PWoH). This study assessed the influence of HIV status and sex on acute complications among individuals hospitalized for NFOD in British Columbia.

METHODS
Hospitalized NFOD resulting in discharge alive between April 1, 2012, and March 31, 2020, were identified using ICD-10-CA codes from the Discharge Abstract Database. The primary outcome was the occurrence of ICD-defined complications during a hospitalized NFOD event, including rhabdomyolysis (muscle breakdown), brain injury, respiratory or cardiac complications, acute renal failure, and paraplegia/tetraplegia. Complications were captured across inpatient, outpatient, and emergency department records. Multivariable logistic regression with generalized estimating equations evaluated associations between HIV status, sex, and their interaction, adjusting for confounders.

RESULTS
Acute complications occurred in 70(33%) PWH and 297(25%) PWoH during a NFOD hospitalization. The three most common complications were respiratory (13.68%), cardiac (10.53%), and acute renal failure (8.45%). A significant HIV–sex interaction (p=0.047) indicated that the association between HIV status and complications differed by sex. Compared to females without HIV, adjusted odds of complications were higher among females with HIV (aOR=1.86; 95% CI: 1.08–3.19), males with HIV (aOR=2.70; 95% CI: 1.72–4.24), and males without HIV (aOR=2.81; 95% CI: 2.14–3.68).

CONCLUSION
Acute complications during NFOD hospitalization are common and strongly influenced by HIV status and sex. These findings highlight the need for sex- and HIV-responsive clinical strategies to reduce preventable harms and improve outcomes for overdose survivors living with and without HIV.

Molecular HIV surveillance (MHS) involves the secondary use of drug resistance genotyping data to identify and respond to transmission clusters. Although promising, this approach raises important ethical concerns, particularly related to privacy, consent, stigma, and criminalization. The Community Insights in Phylogenetic HIV Research (CIPHR) project aimed to assess the ethical implications of integrating MHS into key population programs in Nairobi, Kenya.

In our critical knowledge exchange project, we employed a community-based research approach to engage communities, clinicians, and researchers in a series of structured and informal discussions, both virtual and in-person. The sessions built scientific literacy around MHS, identified local priorities, and informed the co-design of a pilot study. During discussions, the CIPHR group raised concerns about delays in viral load testing, which limited clinicians’ abilities to monitor treatment progress. Critical conversations uncovered how viral load testing was frequently disrupted by reagent stockouts and by infrastructure gaps at the clinic level, which prompted the adoption of dried blood spots (DBS) as an interim solution. Although DBS expanded access to viral load testing, interpretation of viral suppression was complicated by the assays lower limit of quantification (873 copies/mL) and the definition of suppression in Kenya (≤50 copies/mL). Clinicians adopted a precautionary approach and used this as an opportunity to re-engage all participants with detectable viral RNA, who would be considered virally suppressed under certain definitions (i.e., ≤1,000 copies/mL).

This study highlights how viral load testing functions not only as a clinical tool, but as a means of fostering trust and continuity of care—reflecting the broader significance of viral suppression as a meaningful personal milestone with important social, sexual, and emotional implications. Our findings demonstrate the importance of centering community voices, adapting to real-world constraints, and aligning MHS efforts with the needs and realities of those most affected.

Background: Immigrants to Canada are disproportionately affected by HCV infection. Little is known about treatment outcomes among immigrants at the national level or how outcomes vary across Canadian provinces.

Methods: We used data from the Canadian Network Undertaking against Hepatitis C (CANUHC), a prospective cohort enrolling HCV RNA positive patients from 17 sites across six Canadian provinces between 2015 and 2025. Sociodemographic data, clinical characteristics, immigration details, time to first consult and treatment outcomes were evaluated. Treatment outcomes included DAA initiation, SVR bloodwork completion, and SVR achievement.

Results: Of 2,521 patients, 427 (16.9%) were immigrants to Canada. Immigrants had higher educational attainment (60.8% vs. 28.2% college/university, p<0.001), higher employment (47.1% vs. 28.0%, p<0.001), and lower proportions with injection drug use history (25.8% vs. 75.3%, p<0.001), incarceration history (12.9% vs. 49.1%, p<0.001), and recreational drug use history (43.5% vs. 91.8%, p<0.001). Immigrants demonstrated excellent DAA treatment outcomes with higher crude rates of DAA initiation (95.6% vs. 92.2%, p=0.02), post-treatment SVR bloodwork completion (81.6% vs. 70.5%, p<0.001), and SVR (100% vs. 98.6%, p=0.03). However, after adjustment, immigration status was not independently associated with these outcomes. The mean time from immigration to specialist assessment was 24.9 years (SD 18.6). The delay in accessing care trended downwards with each 5-year interval from 1990 to the present (median years=26, 22, 16, 12, 7, 2, p<0.001).

Conclusions: Immigrants in the CANUHC cohort achieved excellent DAA treatment outcomes comparable to or exceeding those of Canadian-born patients. When engaged in care, immigrants can successfully complete the HCV treatment cascade.

Introduction : Despite successful ARV treatments, people living with HIV (PWH) face elevated risks of developing chronic comorbidities associated with premature aging and persistent inflammation. Glucose dysmetabolism, a spectrum including Insulin Resistance, Prediabetes and Diabetes is associated with premature morbidity and mortality. This study aims to describe the dysmetabolism among CHACS participants, and to compared them between PWH and people living without HIV[DM1.1] (PWoH).

Methods : CHACS is a controlled prospective cohort and biobank study, collecting data across 10 Canadian sites between September 2011 and march 2025. The exposed (PWH ≥ 40 years old or living with HIV ≥ 15 years) and non-exposed (PWoH participants ≥ 40 years old) groups were followed bi-yearly. Participants from CHACS were eligible to take part to this study if they had the required available data to define glucose dysmetabolism, including laboratory values for fasting insulin and glucose levels, and glycated hemoglobin. Outcomes were classified using laboratories results and antidiabetic medication intake, following Diabetes Canada guidelines. Crude prevalence and incidence rates were computed and compared using Fisher’s exact and Poisson regression tests between PWH and PWoH.

Results : 361 PWH (83.7%males) and 116 PWoH (69.0% males) were included in the study, followed for a total of 838.52 person-years. The table below shows the incidence and prevalence of dysglycemia in the study population.
Over half of both groups were prevalent cases for dysglycemia events, no significant differences appear.

Conclusions : The results display the interest for an aging and fragile population to study dysglycemia events.

Purpose: Optimal antiretroviral therapy (ART) adherence is crucial for maintaining viral suppression. Cabotegravir (CAB) plus rilpivirine (RPV) is a long-acting (LA) injectable approved in Canada in March 2020 for HIV-1 treatment in adults who are virologically stable, requiring 6 or 12 doses (once-monthly [Q1M] or every-two-month [Q2M] injections) per year, potentially enhancing adherence. This study assessed real-world CAB+RPV LA adherence and persistence among people with HIV-1 enrolled in the CAB+RPV LA patient support program (CAB+RPV LA PSP).
Method: We conducted a retrospective study to identify people with HIV-1 enrolled in the CAB+RPV LA PSP who initiated CAB+RPV LA from 18/10/2022 to 30/05/2024. People with HIV-1 aged ≥18 years were followed for 12 months from index date (defined as 1st CAB+RPV LA injection). Outcomes included adherence (proportion of days covered, PDC) and persistence (days to discontinuation from index date).
Results: We identified 431 people with HIV-1: mean (SD) age 46.6 (12.3) years. Most were male (76.1%), resided in Ontario (53.8%), and had public insurance (59.6%). The majority were using single-tablet ART (87.5%) before initiating CAB+RPV LA (BIC/FTC/TAF: 33.2%); 91.6% were on Q2M dosing. At 12 months, 94.9% had a PDC ≥90%. People with HIV-1 with private insurance had significantly higher adherence vs. people with public insurance (PDC ≥90%: 99.4% vs. 91.8%, p<0.001). People with HIV-1 on Q2M dosing had higher adherence vs. people with HIV-1 on Q1M dosing (PDC ≥90%: 98.2% vs. 59.5%, p<0.001). About 96.8% of people with HIV-1 persisted on CAB+RPV LA at 12 months (median [IQR] 365 [365-365] days). People with HIV-1 who initiated Q2M dosing had significantly higher persistence vs. Q1M dosing (98.2% vs. 81.1%, p<0.0001).
Conclusions: High CAB+RPV LA adherence and persistence were observed over 12 months. Our findings suggest that long-acting injectable ART may improve adherence and persistence, which is crucial for maintaining viral suppression.

Background: Rising sexually transmitted and blood-borne infection (STBBI) rates disproportionately affect equity-deserving populations who face barriers to testing. BC’s digital STBBI testing service GetCheckedOnline (GCO) expands access; however, funding constraints have stalled further expansion. To save costs, decision-makers have considered reducing potentially unnecessary testing. Currently, GCO routinely recommends chlamydia, gonorrhea, syphilis and HIV tests for all clients irrespective of testing frequency, warranting exploration of over-recommendation. We explored the extent of potential over-recommendation based on clinical guidelines, and the demographic and behavioural characteristics associated with it.

Methods: A retrospective cohort study was conducted using GCO program data of repeat testers (September 2014 - December 2024). Demographic and behavioural characteristics, aligned with the Andersen Healthcare Utilisation model, were used to explore associations with potential over-recommendation. Negative binomial regression estimated rates of potential over-recommendation. Positivity rates were compared across recommendation categories.

Results: Among 22,267 repeat clients, 28.6% of screening episodes were classified as potential over-recommendations, representing 12.4% of all (repeat and single client) episodes during the study period. 33.9% of the repeat clients had ≥ 1potential over-recommendation episode. Potential over-recommendation rates were higher among racialised clients, 2SLGBTQIA+ and those who preferred not to answer sexual orientation related questions, and those reporting no condom use, having multiple sex partners, previous STBBI diagnoses, and HCV risk. Most potential over-recommendations (96%) occurred when clients tested within three months of a previous episode. Positivity was higher among potential over-recommendations (4.2%) than non-over-recommendations (3.6%, p < 0.01).

Conclusions: Potential over-recommendation mainly reflected high-frequency testing and was more common among clients at higher risk for STBBIs or from equity-deserving populations. Eliminating such episodes could reduce utilisation but pose potential testing barriers and miss diagnoses. Strategies that optimise resources while maintaining autonomy and accessibility are needed.

Introduction:
Antiretroviral therapy (ART) has evolved substantially over the past two decades, but data on uptake of newer agents remain limited. Manitoba has one of the highest HIV prevalence rates in Canada, highlighting the need to understand local ART patterns. This study aimed to examine trends in ART use patterns in Manitoba.
Methods:
We conducted a population-based study using the provincial health databases including all individuals in Manitoba from January 2007 to March 2022. ART use was assessed quarterly overall and by class: protease inhibitors (PI), integrase strand transfer inhibitors (INSTI), nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), and non-nucleoside reverse transcriptase inhibitors (NNRTIs). We also evaluated use of first-line regimens: 2 NRTIs plus either INSTI, PI, or NNRTI. Trends were analyzed using linear regression models.
Results:
Among 5,749 ART users (mean age 27.9 years; 49.5% male; 58.9% from lower-income groups), overall ART use increased more than threefold, from 0.04% in Q1-2007 to 0.14% in Q1-2022 (p < 0.001). Males and lower-income individuals had higher ART use. We observed a 79-fold increase in INSTI-based regimens, rising from 0.0008% in 2007 to 0.07% in 2022 (p < 0.001). In contrast, use of NNRTI-based regimens peaked at 0.013% in 2014 then steadily declined to 0.005% by 2021/2022 (p = 0.002); PI-based regimens increased by 4% in 2014 before declining to 0.014% in 2021/2022 (p = 0.03).
Conclusions:
ART use in Manitoba has grown significantly over 15 years, driven by increased uptake of INSTI-based regimens and declines in older combinations. These trends align with HIV treatment guidelines recommending INSTI-based regimens as preferred first-line therapy.

Aim: Opioid overdose is a major public health threat across North America, disproportionately affecting people living with HIV. Inconsistencies in how nonfatal opioid overdoses are defined and measured, hinders surveillance. This scoping review examines definitions of nonfatal opioid overdose used in the United States (US) and Canada to identify variations and inform standardization.

Methods: We searched six databases in October 2024. Eligible sources included empirical studies or grey literature that defined or measured nonfatal opioid overdose, either as an exposure, an outcome, or a criterion for cohort inclusion. To align with the third wave of the overdose crisis in the US in 2013, characterized by synthetic opioid deaths, we included literature published from 2013-2024. Studies were excluded if published in languages other than English, conducted outside the US or Canada, involved non-human subjects, relied on self-reported overdose, or focused on substances other than opioids. After removing duplicates, we screened titles/abstracts of 6,966 articles. We assessed 635 full-texts, extracting data from 210 studies.

Results: Most studies were based in the US (n=195), compared to Canada (n=15). Definitions of opioid overdose varied: 175 studies examined any opioid, 33 focused on heroin, 19 on prescription opioids, and 16 on non-heroin opioids, with some using multiple definitions. Substantial variability was observed in the interpretation and application of ICD codes, regardless of the codebook used, and case fields searched (e.g., primary, secondary diagnoses). Studies using ICD-10-CM diagnostic codes demonstrated variability in definitions including intent specifications and encounter types, a feature specific to ICD-10-CM.

Conclusion: Inconsistent definitions of nonfatal opioid overdose limit comparability across studies, contributing to misclassification and underreporting. In HIV research, consistency is essential as overdose data informs risk pathways and targeted initiatives. This review provides a foundation for improving clarity in surveillance and underscores the need for standardized definitions and transparent reporting guidelines.

Background
HHV-8 is a Gammaherpesvirus that causes Kaposi sarcoma, lymphoproliferative disorders, and inflammation mostly in immunosuppressed men, including those living with HIV (LWH). Using an in-house serology assay, we determined HHV-8 seropositivity in gay and bisexual men who have sex with men (GBM) by HIV status. We assessed the association between HHV-8-seropositivity and demographics and sexual behaviour.

Methods
We analyzed serum samples from the Engage Montreal (2017-2018) and the McGill HIV (2019-2023) biobanks. We included 759 cis- and transgender participants: 552 HIV-negative GBM, 157 GBM LWH, and 50 HIV-negative heterosexual men. We quantified serum IgG binding to the HHV-8-infected BCBL1 cell line by flow cytometry. Comparisons of HHV-8 seropositivity, demographics, sexual behaviour and clinical information were performed by T-tests, Chi2 tests and logistic regressions.

Results
86% of participants were white. Median age was 47 (HIV-: 35, HIV+: 53, p<0.001).
43.8% of HIV-negative GBM were HHV-8 seropositive, compared to 68.6% of GBM LWH, and 8% of HIV-negative heterosexual men (p<0.0001).
Frequency of HHV-8 seropositivity was higher in Caucasians than GBM from other ethnicities (41.2 vs 34%, p<0.01).
HHV-8 seropositive GBM were older (HIV-: 35 vs 32 p<0.001, HIV+: 52 vs 50, p<0.001), had more male sex partners in the past 6 months (P6M) (8 vs 5, p<0.001, 10 vs 4, p=0.02), and reported having more often been diagnosed with an STI in their lifetime (70.9 vs 57.7%, p<0.001, 94.5 vs 79.5%, p=0.02). HIV-negative HHV-8 seropositive GBM had more often used HIV-PrEP in their lifetime (27.8 vs 14.2%, p=0.003). Overall, HHV-8 seropositive GBM declared more frequent condomless anal sex in the P6M (68.2 vs 63.3%, p=0.03).

Conclusions
Older age, higher numbers of sexual partners, condomless sexual activity, and HIV-PrEP use were associated with HHV-8 seropositivity, suggesting that ongoing transmission may lead to an increase in HHV-8–related conditions in GBM.

Background
Nigeria is the top African country for migrants to Canada. Disparities exist among youth in both Nigeria and Canada regarding HIV incidence and access to prevention, including PrEP. These disparities may result from limited sexual and reproductive health information and from neglect of social determinants of health in both regions, increasing HIV transmission risks after youths’ sexual debut.

Objectives
We aim to investigate the knowledge, attitudes, and practices related to HIV and HIV pre-exposure prophylaxis (PrEP) among young Nigerians aged 19 to 29 living in Nigeria or Canada. We will also explore individual- and community-level factors associated with their knowledge, attitudes, and practices regarding HIV transmission and PrEP.

Proposed Methodology
Our community-based, cross-sectional, multimodal survey focuses on Nigerian youth aged 19-29 years residing in Anambra State, Nigeria, and Nigerian Canadians/migrants living in British Columbia, Canada. Our study is open to all sexes and genders, all HIV statuses, and all immigration statuses. We will recruit 1,000 youth participants (500 from each country) using convenience, purposive, and snowball sampling. We will recruit through academic institutions, community centres, and social media platforms across urban and non-urban settings. Participants will self-complete the survey via Qualtrics, with support available from community-trained peer assistants. Our survey development process includes a literature review, stakeholder engagement, item generation, expert review, pilot test, administration planning, and ethical approvals. We will use descriptive and inferential statistics to conduct a sex-and-gender-based analysis (SGBA+) that considers ethnicity, immigration status, and recruitment country. Multivariate regression models will identify correlates of key outcomes.

Potential impact
Our multinational team includes community advisors from existing partnerships in Nigeria and Canada. Our community-based participatory research approach aims to catalyze transnational migrant health research between Nigeria and Canada, to address the social determinants of health, and to inform targeted interventions for Nigerian migrants.

Primary care plays a critical role in HIV management, yet national-level insights into patient and provider characteristics remain limited. Leveraging data from the Manitoba Primary Care Research Network (MaPCReN) offers an opportunity to identify patterns and inform care strategies. We analyzed MaPCReN data (2010–2024) using a validated HIV case definition (sensitivity 90.7%, specificity 99.9%). Demographics, provider characteristics, comorbidities, and behavioral risk factors were compared between HIV and non-HIV cohorts using chi-square and t-tests. Among 164,531 patients, HIV prevalence was 0.63% (n=1,034). HIV patients were more often male (59.3% vs. 46.1%, p<.0001), urban-dwelling (93.4% vs. 78.6%, p<.0001), and older (mean 47.0 vs. 42.8 years, p<.0001). Providers caring for HIV patients were predominantly female (67.8% vs. 44.4%, p<.0001), Canadian-trained (98.8% vs. 81.8%, p<.0001), and salaried (95.0% vs. 24.6%, p<.0001). HIV patients had higher rates of dyslipidemia (33.7% vs. 15.0%), diabetes (20.6% vs. 13.4%), COPD (11.0% vs. 4.5%), depression (18.0% vs. 12.9%), and schizophrenia (3.7% vs. 0.8%) (all p<.0001). Smoking history (70.4% vs. 47.4%) and substance use (41.9% vs. 24.0%) were significantly more common (p<.0001). HIV patients in the primary care context in Manitoba exhibit distinct sociodemographic and clinical profiles, including higher multimorbidity and behavioral risk factors. A limitation of our work is that the data does not currently include the Northern Health region and does not capture small fee-for-service sites and providers as well. Our data shows that care is concentrated within urban, salaried practices, highlighting the need for integrated, multidisciplinary strategies to optimize HIV management.

Introduction:
Reaching the undiagnosed is a key priority of Canada’s STBBI Action Plan. However, access to testing remains inequitable due to barriers including racism, stigma, and geographic isolation, which disproportionately affect key populations. To address these gaps, the National Laboratory for HIV Reference Services (NLHRS) leads the implementation of decentralized dried blood spot (DBS) testing for HIV, hepatitis C (HCV), syphilis, and hepatitis B (HBV). DBS testing is a low barrier, minimally invasive approach that mitigates many structural and social barriers to testing. This program has demonstrated high acceptability and expansion across diverse settings, including Indigenous communities, STBBI clinics, and community-based organizations.

Methods:
New testing sites are engaged through partnerships with community, municipal, regional, and provincial public health organizations. Training on DBS collection and specimen transport is delivered through virtual and in-person sessions. All screening and confirmatory testing is performed by the NLHRS under an ISO 15189 medical laboratory standard.

Outcomes:
To date, the program has trained more than 600 participants across over 90 sites nationwide, and tested over 8000 DBS card submissions. In 2024, test positivity rates were 1.6% for HIV, 6.7% for HCV, and 9.9% for syphilis antibody, indicating this testing modality is preferentially reaching populations at higher risk compared with those accessing mainstream testing services. DBS testing has been incorporated into policies and case definitions in several Canadian provinces, with multiple jurisdictions at various stages of repatriating DBS testing into their provincial laboratory systems.

Conclusions:
Nationwide DBS-based STBBI testing is feasible, acceptable, and effective for reaching key populations. The NLHRS continues to expand DBS applications to additional infectious and non-infectious conditions and develop DBS-based proficiency programs. Integration of DBS testing into provincial policies and movement toward repatriation highlight the critical role of decentralized, low barrier testing models in advancing equitable access to STBBI diagnosis in Canada.

Background
Monitoring trends among key populations is essential for equitable HIV prevention, care, and policy. The Ontario HIV Treatment Network Cohort Study (OCS) is a long-standing, multi-site cohort of people living with HIV in Ontario that supports longitudinal surveillance of populations disproportionately affected by HIV. We describe 10-year trends (2015–2024) in the representation of key populations within the OCS.
Methods
The OCS is an open prospective cohort recruiting adults (≥16 years) living with HIV from hospital- and community-based clinics across Ontario. Analyses focused on participants with a clinic visit or interview in the current year. Key populations included gay, bisexual, and other men who have sex with men (gbMSM), women, people who inject drugs (PWID), Black populations, and Indigenous Peoples. Annual counts and proportions were examined to assess trends over time.
Results
GbMSM represented the largest key population, comprising 60.8%–66.0% of interviewed participants annually, with 2,155 gbMSM interviewed in 2024 (63.2%). The proportion of women among participants with clinic visits increased from 18.8 % in 2015 to 22.5% in 2024. PWID declined steadily from 7.9% to 2.3%. Black participants increased from 17.0% to 24.2%, while Indigenous Peoples dropped from 4.8%-3.4% Across groups, both male and female participants were represented across race and exposure categories.
Conclusions
The OCS has documented stable proportions of gbMSM, increasing proportions of women and Black populations, and declining proportions of PWID and Indigenous People. These findings underscore the importance of sustained, equity-informed surveillance to guide HIV prevention and care.

Background: The rate of HIV transmission among Indigenous women in Manitoba has progressively increased over the past decade. In 2025, the Public Health Agency of Canada reported that Manitoba also has the highest rate of HIV transmission in Canada (19.5 vs 6.3 per 100K).These drivers have led to increasing rates of transmission among Indigenous women.

Methods: An analysis of intersectional social factors and health epidemiological data was undertaken to identify the drivers of HIV transmission in Manitoba. HIV epi reports as well HIV prevention interventions like sexual health promotion, PrEP and PEP awareness, and stigma reduction as well as social issues such as displacement to urban centres and racism in the healthcare system were included in the review.

Findings: Due to the stigma and complacency associated with the HIV pandemic, Indigenous people in Manitoba are increasing at risk of exposure to HIV and other STBBI. According to the Inquiry into Missing and Murdered Indigenous Women and Girls (MMIWG), Manitoba also has the highest rate of MMIWG. The intersection of resource extraction, importation and sale of prescription and illicit drugs, sexual exploitation and trafficking, and the lack of housing and mental health services has created a public health crisis with regard to HIV transmission.

Conclusion: The lack of a provincial HIV strategy with funding has allowed the HIV pandemic to spiral out of control. Despite the values and philosophies inherent in public health practice, the pandemic is driven by colonialism and systems compromised by implicit bias that fail to meet the needs of the Indigenous population.

Background: Public health efforts coupled with advancements in antiretroviral therapies are driving the global control of HIV epidemic. However, marginalized communities in Canada suffer from a disproportionate burden of HIV owing to socio-economic disparities. Along these lines, Indigenous people experience poor health outcomes in the context of structural and systemic factors deeply rooted in the legacy of colonization spearheaded by the notorious Indian residential school system. This study aimed to analyze percent Indigenous population in the context of HIV diagnosis rate in the Canadian provinces.

Methods: The Percentage of Indigenous population by province was obtained from the latest census of Canada. The new HIV diagnosis rate per 100,000 people was obtained from the Public Health Agency of Canada (PHAC): HIV in Canada: 2024 surveillance highlights. For Québec, the available 2023 HIV diagnosis rate was used. Pearson correlation test at 5%-α was conducted.

Results: A strong, positive (r=0.882; 95% CI [0.567, 0.972]) and statistically significant (p<0.001) correlation was observed between the two variables (Figure-1). These data show that the percentage of Indigenous population correlates with new HIV diagnosis rate in the provinces. Of note, the two provinces with the highest percent Indigenous population (Manitoba = 18.1%, and Saskatchewan = 17%, respectively) were the outliers with HIV diagnosis rates several times the Canadian average.

Conclusion: By highlighting the disproportionate burden of HIV in Indigenous people, the current study underlines the need for community-led, trauma-informed and culturally sensitive health services to close the gaps and to improve health outcomes of the marginalized populations.

Background: Nigeria faces a mixed HIV epidemic, with key populations—female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID), and transgender people—experiencing disproportionately high national HIV prevalence (11-29%) compared to the adult Nigerian population (1%). We employed phylogenetics to characterize HIV transmission clusters and identify factors associated with cluster membership among key populations in Nigeria.
Methods: A cross-sectional integrated bio-behavioural surveillance survey (IBBSS) was conducted with informed consent among FSW, MSM, PWID, and transgender people across all Nigerian geopolitical zones (August to December 2020). HIV protease gene sequences (n = 541; 34% FSW, 32% MSM, 25% transgender, and 9% PWID) were obtained from viremic (>1000 copies/mL) dried blood spots. Phylogenetic clusters were defined by a pairwise genetic distance <2% on maximum-likelihood trees. Multivariable Poisson regression with robust errors estimated adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs) for factors associated with cluster membership.
Results: Overall, 26% of IBBSS sequences formed 47 phylogenetic clusters (2 -8 sequences). Transgender people (aPR=3.97; 95%CI=2.06,7.65) and MSM (aPR=3.86; 95%CI=2.01,7.40) were more likely to be in clusters than FSW. Cluster membership was lower in street-based hotspots compared with nightlife-based hotspots (aPR=0.65; 95%CI=0.43,0.97). HIV testing and outreach in the past year were generally low across both clustered (68% tested; 30% contacted) and non-clustered participants (67% tested; 33% contacted),
Conclusions: Among participants with viremic specimens, MSM and transgender people had higher clustering prevalence, suggesting more recent and ongoing transmission in these networks. Our findings suggest these clustering patterns may reflect gaps in HIV testing and prevention coverage, with hotspot typology offering a strategic entry point for programs. Targeted outreach that brings HIV testing and prevention into settings where key populations meet sexual partners may help overcome barriers to clinic-based care and help limit ongoing HIV transmission in Nigeria.

Background
HIV-1 RNA viral load (VL) and CD4, CD8, and CD3 lymphocyte measures are established surrogate markers for assessing treatment effectiveness and immune function among people living with HIV (PLWH). They can potentially support monitoring of HIV care engagement trends in population-level administrative data. We validated and examined temporal trends in these measures among Ontario residents living with HIV.
Methods
We conducted a population-based, retrospective longitudinal study using health administrative data at ICES (2015–2022). We extracted and cleaned available VL and lymphocyte records in the Ontario Laboratories Information System (OLIS) linked to PLWH. Our validation data source was the Ontario HIV Treatment Network (OHTN) Cohort Study. We defined percent agreement as the proportion of OHTN participants with an OLIS record matched within ±15 days (high ≥90%, moderate 80–89%, low <80%).
Results
Among more than 17,000 PLWH with ≥2 years of follow-up, the proportions with ≥1 VL record declined from 65–67% (2015–2019) to 62–63% (2020–2022) and with ≥1 lymphocyte records declined from 54-57% (2015–2019) to 49-50% (2020–2022) (Figure). The mean number of VL records per person decreased from 2.4 (2015) to 1.9 (2022), and CD4 records decreased from 2.3 (2015) to 1.7 (2022). Among those tested, VL suppression fell from 89% (2019) to 81% (2022), whereas the proportion with CD4 ≥200 cells/µL remained 93–95%. Percent agreement increased for VL from 90.6% to 96.6% (2015-2018), and for lymphocyte records from 65% to 76% (2015-2017), with site-level lymphocyte agreement dropping below 10% at two sites.
Conclusions
High agreement for VL records supports the use of OLIS for population-based research in Ontario. Lower agreement for lymphocyte records likely reflects data-flow artifacts and non-uniform reporting requiring further investigation. These findings underscore the need for periodic external validation of HIV laboratory measures in administrative data and routine reporting of data completeness as a standard practice.

Background: Cardiovascular disease (CVD) is a leading cause of mortality worldwide, and People Living with HIV (PLWH) may face an elevated risk of repeated CVD events. Our community-led team examined how HIV status affects the likelihood of remaining free from a subsequent CVD event among PLWH and people without HIV (PWoH) who have had an initial CVD event in British Columbia.

Methods: We used data from the Comparative Outcomes and Service Utilization Trends (COAST) study, a population-based administrative health data linkage from 01-Apr-1992 to 31-Mar-2020, including virtually all PLWH and a 10% random sample of all PWoH in BC aged ≥19 years. CVD events were identified using ICD codes from emergency department visits and inpatient hospitalizations. We restricted the study sample to those who experienced at least one CVD event. Recurrence-free time was defined as the time between an acute index CVD event and a recurrent event, or until the end of follow-up for individuals who did not experience a recurrent event. Kaplan-Meier (KM) curves and multivariable Cox proportional hazards models were used to assess the impact of HIV status on recurrence-free time after the index CVD event.

Results: Among 1,239 PLWH and 59,891 PWoH who experienced an acute index CVD event, 447 (36%) of PLWH and 29,068 (49%) of PWoH experienced a recurrent CVD event. The median follow-up time for PLWH was 931 days (Q1, Q3: 139-2,129) and 1,653 days for PWoH (Q1, Q3: 334-3,674). KM estimate was not statistically significant, however, after adjusting for time-varying confounders, PLWH had a higher hazard of a recurrent CVD event compared to PWoH (aHR: 1.19, 95% CI 1.12-1.26).

Conclusion: PLWH were less likely to experience recurrence-free survival, demonstrating the need for targeted secondary prevention efforts that address both medical and social determinants of cardiovascular health in this population.

Objectives:
To evaluate sex differences in healthcare utilization among People Living with HIV (PLWH) and without (PLWoH) following a nonfatal overdose (NFOD). We compared rates of all-cause emergency department visits, hospitalizations, and outpatient primary care encounters in the year before and after an NFOD.

Methods:
Using linked administrative data from the Comparative Outcomes and Service Utilization Trends (COAST) study, we identified PLWH and a 10% random sample of PLWoH aged ≥19 years who experienced an NFOD between April 1, 2012 and March 31, 2020. NFOD events and all-cause emergency department visits, hospitalizations, and outpatient primary care encounters were identified using ICD-codes. Poisson regression quantified associations between healthcare utilization rates and HIV status, sex, and period (year before vs. after the index NFOD) adjusting for potential confounders (Table 1).

Results:
The study included 921 PLWH (29.5% female) and 4551 PLWoH (45.9% female) who experienced an NFOD. Compared to the year before, with females without HIV as a reference, emergency department visit rates were significantly higher in the year after an NFOD for nearly all groups. Hospitalization rates were significantly higher after an NFOD across all groups. Outpatient primary care encounter rates were slightly higher after an NFOD among PLWH and significantly higher among PLWoH (Table 1).

Conclusion:
Healthcare utilization was generally higher in the year following an NFOD compared to the year before, most consistently for hospitalizations. These findings suggest NFODs have a substantial impact on healthcare systems; hence, interventions may be needed to better align care with post-overdose needs.

Background: In Canada, FTC/TDF for PrEP was first approved in 2016. Since then, multiple PrEP options have emerged. As the PrEP landscape evolves, understanding modality awareness and preferences may help expand implementation across key populations in Canada.

Methods: We conducted a cross-sectional, observational, multi-country—Canada, US, UK, and South Africa—survey to better understand current PrEP use patterns and unmet needs. Eligible participants were recruited via multiple channels, such as social media and referrals from patient advocacy groups, and completed survey questionnaires on PrEP use, awareness, preferences, unmet needs, drivers, and barriers.

Results: 260 Canadian respondents participated in the survey: 47 (18.1%) reported current PrEP use; 46 (18%) reported previously used PrEP; 130 (50%) reported never used PrEP but have heard of it; and 37 (14%) reported never used PrEP and never heard of it. Among those who used PrEP in the past or have never used it, 50% reported an intention to use PrEP in the future. Among participants who have never used PrEP but have heard of it, 118 (80.9%) reported some level of knowledge regarding PrEP. Awareness of current PrEP options was high, but knowledge of emerging options was limited. Regarding PrEP modalities, comfort was greatest with weekly oral PrEP, followed by daily oral and twice-yearly injectable PrEP.

Conclusion: PrEP awareness among Canadian respondents is high. Half of non-users expressed future intent, indicating potential for PrEP expansion. Limited knowledge of emerging modalities underscores the need for education on diverse options as the PrEP landscape continues to evolve.

Background: In Canada, gay, bi, and other men who have sex with men have been prioritized for HIV PrEP education and implementation. Given this focus, PrEP uptake among cisgender women (CGW) is low. Canadian HIV epidemiology suggests that HIV prevention needs among CGW remain unaddressed.

Methods: Community HERO Prevention Survey is a cross-sectional, observational, multi-country—Canada, US, UK, and South Africa—survey on understanding the HIV prevention environment. Multiple strategies were used to recruit and identify individuals at risk of acquiring HIV to complete questionnaires on awareness, drivers and barriers, and unmet need for PrEP.

Results: We recruited 260 Canadian participants, with 127 (48.8%) CGW. 51.2% of CGW reported that their overall personal HIV acquisition risk was low. Reported condom use with sexual partners with unknown HIV status was low (34.6%). 43.3% of respondents reported engaging in regular HIV testing, frequency ranging from monthly to yearly. 53.3% reported experience discussing HIV prevention with their healthcare providers. 3.9% reported currently using PrEP; 13.4% reported previously used PrEP; 60.6% reported never used PrEP but heard about it; and 22% reported never used nor heard about PrEP. Intention to use PrEP in the future varied: yes (47.1%); no (11.6%); and I don’t know (41.3%). Participants reported various reasons—personal, access, and knowledge—for never taking PrEP.

Conclusion: There are gaps in terms of PrEP awareness, knowledge, and perceived needs among CGW. Tailored engagement, education, and counselling strategies are needed to address barriers and concerns for increasing PrEP uptake among CGW.

Background
Deaths with an unknown underlying cause increased markedly alongside the 2016 declaration of the unregulated drug toxicity crisis in British Columbia and the COVID-19 pandemic, undermining accurate cause-specific mortality estimates. We examined cause-specific mortality during this era among people with HIV (PWH), who are disproportionately affected by these dual public health emergencies, and applied a method to classify suspected unregulated drug toxicity deaths (“drug-related deaths” hereafter) among unknown-cause deaths in this population.

Methods
We characterized and compared all deaths among PWH enrolled in the BC Centre for Excellence in HIV/AIDS Drug Treatment Program between January 2010 – December 2025 by three underlying cause groupings: unknown-cause (ICD-10 coded “R99”), drug-related (X41-X42;X44,Y11-Y12;Y14), and non-drug-related (all other deaths). We classified unknown-cause deaths as likely drug-related based on: 1) aged 20-64, 2) an undetermined/unknown/pending manner of death, and 3) drug use history from clinical and survey data.

Results
Among 2,433 deaths, 10% were unknown-cause, 19% drug-related, and 69% non-drug-related. Unknown-cause deaths rose in 2016 following the public health emergency declaration and peaked between 2019-2021, accounting for 22-26% of all deaths (Figure 1). From 2019 onwards, inverse patterns of unknown-cause and drug-related deaths were prominent; furthermore, notable similarities occurred regarding demographic characteristics (age/sex/residence/death location) and drug use history between these two groups. Our criteria classified 74% (181/244) of unknown-cause deaths as likely drug-related.

Conclusion
Our findings highlighted gaps in cause-specific mortality ascertainment for PWH amid the unregulated drug toxicity crisis and COVID-19 pandemic, and suggested many unknown-cause deaths in this period were likely drug-related.

Background: HIV testing is the first step in getting treatment and prevention. HIV self-tests (HIVSTs) may help people do testing and have been promoted as one way to increase testing. We wanted to see people's real-world uptake of HIV self-tests compared to serology when both were made equally available to them.

Methods: We extracted data from the GetaKit study for October 11, 2023 to June 30, 2025, focusing on participants to whom we co-offered an HIVST and serology.

Results: We co-offered HIVST and serology to 3611 persons; 71.9% agreed to go to a lab and 19.4% opted for only the HIVST. Participants who were Black, Indigenous, or Persons of Color were less willing to attend a lab; participants who were men who have sex with men or reported injection drug use or sex work were more willing to attend a lab. First-time testers opted for the HIVST at a higher rate. No one tested positive through the self-test, suggesting that the self-test might be better suited for targeted use to identify people who could use prevention strategies.

Conclusions: HIVSTs were an entry point to testing for some but were not the preferred modality for most. The outcome of co-offering an HIVST and serology was increased HIV testing, but without additional diagnoses from the HIVST. Promoting HIVSTs too broadly would not align with patient preference. With advancements in prevention (PrEP and U = U), we think such a re-orientation of the role of HIVSTs may best position it within our HIV prevention armamentarium. From our findings, to promote these devices as the ideal strategy for diagnosis for all populations is misguided and would waste precious resources.

Objectives We sought to determine positivity rates for participants in the GetaKit study who identified as asymptomatic contacts of Neisseria gonorrhoeae (NG) and/or Chlamydia trachomatis (CT). Our goal was to shed light on current discrepancies between international sexually transmitted infection (STI) guidelines, some of which recommend blanket empiric treatment for all NG and CT contacts (eg, Canadian and United States guidelines) versus others which recommend waiting for positive results (BASHH, Australian, and European).

Methods We extracted data for the period of 1 June 2023 to 30 June 2025 from GetaKit, which is a research website through which persons in Ontario, Canada can complete an online risk assessment and obtain access to laboratory-based testing for STIs, including NG, CT, HIV, syphilis and hepatitis C. From these data, we calculated positivity rates for NG and CT and the numbers needed to treat. We also evaluated for correlations of risk factors for testing positive.

Results During our 25-month study period, participants ordered NG/CT testing 12 775 times. In a total of 6.7% of these orders, participants identified as an NG and/or CT contact. Positivity rates, for all completed testing, were 1.2% (n=115 diagnoses) for NG and 4.3% (n=395 diagnoses) for CT. Positivity among asymptomatic contacts ranged from 0% for NG in heterosexual males to 30.6% for CT in females who were ≤24 years old, with most positivity rates being <20% for both infections.

Conclusions Our results suggest that blanket recommendations to treat or defer treatment seems inappropriate. More nuance is required. Empiric treatment of all NG and CT contacts will likely result in mass overuse of antibiotics. In contrast, deferring treatment seems inappropriate for asymptomatic females who are ≤24 years old and for anyone who cannot immediately obtain testing and treatment.

Background: Hamilton, Canada continues to experience unacceptably high numbers of new diagnoses of HIV infection in people who use drugs (PWUD). A small but significant proportion of individuals living with HIV do not engage appropriately in treatment and prevention services due to barriers such as poverty and mental health diagnoses. To better meet the needs of this vulnerable population, a service delivery method, supported by the literature, was implemented which focuses on lowering barriers and providing a patient-centred approach to HIV care, with the aim of increasing access to care.

Methods: While the Hamilton HIV Treatment and Prevention Clinic consists of primary care physicians, an infectious disease specialist, psychiatrist, registered nurses and peer support workers, it is predominately led by the community of PWUD through partnership with a local PWUD advocacy group. Operating under a low-barrier approach, the program has weekly drop-in hours, free food, a safe place to interact with the patients’ community, and access to primary care and psychiatry including medications to manage substance use disorders. To assess impact, patient chart review was conducted at baseline and at five time points over 18 months between 2020 and 2022 to analyze clinic retention rates and changes in viral load.

Results: Of the 15 HIV-positive patients recruited, all but two remained in care at study end. Two individuals had increased viral load levels during the study period, while the remaining 11 (85%) had either decreased levels or successfully remained undetectable. Further recruitment was impacted by the COVID-19 pandemic.

Conclusions: Integration of treatment and prevention models with peer-led support can lead to positive health outcomes. Evaluation of our model of care continues through additional funding, while also expanding the scope to include a more robust evaluation of the feasibility and effectiveness of a scaled up program of pre-exposure prophylaxis for PWUD.

Background: In January 2024 the Saskatchewan government introduced regressive legislation restricting harm-reduction supply distribution and mandating one-for-one needle exchange. These changes occurred within a syndemic of injection drug use, HIV, syphilis, hepatitis C, and overdose mortality driven by structural inequities including colonialism, stigma, poverty, and housing instability. We examined changes in community needle-collection patterns before and after the policy change.

Methods: Community needle-report data were obtained from ReportNeedles.ca, a geospatial reporting tool used to report discarded needles in Regina, Saskatchewan. Reports from April 2021–September 2025 were classified into pre-policy (April 2021–December 2023) and post-policy (January 2024–September 2025) periods. A Wilcoxon rank-sum test assessed differences in needles collected per report. Overdose mortality data from the Saskatchewan Coroners Service provided context on drug toxicity and demographic impacts.

Results: Across 1,108 reports, needle recovery declined following the January 2024 policy change. Pre-policy, 604 reports resulting in the disposal of 35,734 needles (mean 59.2 per report). Post-policy, 504 reports resulting in 4,954 needles discarded (mean 9.8 per report). Significantly fewer needles were collected per report after January 2024 (W = 135,722, p = 0.0015). Overdose mortality remained high with 343 deaths in 2024 and 267 deaths to October 2025, with increasing proportions of suspected toxicity cases. Deaths were concentrated in urban centres, and adults aged 20–49 and First Nations people were disproportionately represented among overdose fatalities.

Conclusions: A marked decline in needle recovery, despite stable community reporting volumes, followed Saskatchewan’s 2024 harm-reduction restrictions. Reduced discarded needles may reflect changes in injection practices or access to sterile supplies, among other explanations. These shifts occurred alongside sustained overdose mortality and persistent inequities. Although provisional overdose counts show a slight year-to-date increase, this does not represent a meaningful improvement. Together, these findings underscore the need to strengthen evidence-based, accessible harm-reduction services in Saskatchewan.

Issue: Nonfatal drug poisonings remain a significant health concern in Canada, particularly for People Living with HIV (PLHIV), who face intersecting social-structural and clinical vulnerabilities. Current administrative data definitions are narrow and poorly aligned with lived/living realities, often overlooking care encounters outside hospitals, stigma-related care avoidance, gendered pathways into and out of care, and experiences of trauma in healthcare settings. Population-level surveillance requires community-driven perspectives to accurately capture and reflect nonfatal poisoning events. However, there remains a paucity of approaches designed to meaningfully engage peers in administrative data research.

Approach: This project will combine community-based participatory research with linked administrative data to strengthen the measurement, interpretation, and relevance of nonfatal poisoning surveillance among PLHIV in British Columbia. Working alongside peer researchers with lived/living experience of drug use, HIV, drug poisoning, and structural violence, we will co-develop: a community-informed definition of nonfatal drug poisoning; collaborative approaches, including community-led Directed Acyclic Graphs, to engage peers in administrative data analyses; and an analysis of healthcare utilization in the year following a nonfatal drug poisoning. Peer researchers will play a central role in shaping research questions, analytic decisions, and interpretation.

Potential findings: We anticipate that peer-led analysis will reveal gaps in coding algorithms, including missed poisoning events and inequitable gendered and racialized patterns of care. Co-created causal diagrams are expected to elucidate structural pathways shaped by stigma, criminalization, and service fragmentation.

Implications: This work will demonstrate how community leadership can strengthen administrative data research by improving validity, equity, and policy relevance. Furthermore, we will generate practical guidance for integrating peer expertise into administrative data studies. By centering gender-responsive and Indigenous-informed governance, this work will advance ethical, trauma-responsive approaches to data use that address power imbalances and structural inequities, while offering a transferable model to inform harm reduction, HIV care, and health-system planning across contexts.

Introduction: In 2022, Saskatchewan conducted a pilot offering 797 HIV Self Testing Kits (STK) from 44 sites. Between November 2022 to December 2024, 49 HIV STK sites accessed the Public Health Agency of Canada (PHAC) HIV Self Testing kits. When the PHAC funding ended on March 31, 2024, the Saskatchewan government allocated base funding to continue a HIV Self Testing program.
Method: The HIV Self Testing program includes one REDCap research officer and eight Nurses from Saskatchewan Health Authority (SHA), Indigenous Services Canada (ISC) and Northern Inter-Tribal Health Authority (NITHA), led by the SHA Provincial STBBI Coordinator. The group developed a low barrier program with Saskatchewan-specific work standard, application form, tracking sheet, order form and poster. REDCap manages real-time inventory. In December 2025, Saskatchewan announced its commitment to make at-home HIV testing easier and more accessible. All Saskatchewan sites can be found on the ministry of health website.
Results: Between June 12, 2025, and January 12, 2026 there are seventy (70) HIV STK sites. Saskatchewan Health Authority have 45 (64.3%) sites, First Nations have 9 (12.9%) sites, and Non-Profit Organizations have 8 (11.4) sites. Ten (10) geographical SHA networks (76.9%, 10/13) have two or more sites in their area. REDCap captured 815 entries for inventory movement at point of service. This includes 3560 incoming, 1469 outgoing, 14 moved and zero (0) expired HIV STK. There are no self-reports of reactive HIV STK. Majority of clients (79.1%, 578/731) took 1 or 2 HIV STK and half of the clients (54.8%, 399/728) indicated this was their first time using a HIV STK.
Conclusion: The HIV STK program in the first 6 months has surpassed previous programs offered in the province. Provincial funding across all jurisdictions is pivotal for its success and uptake will continue in the first year of programming.

Background
In British Columbia (BC), HIV treatment and prevention medication programs, and their monitoring and evaluation, are centralized, enabling a rapid rollout of a doxycycline for bacterial STI (bSTI) prevention (DoxyPEP) initiative in December 2023 for eligible persons living with HIV (PLWH) or receiving HIV pre-exposure prophylaxis (PrEP). The intersection of HIV, bacterial and other STIs emphasizes the need for an integrated status-neutral (regardless of HIV status) care continuum, to streamline monitoring and evaluation efforts. We developed a framework to harmonize PLWH and HIV PrEP registries into a single analytical cohort and highlight analytical considerations.

Methods
We aggregated data from the BC Centre for Excellence in HIV/AIDS (BC-CfE) HIV care registries (1987–2025), including client and provider demographics, program enrollment and discontinuation, medication dispensing, laboratory testing, and mortality. The current analytical population (active cohort) was defined using an antiretroviral medication dispensing-based proxy (Dec 1, 2023 to Dec 1, 2025).

Results
The harmonized cohort (N=33,316; n=17,489 (52.5%) PLWH, n=15,827 (47.5%) PrEP) represents >261,000 person-years of follow-up. The active cohort (n=22,382) comprised 59.5% PrEP participants (n=13,320) and 40.5% PLWH (n=9,062).

The framework enabled identification of all individuals (n=96) transitioning from PrEP to HIV treatment, preserving longitudinal history across the serostatus change, and highlighted differential uptake of the DoxyPEP initiative: 37.7% (n=5,024) of active PrEP clients versus 9.1% (n=823) of active PLWH.

The harmonization process highlighted critical analytical considerations, including heterogeneous definitions of retention, survivor bias, and the alignment of time zero. It demonstrated that medication gaps require context-specific definitions; while HIV treatment interruptions signal suboptimal utilization, PrEP gaps may reflect decreased risk or inappropriate discontinuation.

Conclusion
This cohort reveals a shift in BC’s HIV/STI care landscape; prevention clients now outnumber treatment clients. While the harmonization process presents analytical challenges, the framework provides a vital platform for monitoring syndemics across the status-neutral continuum.

Background: HIV incidence in Canada has increased since 2019, with the national rate reaching 6.1 per 100,000 people in 2023. In Western Canada, acquisition is increasingly concentrated among people who inject drugs, particularly in Saskatchewan where injection drug use is attributed to most new infections. Despite the known effectiveness of HIV Pre-Exposure Prophylaxis (PrEP), less than 2% of this population utilize it due to stigma and access (health system) constraints. Given that PrEP is covered by most provincial formularies, there is an urgent need to integrate HIV chemoprophylaxis into existing health services utilized by people who inject drugs.
Methods: This prospective implementation study at four clinics and multiple pharmacies in Alberta and Saskatchewan aims to enroll 350 participants aged 16 and older who are engaged in an opioid agonist therapy (OAT) program. Participants are offered daily oral PrEP—tenofovir alafenamide/emtricitabine or tenofovir disoproxil fumarate/emtricitabine—to be dispensed with their OAT for up to 12 months. Evaluation includes tracking initiation and maintenance via clinic records and dried blood spot adherence testing. Mixed-methods assessments of patients and providers collected at baseline; PrEP-initiation; regular intervals during PrEP use; and PrEP or study discontinuation.
Objectives: The study aims to evaluate oral PrEP awareness and uptake in an OAT setting by comparing baseline use to initiation and maintenance rates over six months. Patient- and provider-reported outcomes will contextualize numerical results and explore barriers, facilitators, and preferences related to PrEP uptake and adherence. Interest in alternative forms of prevention (e.g. long-acting injectable) to guide future care delivery models will also be explored.
Conclusions: By leveraging established OAT programs, this project offers a sustainable strategy to expand PrEP access to people who inject drugs. Findings will inform integrated service delivery frameworks to counter rising national infection rates.

Introduction

Effective surveillance is a core pillar of public health, driving evidence-based action. The National HIV Surveillance Program collects HIV diagnosis data submitted by provinces, territories and other data providers and publishes national trends on HIV epidemiology in Canada. An ongoing renewal process is aimed at improving data quality and usefulness to better meet diverse information needs.

Methods

A comprehensive review was completed to determine the gaps and needs for national-level HIV surveillance by conducting a technical assessment, questionnaires among data providers and users, community engagement, key informant interviews with other national programs, and literature reviews to identify best practices. Findings were synthesized to identify priorities for the renewal process and to develop an implementation approach.

Results

The Renewal involves various improvements, including revisions to the data elements collected through the program, an updated HIV case report form, and the development of tools including scripts and training materials to support the consistent and safe collection of information from newly diagnosed individuals. The Black Expert Working Group for National HIV Surveillance and the First Nations, Inuit, and Métis Working Group for National HIV and Syphilis Surveillance have been launched to facilitate ongoing engagement with experts from disproportionately affected communities to help inform routine work and program improvements. The working groups have also provided guidance for the improvement of race and Indigenous identity data. Revisions are also being made to sex, gender, and exposure data and the program is moving towards presenting HIV stage information rather than separately reporting new AIDS diagnoses.

Conclusion

The improvements being made to the national HIV surveillance program are key to improving the quality and availability of critical data to inform prevention and care programs, research, and policy. Through this evidence-based and community-engaged approach, progress towards addressing these key information needs will be made.

Age-Specific HIV Epidemiology in Children and Adolescents: A Canadian Analysis with Implications for Prevention, Care, and Equity

Background:
Adolescents are a priority population for achieving HIV elimination targets, yet age-disaggregated epidemiological evidence to inform adolescent-specific HIV policy and programming in Canada remains limited. Surveillance data are often aggregated across younger age groups, obscuring sex- and age-specific patterns critical for prevention, early diagnosis, and continuity of care. This study addresses this gap by providing a long-term, adolescent-focused assessment of HIV trends in Canada, contextualized within global patterns.

Methods:
Using UNAIDS 2025 estimates from a harmonized global dataset (2000–2022), we conducted a population-level analysis of HIV epidemiological indicators among Canadian adolescents aged 15–19 years. Sex-stratified trends were examined for (i) estimated HIV incidence rates per 1,000 uninfected population and (ii) estimated annual AIDS-related death rates per 100,000 population. Canada’s most recent estimates (2022) were benchmarked against the global distribution of countries using medians and interquartile ranges (IQRs).

Results:
Among Canadian adolescents, the estimated HIV incidence rate (both sexes) declined by 33%, from 0.03 in 2000 to 0.02 per 1,000 in 2022. The estimated annual AIDS-related death rate declined by 86%, from 0.07 to 0.01 per 100,000, with substantial reductions among females (0.08→0.01) and males (0.06→0.005). In 2022, Canada’s adolescent HIV incidence rate was below the global median (0.11; IQR 0.03–0.37) and ranked around the 23rd percentile of countries. The AIDS-related death rate ranked around the 13th percentile, well below the global median (0.40; IQR 0.05–4.05).

Conclusions:
Canada has achieved sustained progress in reducing adolescent HIV incidence and AIDS-related mortality; however, residual adolescent-specific vulnerabilities persist. These findings highlight the importance of age-disaggregated surveillance and provide policy-relevant evidence to support equity-focused, adolescent-tailored prevention, testing, and care strategies essential for accelerating progress toward national HIV elimination goals.

Background: Community-based services provide critical supports for people living with HIV (PLWH), from peer navigation to food programs. We characterized community-based service use among a cohort of PLWH across British Columbia (BC) and assessed the perceived impact of those services.

Methods: PLWH aged ≥19 years across BC were recruited into the longitudinal STOP HIV/AIDS Program Evaluation (SHAPE) study launched in 2016. In this study, we analyzed descriptive data from follow-up surveys administered between March 2019-September 2021 to examine services used in the past year and the perceived influence of accessing these services on knowledge and practices concerning general health, mental health, connection with peers, and having a positive outlook on life.

Results: Among 402 PLWH at follow-up, 61.4% were 40-59 years old, 19.7% were women, 20.1% identified as Indigenous, 66.9% identified as gay, bisexual men who have sex with men (gbMSM), and 18.7% identified as people who inject drugs. A total of 212 (52.7%) reported using any community services, with 149 (37.9%) using AIDS service organizations (ASOs), 93 (23.6%) using food banks or meal programs, and 51 (12.9%) using peer support (Table). The most commonly reported influences were “Improving knowledge and practices concerning general health” among ASO users, “becoming more positive about life” among food bank users, and “Improving mental health and wellness” among peer support users.

Conclusion: Community-based services are commonly used by PLWH in BC and were felt to have a positive impact on their general and mental health and helped them be more positive about their lives.

Purpose: To determine correlates of HIV infection among under-housed individuals identifying as female living in British Columbia, Canada.

Methods: Weekly pop-up testing events were conducted at places of residence, shelters, and other community locations in Vancouver’s inner city and other cities in BC from 01/15 to 08/25. Point-of- care testing for HIV is completed on site, and a survey which includes several demographic and behaviour variables is filled out.

Results: HIV+ females (mean: 42.6) are generally younger than their HIV- (mean: 46.4) counterparts. It can also be seen that, of the HIV+ females, significantly more have also been exposed to HCV, making up 66.67% of the HIV+ vs. 33.3% of the HIV- group. There are differences in ethnicity between the HIV+ and HIV- groups, with the HIV+ female population consisting of significantly more indigenous than non-indigenous individuals. Differences in education are also significant, with a greater number of HIV negative individuals having completed college, university, or trade school. Regarding use of drugs, the HIV+ population has more individuals with a history of injection drug use, but not a significantly higher rate of using drugs alone or having a history of overdose. There was no difference in rates of incarceration between the HIV+ and HIV- cohorts. Significantly more HIV+ individuals always or mostly use sex protective measures than individuals who are not living with HIV.

Conclusions: Consistent with previous literature, we have shown that HIV disproportionately affects females who are Indigenous and living in inner-city communities in BC. Lower education attainment was also more common among HIV-positive females compared to their HIV-negative counterparts, highlighting the intersection of social determinants of health with HIV risk and outcomes. These findings underscore the importance of addressing both structural inequities and diverse transmission pathways to improve prevention and care strategies for women affected by HIV.

Background: Co-occurring mental disorders can complicate the effectiveness of opioid agonist therapy (OAT) for opioid use disorder (OUD), especially among people living with HIV (PLWH). While most research has focused on OAT retention, less is known about the broader continuum of OAT care in multimorbid populations. This study comprehensively characterizes OAT episodes and adherence among PLWH with co-occurring OUD and mood and anxiety disorders (MAD-Only), psychotic disorders (PsyD-Only), or both (MAD-PsyD).
Methods: We used data from the population-based Comparative Outcomes and Service Utilization Trends cohort in British Columbia, including PLWH aged ≥19 years (2012¬¬−2020). Using Allen’s relations, temporal margins (Ɛ), and drug-specific permissible gaps, we classified OAT episodes as monotherapy, transition, multitherapy, or transition-multitherapy. Key outcomes included induction completion (achieving a therapeutic dose), stabilization (continued treatment post-induction), retention (>1 year), and adherence. Adherence was measured using the prescription- and interval-based proportion of days covered. The latter was calculated annually and across the study period. Outcomes were compared across mental disorder categories, using Holm-Bonferroni-adjusted pairwise tests.
Results: We identified 7,232 OAT episodes, predominantly monotherapy (>90%). Across all mental disorder categories, induction completion was <30%, median stabilization was <6 months, and retention was <20%. Median prescription-based adherence was moderate (MAD-Only: 74.2%; PsyD-Only: 70.0%; MAD-PsyD: 66.7%), but median persistence remained short (<2 months). Interval-based adherence was <50% throughout the study period for all groups. Compared with MAD-Only, both PsyD-Only and MAD-PsyD showed significantly lower retention and adherence (adjusted p<0.01). Methadone and slow-release oral morphine adherence ranged from 60–80%. Buprenorphine adherence was highest in MAD-Only (70.0%), whereas injectable OAT showed high adherence in MAD-PsyD (92.5%). Annual adherence declined across all groups, with the lowest decline observed in MAD-PsyD.
Conclusion: OAT outcomes were suboptimal among PLWH with OUD and mental disorders, with overall adherence below 50%. Personalized OAT regimens and continuous adherence monitoring are recommended.

Background: Among people living with HIV (PLWH) and opioid use disorder (OUD), co-occurring mental disorders are common and worsen outcomes. Opioid agonist therapy (OAT) is effective for treating OUD and improves HIV care. However, its role in mental disorders pharmacotherapy remains unclear. This study examined (1) the relationship between overall OAT exposure and mental disorder medication dispensations, and (2) the effect of OAT engagement, measured by adherence and induction completion, on these dispensations.
Methods: We used data from the population-based Comparative Outcomes and Service Utilization Trends (COAST) cohort in British Columbia, including PLWH aged ≥19 years (2012−2020). OAT episodes were constructed in a time-varying fashion using an integrated framework incorporating Allen’s interval algebra, temporal margins, and drug-specific permissible gaps. Mixed-effects negative binomial models were used: a person-level model examined the relationship between OAT exposure and dispensing rates, while an episode-level model among OAT recipients evaluated the effects of engagement measures on dispensation counts.
Results: Among 17,119 PLWH in COAST, 1,486 (8.7%) had co-occurring OUD and a mental disorder, and 1,177 (79.2%) received at least one OAT dispensation. Across these individuals, 7,232 OAT episodes were constructed. Median adherence across episodes was 70% (IQR 45.5–89.2), and 1,824 episodes (25.2%) achieved induction completion. OAT exposure was associated with a significant increase in dispensation rates (RR 3.11, 95% CI [2.74, 3.53]). Female sex, older age, unstable housing, alcohol use disorder, and hepatitis C were also associated with increased rates. Completion of OAT induction was associated with higher dispensation counts (2.24 [1.94, 2.57]), and adherence showed a positive dose–response pattern, with counts exceeding sixfold at ≥90% adherence.
Conclusion: OAT was strongly associated with mental disorder pharmacotherapy, with the largest effects at adherence ≥90%. Our findings underscore the need for OAT-centered, integrated care models within adherence-supportive frameworks to address co-occurring mental disorders.

Background: HIV is associated with higher comorbidity burden in women. However, most studies of women living with HIV (WLWH) include sociodemographically-dissimilar comparison groups such that disentangling the effects of HIV and other comorbidity drivers is challenging. We investigated the roles of these factors by comparing comorbidity burden in WLWH and two control groups of women in British Columbia (BC).

Methods: We included women ≥45 years from three cohorts: WLWH from the BC CARMA-CHIWOS Collaboration (BCC3; recruited 2020-2025), BCC3 women without HIV with similar lived experiences, and age-matched women from the Canadian Longitudinal Study on Aging (CLSA; recruited 2011-2015) representing BC’s general population. Self-report and biometric data were used to measure the prevalence of eight comorbidities. Quasi-Poisson regression was used to compare comorbidity counts.

Results: We included 188 BCC3 WLWH, 178 BCC3 women without HIV, and 563 women from CLSA. BCC3 participants were more likely to identify as non-white, report smoking tobacco, have lower household income and education relative to CLSA participants (Table 1). They were also more likely than CLSA participants to experience three or more comorbidities. In age-adjusted models, WLWH experienced similar comorbidity prevalence to BCC3 controls (β=0.01, p=0.98), but higher prevalence than CLSA controls (β=1.67, p=0.001).

Conclusion: BCC3 WLWH and BCC3 controls with similar lived experiences had comparable comorbidity burden, which was higher than that of women from the general population. This highlights that sociodemographic factors may be key comorbidity drivers in WLWH. Further investigation of these factors will inform targeted strategies for reducing comorbidity in this population.