Introduction: In BC, HIV Treatment (HIV-Tx) and PrEP are centrally distributed and program therapeutic guidelines recommend screening for syndemic conditions including HCV. A lab-based HCV screening and clearance cascade was developed to inform potential quality improvement measures.

Methods: BC Centre for Excellence in HIV/AIDS HIV-Tx and PrEP program participants active in 2024 were included. Program registry lab records (2015-2024) were utilized for the cascade: (1) HCV ever screened, (2) Anti-HCV ever reactive, (3) HCV RNA ever tested, (4) Last HCV RNA negative. We described client demographics, HCV screening rates, and compared HIV-Tx and PrEP (Chi-square and Kruskal-Wallis tests).

Results: 8356 HIV-Tx and 9318 PrEP participants were included. Differences between HIV-Tx vs PrEP included median [Q1-Q3] age (55 [43-63] vs 36 [30-45] years, p<0.001); gender (cis-men 82% vs 96%, p<0.001), key populations (e.g., men-who-have-sex-with-men/MSM 44% vs 95%, p<0.001), and reported substance use history (26% vs 2%, p<0.001).

Most participants (>95%) had prior HCV screening. Screening rates (per person-year [95%CI]) were 1.15 [1.14-1.16] in HIV-Tx and 1.27 [1.26-1.28] in PrEP, over median [Q1-Q3] 10 [7-10] and 2.8 [1.3-5.6] years of follow-up per person, respectively. Most participants (82% HIV-Tx and 93% PrEP) had recent screening (2023-2024).

History of HCV was higher in HIV-Tx than PrEP (21% vs 1%, p<0.001); however, recent/current HCV viremia was low in both cohorts (Figure).

Conclusion: Adherence to HCV screening guidance, low population prevalence amongst MSM, and active provider involvement in care appear to have resulted in low numbers of HCV viremic participants needing repeat testing and potential treatment.

Background: Incarcerated individuals are disproportionately affected by sexually transmitted and bloodborne infections (STBBIs) and studies suggest that incarcerated females have a higher prevalence of STBBIs compared with incarcerated males. As Canadian data are lacking, we aimed to determine the prevalence of bloodborne (HIV, hepatitis B virus (HBV), and hepatitis C virus (HCV)) and bacterial sexually transmitted infections (chlamydia, gonorrhea, and syphilis), stratified by sex, among people in Quebec provincial prisons.

Methods: Convenience sampling of adults (age >18) in three prisons in Montreal (two male and one female), where individuals are sentenced for <2 years, was undertaken. Participants were offered self- or peer-collected dried blood spot (DBS) testing for HIV and HCV antibodies (and HCV RNA if positive), hepatitis B surface antigen (HBsAg), and Treponema pallidum enzyme immunoassay (EIA; syphilis antibody). PCR testing was conducted on urine samples for Chlamydia trachomatis (chlamydia) and Neisseria gonorrhoea (gonorrhea). Test results were stratified by sex.

Results: From October 7, 2024–October 29, 2025, 811 participants were recruited (547 males (67%) and 264 (33%) females, median age: 37 years). Overall, 71/264 (27%) females and 84/547 (15%) males reported a history of injection drug use. 10% (84/811) self-collected their DBS. Among females, the prevalence of STBBIs was HIV: 1.1% (n=3); HBsAg: 0.4% (n=1); HCV antibodies: 13.3% (n=35); HCV RNA: 2.7% (n=7); chlamydia: 1.9% (n=5); gonorrhea: 1.1% (n=3); and syphilis: 6.8% (n=18). Among males, the corresponding estimates were HIV: 0.4% (n=2); HBsAg: 0.5% (n=3); HCV antibodies: 4.6% (n=25); HCV RNA: 0.9% (n=5); chlamydia: 2.4% (n=13); gonorrhea: 0.5% (n=3); and syphilis: 4.2% (n=23). Test positivity was two-fold higher among females than males (27.3% vs. 13.5%).

Conclusion: Females in Quebec provincial prisons had a higher prevalence of most STBBIs compared to males, underscoring the importance of gender-informed public health planning for incarcerated females to meet Canada’s STBBI elimination goals.

Background:
To reach the WHO’s 2030 hepatitis C virus (HCV) elimination target, Canada must maintain high treatment rates, especially among people who use drugs (PWUD), who account for the majority of new HCV cases in British Columbia and represent the highest proportion of HCV/HIV co-infection in Canada. Strategic elimination of HCV in this population will have both individual and community benefits as the potential for transmission, liver disease, and liver cancer risk will significantly decrease.

Methods:
A retrospective chart review of people living with HIV (plwHIV) was conducted through the Cool Aid Community Health Centre by reviewing data entered in electronic medical records from January 2019 to December 2025. History of HIV/HCV co-infection and results of strategic HCV treatment including sustained virologic response (SVR) were evaluated.

Results:
Of a total of 244 plwHIV, 91 (38%) had evidence of prior HCV co-infection indicated by a positive HCV antibody test. At the time of analysis, none had active HCV infection: 72 (79%) have been treated with SVR, 16 (18%) spontaneously cleared, and 3 (3%) are unknown if cleared or SVR. 16 (18%) experienced reinfection and all have been successfully retreated.

Conclusion:
This retrospective chart review data indicates significant progress towards elimination of HCV within plwHIV locally, with the entire cohort (100%) no longer burdened with HCV. Similar efforts are needed to eliminate HCV in plwHIV lost to follow up nationally. The overall progress towards elimination was impacted by the 18% reinfection rate observed but retreatment is now easily obtained through provincial reimbursement and should be prioritized to support the health of plwHIV.

Persistent health inequities drive disproportionate HIV rates among key populations in Canada. The I’m Ready program aims to reduce these inequities by improving access to HIV self-testing. To evaluate effectiveness of the I’m Ready program to address health equity, we compared participant characteristics and outcomes with census population distributions across Canada.

We analyzed 15,000 I’m Ready participants who received HIV self-tests between June 2021 and November 2025. Sample included all key populations, with > 2,000 Black participants, 500 Indigenous, 5,500 men who have sex with men, and 3,500 women; 90% resided in large urban/metropolitan areas. We compared participants’ socio-demographic characteristics against 2021 Census population distributions. Proportional differences and odds ratios were calculated to assess over and under-representations of populations reached. Results were stratified by geography using Statistics Canada definitions - large cities (Census Metropolitan Areas), smaller cities (Census Agglomerations), and rural regions (non-CMA/CA).

Relative to Canadian population, participants identifying as 2SLGBTQ+ were significantly more likely to participate in I’m Ready (odds ratio [OR] = 27.5) while women were significantly less likely to be reached (OR=0.35). Gender diverse participants were more likely to participate nationally, with the strongest differences observed in smaller cities and rural communities (OR=37.3). Youth under 30 were more likely to participate (OR=3.2), as were Black participants (OR=3.4), particularly in rural regions (OR=19). Canadian citizens were more likely to participate in urban areas (OR=1.8) while non-citizens were more likely to participate in rural regions (OR=1.7).

I’m Ready Program is highly effective in addressing health inequities in HIV testing for most key populations, reaching 2SLGBTQ+ and gender diverse individuals, with higher proportions of gender-diverse participants in smaller cities and rural areas. Women, however, were under-represented, a pattern commonly observed in HIV testing. REACH Nexus is working on strategies to ensure women get access to low-barrier access in their community.

Background: Survival among people living with HIV (PLWH) is shaped by intersecting socioeconomic and structural conditions. We applied latent class analysis (LCA) to identify intersectional social subgroups among PLWH in British Columbia (BC) and examined their relationship with all-cause mortality.
Methods: We linked survey data from the Longitudinal Investigation into Supportive and Ancillary Health Services (LISA) Study with administrative clinical and mortality records from the Comparative Outcomes and Service Utilization Trends (COAST) cohort (2007–2017). LCA indicators included income, education, employment, food security, housing stability, physical limitation, social supports, access to care, neighborhood cohesion, race/ethnicity, gender, immigration status, and sexual orientation. Identified classes were treated as baseline exposures. Time-varying clinical confounders (i.e., Charlson Comorbidity Index, viral suppression, and CD4 cell count) along with age and illegal drug use, were incorporated into the final Cox models.
Results: Of 1,000 participants, 996 were included in the analysis. A two-class LCA model best fit the data. The high structural vulnerability class (n = 658, 66%) was characterized by low income, limited education, food insecurity, unstable housing, physical limitation, and higher proportion of racial/ethnic groups whereas the low structural vulnerability class (n = 338, 34%) exhibited comparatively stable socioeconomic conditions. The high structural vulnerability group accounted for 198 (85.3%) of 232 deaths, and was associated with significantly higher mortality, after adjusting for confounders (adjusted Hazard Ratios = 2.47; 95% CI: 1.54–3.95).
Conclusions: Intersectional social profiles were strongly associated with mortality among people living with HIV, after adjustment for clinical confounders. Even in a setting with universal HIV care, these intersectional profiles were associated with mortality, underscoring that preventable deaths will persist unless HIV policy and practice address social conditions as co-occurring systems of risk rather than isolated determinants.

Background. HIV and other sexually transmitted and bloodborne infections (STBBI), including chlamydia (CT), gonorrhea (GC), and syphilis, remain major public health concerns, with disproportionate impacts linked to structural inequities. Contemporary, population-based descriptions of income-related disparities across multiple STBBI are limited. We describe STBBI trends in Manitoba from 2012-2021, focusing on area-level income gradients.
Methods. A retrospective, population-based analysis using linked, anonymized administrative and laboratory data housed at the Manitoba Centre for Health Policy. Diagnoses followed provincial case definitions. Annual person-year (PY) rates with 95% confidence intervals (CI) were calculated for residents aged 16+ years, stratified by area-level income quintile (IQ). IQs were based on average household income from census data. Absolute risk differences (ARD) and rate ratios (RR) compared rates between lowest (IQ1) and highest (IQ5) income areas. Inequalities over time (2012–2015, 2016–2019, 2020–2021) were visualized using equiplots.
Results. HIV rates were 7.2 (95% CI: 6.5–8.1) and 7.4 (6.4–8.6) per 100,000 PY between 2012–2015 and 2020–2021. Syphilis rates rose ten-fold, from 16.5 (15.1–18.0) to 171.2 (165.8–176.7) per 100,000 PY. STBBI were consistently highest in lower-income areas. From 2012–2021, ARDs comparing IQ1 to IQ5 were: HIV 15.5 (95% CI: 13.6–17.4), syphilis 156.4 (150.1–162.3), CT 1015.6 (999.9–1032.2), and GC 494.1 (484.0–504.3) per 100,000 PY. Strong income-related gradients persisted across infections, with an HIV RR of 7.3 (95% CI: 5.5–9.9), although gradient changes varied by infection over time (Fig. 1).
Conclusions. Substantial income-based inequalities persist across multiple STBBI. Surveillance incorporating socioeconomic context is critical for guiding equitable prevention, testing, and care strategies.

Background
Comprehensive and timely data capture are central to contemporary HIV surveillance, prevention, and control. Over the past decade, the Ontario HIV Treatment Network Cohort Study (OCS) has evolved into a mature data platform linking clinical, laboratory, and participant-reported data. We describe cohort characteristics, and data contributions from 2015 to 2024.
Methods
The OCS is an open, multi-site prospective cohort of adults (≥16 years) living with HIV in Ontario. Longitudinal follow-up integrates standardized clinical chart abstraction, structured interviews, and linkage to Public Health Ontario Laboratory (PHOL) for viral load. Data are harmonized to support HIV care cascade measurement and several embedded sub studies addressing HIV priorities in Ontario.
Results
Between 2015 and 2024, cumulative enrollment increased from 6,335 to 8,390 participants, with 2,208 new enrollments. As of 2024, 4,025 participants were active, contributing more than 72,000 cumulative person-years of follow-up. Active participants were geographically distributed across Toronto (66.8%), Southwest (18.0%), Eastern (12.3%), and Northern Ontario (2.9%). Sex at birth among active participants was 75.7% male, 24.0% female, and 0.3% intersex/other.
Average annual attrition was 4.8%, peaking during the COVID-19 period (6.0% in 2020). Each year, 800–1,400 participants contributed clinical-only data via chart abstraction and EMR, while 1,700–2,466 contributed both clinical and interview data. Interview completion among active participants ranged from 45.8% to 65.0%, while capture of clinical encounters exceeded 70% in 2024.
Conclusions
The OCS shows how integrated clinical, laboratory, and participant-reported data strengthen HIV surveillance and support priority research for people living with HIV.

Introduction: In cross-sectional research, problematic crystal methamphetamine (CM) use (e.g., high frequency, cravings, and health, social, legal, or financial problems) is associated with condomless anal sex (CAS) and bacterial STI prevalence. In longitudinal research, changes can be measured over time within and between individuals. However, it is unclear whether within-person changes in CM use risk or between-person CM use risk differences predict STI diagnosis among GBM.

Methods: We analyzed longitudinal data from 2449 sexually-active GBM from the Engage Cohort Study (2017-2022). We examined direct and indirect within- and between-person effects of CM use risk on CAS and incident bacterial STI diagnoses using multilevel mediation. CM use risk was assessed via the ASSIST-stimulant score among GBM reporting CM use in the past six months (ASSIST-CM). Potential mediators included escape motives and condom use attitudes.

Results: 9.3% participants reported using CM at any visit, and 27.5% developed an incident bacterial STI over a median of 1.70 years. Between-person differences in ASSIST-CM scores were associated with any bacterial STI diagnosis (β = 0.068, 95% CI: 0.014–0.122, p = 0.013), whereas within-person changes were not (β = 0.012, 95% CI: −0.008–0.033, p = 0.238). We also observed significant indirect effects between participants via greater escape motives, higher CAS, and more negative condom use attitudes.

Conclusions: STI outcomes differences were primarily driven by between-person differences in CM use risk, CAS, and condom attitudes, rather than within-person changes. These findings highlight the importance of targeted substance use treatment and STI prevention support for all CM-use GBM.