African, Caribbean, and Black (ACB) men in Canada face a significantly higher risk of HIV infection relative to other men. Despite this concern, only few studies have specifically focused on the usage of HIV testing services among ACB men. To contribute to the literature and health policy in Canada, we seek to understand the prevalence and correlates of HIV testing among heterosexual ACB men in Toronto. We use a sample of 325 self-identified heterosexual Black men in Ontario that participated in the weSpeak study that examines HIV vulnerability and resilience among ACB men. Guided by the Andersen’s framework of health services utilization, we fitted negative log-log regression models to cross-sectional data of ACB men who are 16 years or older. Findings indicate that: (1) ACB men with some postsecondary education (OR=0.57, p<0.1) and high school or below (OR=0.53, p<0.1) are less likely to have ever been tested for HIV compared to their counterparts with university education or higher; (2), Men who identify as Muslim are less likely to have ever been tested for HIV than their colleagues who identify as Christian (OR=0.56, p<0.1); (3) foreign-born men are more likely to have ever been tested for HIV than their Canadian-born counterparts (OR=2.79, p<0.001); (4) unemployed men (OR=2.14, p<0.05) and those with part-time employment (OR=1.90, p<0.05) are more likely to have ever been tested for HIV than their counterparts with full-time employment; and (5) ACB men who report consistent usage of condoms are less likely to have ever been tested for HIV than those with inconsistent usage (OR=0.55, p<0.01). Based on these findings, we recommend further research to understand the barriers to HIV testing and the design of a more nuanced population-based approach to HIV testing that incorporates case-management or various incentives.

View Poster PDF

Background
Latinx individuals have shown an increasing number of infections in the past years, among all other ethnicities. Numbers and percentages are striking, the same is true for the number of programs, sexual health educators, and research investigators who speak Spanish and who are trained to attend the social determinants of health at a micro, meso and macro level, from a city, provincial and national perspectives. CWB was a three-year intervention that accounted for 12 program iteration (4 sessions a year). Over the three years, more than (n=70) participants were part of the different programs.

Methodology
From a quantitative perspective, a pre/post Likert scale was used. From a qualitative perspective, the evaluation forms had space for participants who wanted to share their experience in the group. Also, Hand Mapping, a qualitative methodology that was created in the intervention was used to elicit topics, themes, questions, and level of satisfaction of CWB’s individuals. Theory and program science were both used, CWB’s curriculum and delivery, and program’s evaluation.

Lessons Learned
From an evidence/knowledge model, CWB was a great success, meeting the intervention’s goal of increasing participants' sexual health knowledge, HIV testing, and empowerment. Another great contribution was the inclusion of not only gay cisgender men, but also, all Latinx, regardless of gender, identities, or sexual orientation. Another lesson learned was the urgent need to incorporate social media in the program, and the use of technology that defeat geographic restrictions, this was more evident due to the presence of COVID-19 and the need to complete two more interventions under lock down conditions.

Policy Implications
There is an urgent need for policymakers who belong to the Latinx communities, with experience in evidence-based approaches and, both scientific and community expertise, to break barriers between policymakers, funding entities, research institutions, and communities at large.

View Poster PDF

Background
Back in 2006, the International AIDS conference was placed in the city of Toronto, changing HIV/AIDS forever in Canada. Antiretrovirals were in some way still “new”, condoms were a physical barrier, and there was a need for reducing stigma and ignorance in communities at risk. The event helped to fuel the opening of the HIV prevention program (CSSP), in downtown Toronto, with the idea of facilitating more participants coming for services and information. There was a lack of interventions, at the time. The OHTN and researchers joined forces for the creation of the first Latinx HIV intervention called “Mano en Mano” (MM) (evidence published in a journal), MM used program science to adapt an intervention from California. After 3 years, and with local experience gained, an updated intervention was created, “Chicos Net” (CN). CN published its theoretical model, advancing science, and theoretical bases. Finally, “Community Without Borders” (CWB), was in place from 2017-2020 (pre-and during COVID).
Core Elements
Grounded on evidence-based, program science, focus groups, communities scan, program evaluation, and one-on-one interactions with members of the community, intervention’s four objectives have consisted. 1) To increase sexual health information concerning HIV/STI’s, reduce HIV stigma, and inform about PrEP, PEP, and U=U. 2) To reduce social isolation and introduce peers one to another (friendship). 3) Reduce stigma and internalized homophobia that hunts individuals. 4) To develop critical consciousness (Freire’s).

Next Steps and Challenges
a) Funding has been a challenge, the different programs had to apply for funding packages, taking time, energy, and momentum from front-line workers.
b) An evaluation has revealed the need for a case manager for aiding an individual’s challenges.
c) The program needs an official evaluator professional, to improve data collection, interpretation, and KTE activities.
d) The program needs to use more social media to alleviate geographical challenges.

View Poster PDF

Introduction:
In India, Key Populations (KPs), such as men who have sex with men (MSM), bear a disproportionate burden of HIV disease. Conventional targeted intervention programs (TI) mitigate HIV transmission by focusing on engaging MSM and delivering services in physical locations. As solicitation behavior within India’s MSM community shifts online, novel approaches are needed to map virtual platforms where sexual networks are formed.

Objectives:
To estimate the number of MSM in Delhi using virtual platforms to meet sex partners and to characterize the platforms.

Methodology:
This study was conducted in all eleven districts of Delhi in 2020. The study population included consenting MSM, over 18 years of age, who used virtual platforms to meet sex partners. A list of virtual platforms was established with community consultations, including organizations working on HIV Prevention for MSM. Size estimation was carried out by counting the number of active online users with adjustments for duplication. 565 individuals consented to structured interviews.

Results:
28,058 MSM (range 26,000 to 30,000) use virtual sites to find sexual partners. We identified 14 virtual sites, 19 social networking pages and 112 messenger groups, all exclusively for MSM. 5 virtual platforms met feasibility criteria for virtual mapping. These platforms were most active at night (81%) and on Sundays (94%). Among participants, 16% were aware of organizations providing HIV services and 7% were contacted by peer educators in the preceding three months. 42% visited a physical location for solicitation in the month prior to the study.

Conclusion:
TI programs that focus on physical hotspots do not reach the majority of MSM who use virtual platforms for sexual solicitation. MSM active on virtual platforms have a low awareness of HIV services. Virtual mapping must be incorporated into current public health interventions to reach MSM unreached by traditional programs.

View Poster PDF

Background:
Activism by people living with HIV has established calls for meaningful inclusion in research and programming that impacts their lives. Few studies describe the process of meaningful engagement, especially within clinical research. We discuss how we hired, trained, and continue to support women living with HIV (WLWH) as Peer Research Associates (PRAs) in the BC CARMA-CHIWOS Collaboration (BCC3) Study, and how we are engaging WLWH through a peer-mentorship model.

Process and Lessons Learned:
We hired five WLWH as PRAs, with diverse lived and living experiences and expertise. Some women had previous research experience, while others did not. Multi-modal experiential training was held virtually between July–November 2020. An Indigenous Elder opened and guided sessions in a Good Way. Training included survey administration, research ethics and methods, scientific curricula related to hormones and aging, data quality, self-care, and well-being. PRA’s strengths and expertise were emphasized as they led training sessions and activities, engaged in paid study opportunities beyond survey administration, and were supported to set personal goals throughout and beyond training.

Tailoring training to the goals, voices, and priorities of PRAs provided transformational learning opportunities for the entire research team. This included expanding the definition of the PRA role, and mirroring the diversity of women’s lives, needs, and experiences throughout and beyond the training. Challenges included virtually engaging women during a pandemic; meaningful engagement with complex scientific concepts; and creating a curriculum built upon and responsive to the varying expertise of PRAs.

Recommendations:
Research teams must be responsive to the goals of PRAs; incorporate opportunities for bidirectional learning and knowledge sharing; dedicate time for team relationship building and trust; leverage existing community-based research training materials; and create a research environment that supports WLWH to share their expertise and experiences, ask questions, interrogate study practices, and mentor other team members.

View Poster PDF

Background:

CATIE strengthens Canada’s response to HIV and hepatitis C by bridging research and practice. We connect healthcare and community-based service providers with the latest science, and promote good practices for prevention and treatment programs.

As Canada’s official knowledge broker for HIV and hepatitis C, CATIE provides up-to-date, accurate and unbiased information.

Methods:

In 2019, CATIE conducted a national online survey of people working in HIV and hepatitis C including public health, healthcare, not-for-profit organizations and government, to assess the overall impact of our complement of services and resources in knowledge exchange and mobilization. The survey was designed to evaluate CATIE’s reach, frequency of use and effectiveness. Frequency descriptives were compiled from 1,973 respondents from across Canada who completed the survey.

Results:

CATIE is reaching its intended audiences. Respondents came from a diverse array of organizations working in HIV, hepatitis C, sexually transmitted infections and harm reduction – most of whom (81%) work from an integrated STBBI approach. Collectively these organizations provide a full range of HIV and hepatitis C services across Canada.

Respondents report that CATIE’s services and resources increase their knowledge of HIV (95%), hepatitis C (93%) and new developments, best practices and other evidence-informed program innovations (93%) and increase their capacity to respond to the needs of their community (94%).

Ninety-eight percent of respondents report CATIE’s services and resources have an overall impact on their application of HIV and hepatitis C knowledge and 92% report an overall impact on their programming. Respondents provided over 602 examples of how CATIE’s services and resources have changed their policies, practices and programming.

Conclusion:

Respondents feel CATIE is meeting their knowledge exchange needs and expectations. CATIE continues to effectively support and impact HIV and hepatitis C work in Canada.

View Poster PDF

BACKGROUND:

Physical Activity can mitigate disability and improve health outcomes for people living with HIV. The social determinants of health (SDOH) include factors that may influence health status and engagement in physical activity. However, it is unclear how SDOH may influence engagement in exercise among people living with HIV.

PURPOSE & OBJECTIVES:

The purpose of this study is to examine the nature and extent of engagement in exercise among people living with HIV. Specific objectives are 1) to describe the nature and extent of engagement in exercise; and 2) to examine whether SDOH predicts engagement in exercise among adults living with HIV enrolled in a 25-week community-based exercise (CBE) intervention in Toronto.

METHODS:

We will conduct a quantitative longitudinal study using data collected with adults living with HIV who participated in a 25-week CBE intervention. Participants were asked to engage in a combination of aerobic, resistive, balance and flexibility exercise, 90 mins, 3 times per week, supervised weekly by fitness instructors at the Toronto YMCA. Using the Public Health Agency SDOH Framework, we identified 10 out of 12 demographic characteristics measured in our study that may be used as proxies for social determinants of health. For objective 1, we will descriptively analyze: i) nature (type: aerobic, resistive, balance, flexibility) and ii) extent (frequency, time, intensity, progression) of exercise across the intervention as measured by self-reported exercise logs and weekly coaching logs and YMCA usage. For objective 2, ‘engagement in exercise’ will be defined as attending ≥ 72% (18/25) weekly sessions. We will conduct univariate analyses between engagement in exercise and each determinant followed by a logistic regression model to determine predictors of engagement in exercise.

IMPLICATIONS:

Results will help to establish a better understanding of the role of SDOH on engagement in exercise among people living with HIV.

View Poster PDF

In response to the COVID-19 pandemic, sexual health services have begun to adapt alternative service delivery methods that reduce in-person contact (e.g., telemedicine, virtual health). We sought to understand interest in alternative service delivery methods among BC sexual health service clients during the pandemic.

We used data from an online anonymous survey administered from 21/07/2020-04/08/2020 to clients (≥16 years old) who had used the BC Centre for Disease Control’s sexually-transmitted infection (STI) clinic and/or the GetCheckedOnline testing service in the year prior to COVID-19 public health responses (03/2020). We described participants’ likelihood of using alternative sexual health service delivery methods (if available), and conducted bivariate analysis to examine its association with experiencing any sexual health service access barrier during the pandemic.

Of the 1198 survey participants (aged 17-76 years), 48% identified as men, 47% as women, and 5% as another gender; 71% identified as White, 24% as racialized minorities, and 4% as Indigenous. Support for using alternative STI testing models was high overall, with 88% likely to use at-home self-collection kits and 79% likely to use an express testing model (i.e., phone/video triage prior to specimen collection at a clinic). More participants were likely to discuss sexual health with a health care provider over the phone (64%), compared with video visits (53%) and text (49%). Text messaging to receive STI test results and reminders were of high interest (71% and 63% likely to use, respectively). Likelihood of using alternative service delivery methods did not differ by participants’ experience of access barriers, where 66% of total participants reported having avoided/delayed seeking services during 03/2020-07/2020.

Likelihood of using alternative methods of sexual health service delivery was high, even among participants who did not avoid/delay seeking services. Sustaining and expanding such services would facilitate access during and beyond the COVID-19 pandemic.

View Poster PDF

Background:
Existing disparities in sexual health service access experienced by sexual and gender minorities may have been exacerbated by public health responses to the COVID-19 pandemic. We describe differences in service access among a diverse sample of sexual health service clients in British Columbia (BC).

Methods:
We used data from the Sex in the Time of COVID-19 survey administered from July 21-August 4, 2020. Clients >15 years old who had visited the BC Centre for Disease Control’s STI clinic or GetCheckedOnline, BC’s internet-based testing program, in the year prior to March 2020 were invited to complete the online anonymous survey. We describe sexual health needs and service access during the initial months of the pandemic, stratified by gender and sexual orientation: heterosexual men (het-men), sexual minority men (SMM), heterosexual women (het-women), sexual minority women (SMW), and non-binary/genderfluid people (NB).

Results:
Of n=1196 survey participants (median age: 32; 4% Indigenous; 24% racialized minority), 21% (n=247) were het-men, 28% (n=331) were SMM, 29% (n=342) were het-women, 18% (n=221) were SMW, and 5% (n=55) were NB. Almost two-thirds of SMW (65%) and het-men (62%) needing sexual health services, including STI testing, had unmet sexual health needs. Most SMW (73%) and NB participants (92%) reported any reason for delaying/avoiding sexual healthcare. Details of sexual health service needs and access barriers are presented in Table 1.

Conclusion:
Inequities in sexual health care access experienced by sexual and gender minorities must be addressed in service planning and delivery throughout and beyond the COVID-19 pandemic response.

View Poster PDF

Background. Several factors continue to place gay, bisexual and other men who have sex with men (GBM), particularly those marginalized by racism and other identities and experiences, at disproportionate risk for HIV and STBBIs. These include limited access to HIV prevention services (HIV/STI testing, PrEP), and mental health services. Given close ties to communities, AIDS service organizations (ASOs) are well-positioned to provide some of these services yet typically lack the resources or training to do so. Task-shifting, or the delegation of some non-regulated clinical tasks to non-clinical personnel, has been used in settings where resources are limited or where specialized services are needed.

Method. The Synergizing Health Interventions for Toronto gay and bisexual men (SHIFT) study - a community-based, multi-phase, implementation project - was conducted to explore the possibility of task-shifting HIV/STBBI prevention services for GBM in Toronto. Interviews were conducted with 31 healthcare providers (i.e., physicians, nurses, psychotherapists, pharmacists) and community workers who work with GBM regarding the prospect of giving ASO workers a more quasi-clinical role to increase uptake for HIV/STI testing, PrEP, and mental health services. Interview data were transcribed verbatim and thematic analysis was employed to suggest possible future implementable solutions for increased access to care.

Results. Our findings revealed substantial agreement between healthcare providers and community workers about the services that could be task-shifted to ASOs. In particular, self- or home-testing for HIV and STIs, and PrEP education, initiation, and follow-up provided opportunities to leverage the skills and expertise of community workers. Responses to the question of mental health were more complex. With the help of participants and other community stakeholders, future SHIFT project work includes the development and implementation of a task-shifting plan to increase access to these essential services for a diversity of GBM in the city of Toronto.

View Poster PDF

Background: Routine syphilis screening is recommended among people living with HIV (PLWH). We sought to determine the frequency of syphilis screening over time among PLWH engaged in anti-retroviral therapy in British Columbia (BC) and variables associated with frequent screening.
Methods: We reviewed laboratory results for all individuals enrolled in the BC Drug Treatment Program between January 1, 2015 and December 31, 2019. A syphilis test was defined as a routine screen if performed within 7 days of an HIV viral load measurement. Frequent testing was defined as two or more tests per year. Logistic regression was used to determine variables associated with frequent testing.
Results: Among 8211 patients enrolled, 7364 (90%) had at least one syphilis test over the study period. 93.4% of all tests were routine screens. The proportion tested per year increased over time (71% in 2015 vs. 79% in 2019, p<0.001); as did the proportion of those tested who were tested frequently (72% in 2015 vs. 83% in 2019, p<0.001). Increased testing was observed among MSM (83% in 2015 vs. 90% in 2019, p=0.005), but not among non-MSM (65% in 2015 vs. 72% in 2019, p=0.087). Frequent testing was associated with attending a hospital-based HIV clinic (aOR 5.14, 95% CI 4.65-5.68), community-based HIV primary care clinic (aOR 4.78, 95% CI 4.29-5.33), being MSM (aOR 1.90, 95% CI 1.73-2.08), residing in Vancouver’s West End (aOR 1.74, 95% CI 1.55-1.95,) or elsewhere in Vancouver (aOR 1.32, 95% CI 1.19-1.47) compared to the rest of the province, and calendar year (aOR 1.17 per year increase, 95% CI 1.15-1.19).
Conclusion: The vast majority of syphilis testing among PLWH in BC is routine screening linked to viral load monitoring. As HIV monitoring becomes less frequent in stable PLWH, the frequency of syphilis testing could be compromised, and stand-alone testing may be needed.

View Poster PDF

Background: Estimating the number of gay, bisexual, and other men who have sex with men (GBMSM) in Ontario and sub-provincial regions enables the estimation of GBMSM-specific HIV metrics, including prevalence, incidence, and testing rates.
Methods: We estimated the number of GBMSM in Ontario beginning with a base estimate of the number of males aged ≥15 who identified as “homosexual” or “bisexual” in the Canadian Community Health Survey (CCHS 2017-2019 [combined yearly cross-sectional data]). As this was a known undercount of GBMSM, two adjusted estimates were created. The first estimate was defined by identity and adjusted for non-disclosure of sexual orientation (using SexNow 2019 cross-sectional survey data) and men who did not identify as gay or bisexual who reported anal sex with another man in the past twelve/six months (CCHS/SexNow). The second estimate was defined by sexual behaviour and additionally restricted gay- or bisexual-identifying men (GBM) to those who reported anal sex with another man in the past twelve/six months (CCHS/SexNow).
Results: Among GBM, 84.1% reported themselves likely to disclose their sexual orientation on a Statistics Canada survey (SexNow), and 57.3% (CCHS) and 77.3% (SexNow) reported anal sex with another man in the past twelve and six months, respectively. Men who did not identify as gay or bisexual comprised 5.9%-9.4% of the total GBMSM population, depending on the population definition (identity or behaviour). The first identity-defined estimate of the number of GBMSM was 217,885 for Ontario and 72,539 for Toronto, and the second behaviour-defined estimate was 150,298 for Ontario.
Conclusions: These estimates provide an evidence-informed measure of the size of the GBMSM population and improve our understanding of the size of the target population for HIV prevention activities. This work is foundational to produce population-specific metrics including prevalence, incidence, and testing rates which will better describe the HIV epidemic among GBMSM.

View Poster PDF

Compared to heterosexuals, gay, bisexual, and other men who have sex with men (gbMSM) are disproportionately affected by sexually transmitted and blood-borne infections (STBBIs). Barriers accessing in-person clinical services experienced by gbMSM, including distance and limited hours, has been exacerbated by the COVID-19 pandemic. Online STBBI testing addresses these barriers, however it is not available in Ontario. We assessed acceptability of online STBBI testing, barriers to clinic-based STBBI testing, and the perceived benefits and drawbacks of this service among gbMSM living in Ontario.

Sex Now 2019 was an online national bilingual cross-sectional survey of gbMSM aged ≥15. Participants were asked on a 5-point scale (very likely – never) how likely would they use an online STBBI testing service. Participants were also asked to select their reasons for delaying STBBI testing and their perceived benefits and drawbacks in using online STBBI testing.

The Ontario sample included n=2375 gbMSM (median age: 38 and 75.4% gay). A third (35.8%) reported no delays in STBBI testing. However, many delayed testing due to being too busy (26.4%) or inconvenient clinic hours (23.9%). Acceptability for online STBBI testing was high: 78.8% reported they would likely use this service. Convenience (61.9%) and saving time (62.7%) were the two most commonly endorsed benefits, while concerns around the privacy of one’s information was the most selected drawback (36.5%).

Acceptability of online STBBI testing was high among a sample of gbMSM living in Ontario. Implementation of this service within the province may address STBBI testing barriers experienced by this population.

View Poster PDF

Introduction: The use of illicit substances during sex (chemsex) among gay, bisexual and other men who have sex with men (gbMSM) has been associated with transmission of sexually transmitted infections (STI), including HIV. Pre-exposure prophylaxis (PrEP) is highly effective at preventing HIV transmission, addressing an important HIV prevention need among those practising chemsex. This study aims to assess whether chemsex is associated with STI incidence among PrEP users.
Methods: We use data from the l’Actuel PrEP Cohort including baseline sociodemographic and behavioural data and follow-up STI testing from 2013-2020 among gbMSM and transgender women. We estimate the incidence of chlamydia and gonorrhea and use Kaplan-Meier curves to examine differences among individuals who reported chemsex at baseline and those who did not. We also estimate the impact of reporting chemsex at baseline on STI incidence over 24 months following PrEP initiation using Cox proportional hazards regression.
Results: A total of 2,090 individuals (2,086 gbMSM, 4 trans women) consulted for PrEP and attended at least one follow-up visit, contributing 1,477 years of follow-up. There were no incident HIV infection among patients who were on PrEP In the chemsex group, crude incidence rates for chlamydia, gonorrhea, and either STI were 28, 39 and 60 diagnoses per 100 person-years, respectively; compared to 23, 24 and 47 in the no-chemsex group. When controlling for age, education, income and year of baseline consultation, the hazard of being diagnosed with gonorrhea and/or chlamydia was 30% higher (adjusted hazard ratio = 1.3; 95%CI: 1.1-1.6) among participants reporting chemsex at baseline.
Conclusion: Among PrEP users, chemsex is associated with an increased incidence of gonorrhea and chlamydia. The high incidence of STIs among people who report chemsex highlights the importance of PrEP for this population and the need for tailored interventions. Future work will examine potential mediators of this association.

View Poster PDF

Background: African Caribbean Black communities are disproportionately affected by the HIV/AIDS epidemic. Whilst ACB people constitute 4.3% of Ontario’s total population, they account for 18.8% of people infected with HIV through heterosexual contact. Religious and spiritual influence on health beliefs and practices are multifaceted. However, this has been minimally explored in the context of HIV in the ACB community in Canada. This paper examined the role of Spirituality in building Resilience of ACB men’s deal with HIV/AIDS in Ottawa.
Methodology: We used a multi-phase mixed-method informed by Community Based participatory research (CBPR) approach to engage straight Black men. Phase 1 was primarily qualitative and data sources were Focus Group Discussions and Individual in-depth Interviews involving 170 participants. Data were transcribed verbatim and analyzed with Nvivo guided by thematic analysis.
Results: The major themes of the study included spirituality, resilience, and community resources as strategies for coping with HIV. Community resources such as local ethnocultural health and service organizations and faith-based organizations as resources for well-being. Study participants described that Spirituality in the form of organized religion as Christianity plays a very crucial role to develop resilience and cope with desperate life events, trauma, stress, and other forms of risk. The Church has become a major rally point where most ACB meet providing one of the most important bonding to this highly heterogeneous group.
Conclusion: In the context of HIV/AIDS prevention and service utilization in the ACB community, spirituality helps people to cope with stigma and discrimination, and to facilitate access to care and support. Spirituality was identified as a source of strength, resilience, and wellbeing. Thus, it is vital for health and social service organizations to meaningfully engage the ACB community and faith-based institutions.
Keywords: Spirituality, Resilience, HIV/AIDS, ACB men.

Background: Characterizing new HIV diagnoses can help inform public health responses. Using almost four decades of data, this study describes the changing profiles of newly HIV diagnosed individuals attending a large sexual health clinic in Montréal, Canada.

Methods: HIV diagnosis data from participants of the l'Actuel's clinical cohort was used to assess the distribution of HIV exposure categories by gender and year of diagnosis. Time trends in mean age and CD4 count at diagnosis were assessed.

Results: We analysed 3,457 patients diagnosed between 1983-2019. Over this period, mean age at diagnosis increased from <30 years to mid-30s. Overall, the mean CD4 count at diagnosis was estimated at 480 cells/µL and remained stable over time. Although men who have sex with men (MSM) consistently accounted for the highest proportion of new diagnoses (77%), their proportion decreased since 2013. There was also a concomitant decrease in the proportion of people who inject drugs, and an important increase in the proportion of patients from HIV-endemic countries (24% in 2019), especially among women (Figure). Over 2015-2019, 63% of women diagnosed were born in a HIV-endemic country. Those from endemic countries were characterized by higher proportions of heterosexuals (89% vs 17%) and of women (52% vs 7%), and lower CD4 count at diagnosis (370 vs 480 cells/µL).

Conclusion: In absolute numbers, MSM continue to account for the largest exposure category. Patients from HIV-endemic countries constitute an increasing proportion of new diagnoses. Tailoring HIV testing strategies and other prevention interventions to these individuals is warranted.

View Poster PDF

Background:
GetCheckedOnline is an internet-based testing service for sexually-transmitted and blood borne infections (STBBI) offered in select British Columbia (BC) communities since late 2014. Users complete an online risk assessment to inform STBBI test recommendations, auto-generating a lab requisition which can be used at any participating laboratory location, with results available online or by phone. While many in-person sexual healthcare services were reduced or stopped due to COVID-19, GetCheckedOnline remained accessible. We describe GetCheckedOnline program utilization and selected risk factors before and during the COVID-19 pandemic.

Methods:
We used GetCheckedOnline and linked laboratory testing data to generate descriptive statistics. We compared the mean of selected monthly program measures during the COVID-19 pandemic (March 2020 – December 2020) to the same time period the previous year, defined as pre-pandemic (March 2019 – December 2019).

Results:
The median number of monthly test episodes completed was higher during the pandemic (median=1088; n=9470 total episodes completed), compared to pre-pandemic (median=824, n=8237 total episodes completed), despite a sharp decline and rapid recovery in March-May 2020. During the pandemic, the mean proportion of test episodes completed by those using GetCheckedOnline for the first time was 57%; an increase from pre-pandemic (51%). We observed an increase in the percent positivity during the pandemic compared to pre-pandemic (6.44% vs. 5.72%), as well as in the mean proportion of those reporting symptoms (20.3% vs 19.4%) or being a contact to someone with an STBBI (11.0% vs 9.3%).

Conclusion:
The increase in first time GetCheckedOnline testers, percent positivity, and those reporting symptoms or being a contact to an STBBI during the COVID-19 pandemic suggest the program has filled a gap in STBBI testing services in BC, and remains a critical service for accessing sexual healthcare.

View Poster PDF

Background: Engage-COVID-19 is a mixed-method study collecting biobehavioural data to understand the impacts of COVID-19 on gay, bisexual, and other men who have sex with men (GBM) living in Vancouver, Toronto, and Montreal. In this preliminary analysis we describe how the COVID-19 pandemic has impacted the sexual behaviour, PrEP use, and healthcare access of GBM.

Methods: Beginning in 09/2020, we asked Engage Cohort Study participants COVID-19-specific questions. GBM were asked how their sexual activities between 03/2020 to the end of 05/2020 changed when compared with before 03/2020. We report percentages of responses to key questions.

Results: Data were collected from 492 participants as of 12/2020 and is ongoing (Vancouver=214, Toronto=30, Montreal=248). Compared with before the COVID-19-pandemic, participants reported increased engagement in physically distanced sexual activities (e.g., more camming (48.5%), sexting (37.4%), solo masturbation (46.8%)) and decreased behaviours that may increase risk for COVID-19 exposure (e.g., less in-person sex with new casual partners (74.1%), less outside household sexual meet-ups (69.6%)) (Table 1). Half (50%) of GBM taking PrEP reported COVID-19 did not impact their use; however, 19.7% stopped using PrEP completely and 13.8% switched from continuous to on-demand use of PrEP. Only 6.4% of GBM living with HIV reported COVID-19 impacted their access to HIV care. One third (32.8%) of participants reported avoiding health services because of concerns about COVID-19 exposure.

Conclusion: The COVID-19 pandemic led to changes in the sexual behaviours and PrEP use of many GBM during this period. Our preliminary findings also point to significant healthcare access disruptions.

View Poster PDF

Objectives
The last national biobehavioural surveillance study of GBM was in 2010. We measured prevalent HIV and other STBBI and documented related preventive and risk behaviours in Canada’s three largest metropolitan areas.
Methods
The Engage cohort study used respondent-driven sampling (RDS) to recruit GBM aged 16 years or older who reported sex with another man in the past six months. At baseline, we examined RDS-II adjusted distributions of laboratory-confirmed HIV and other STBBIs, and related behaviours, with a focus on city differences. We made pairwise comparisons between cities, using nonparametric tests considering unequal variances and sample sizes across cities.
Results
A total of 2,449 GBM were recruited from February 2017-August 2019. HIV prevalence was lower in Montreal (14.2%) than in Toronto (22.2%) or Vancouver (20.4%). While history of syphilis infection was similar across cities (14-16%), the occurrence of other STBBIs varied. Vancouver had more HIV-negative/unknown participants (18.6%) who reported never being HIV tested compared with Toronto (12.9%) or Montreal (11.5%). Both Montreal (74.9%) and Vancouver (78.8%) had higher proportions of men who had tested for another STBBI in the past six months compared with Toronto (67.4%). Vancouver had a higher proportion of men who used Pre-Exposure Prophylaxis (PrEP) in the past six months (18.9%) than Toronto (11.1%) or Montreal (9.6%).
Conclusion
The three largest cities of Canada differed in HIV and some other STBBI prevalence, STBBI testing, and PrEP use among GBM. Our findings also suggest the need for scale-up of both PrEP and STI testing among GBM in Canada.

View Poster PDF

Workplaces for sex workers have various physical, social, political and economic conditions which create different contexts for doing sex work. Different sex work environments can contribute to HIV risk, including experiences of violence (e.g. by clients and police), violations of social and labour rights, and experiences of stigma and discrimination.

We conducted a cross-sectional bio-behavioural survey with 560 female sex workers between September 2017 to October 2018 in the city of Dnipro, approximately 200 km from the conflict in Eastern Ukraine. We describe workplace typologies for sex workers in Dnipro, the demographic profile and earnings of women working in different workplace typologies, as well as their client volume, experiences of violence and perceptions of safety.

Most respondents (59%) reported working in one workplace over the preceding 12-months. The majority named “offices” (40.0%) and apartments (27.3%) their main workplaces. Although hourly wage and client volume varied by workplace, participants’ monthly sex work earnings were comparable across typologies. Highway-based sex workers earned a median of 400 UAH/hr (IQR 300-400) ($14.70 US) and had the most client visits in a 30-day period (median 39.5, IQR 27-49) versus artclub-based sex workers earned a median of 1600 UAH/hr (IQR 1000-1850) ($58.90 US) and had the least visits (median 23, IQR 15-33). While sex workers in Dnipro earned a higher monthly wage from sex work than the city mean, they also reported experiencing high rates of violence and a lack of personal safety at work. Highway-based sex workers reported more physical violence by law enforcement compared with sex workers at “offices” (16.7% and 7.1% respectively).

Gaining a better understanding about sex work workplaces in Dnipro can help local HIV prevention programs optimize their services to meet the needs of sex workers and respond to changing work environments due to ongoing conflict and the evolving COVID-19 pandemic.

View Poster PDF

Introduction: Men who pay for sex can contribute to population-level HIV transmission through sexual relations with both female sex workers and their other sexual partners, but are often neglected in HIV responses. To inform programs, we conducted a systematic analysis of their population size, HIV burden, testing and sexual behaviors, and treatment engagement in sub-Saharan Africa (SSA).

Methods: We performed random-effects meta-analyses of 82 population-based surveys conducted in 35 SSA countries over 2000-2019. We analyzed HIV prevalence, population size, lifetime sexual partners, HIV testing, condom use at last paid sex, anti-retroviral treatment (ART), and viral load suppression (VLS) among men who reported ever paying for sex. Standardized prevalence ratios (PR; age, rural/urban) are also computed and pooled (by region and overall) to compare characteristics of men who have ever paid for sex to those who did not.

Results: Overall, 8% of men reported having ever paid for sex (95% confidence interval [95%CI]: 6-9%, number of surveys [Ns]=82). Men who paid for sex had, on average, 6.7 more lifetime sexual partners than men who did not pay for sex (95%CI: 5.9-7.4, Ns=58), had higher HIV prevalence (PR=1.6, 95%CI:1.4-1.8, Ns=50), and were more likely to have ever tested for HIV (PR=1.1, 95%CI: 1.1-1.2, Ns=77). Among men who paid for sex in the last year, condom use at last paid sex was 67% (95%CI: 63-71%, Ns=62). Among men living with HIV who paid for sex, ART coverage (PR=1.0, 95%CI: 0.9-1.1, Ns=6) and VLS (PR=1.0, 95%CI: 0.9-1.1, Ns=7) were similar to those who did not pay for sex.

Conclusion: Men who pay for sex are 60% more likely to be living with HIV than men who have never paid for sex. Prevention efforts focusing on this key population should be sustained and strengthened. Such initiatives could be important to reduce overall HIV incidence.

View Poster PDF

To combat the HIV Epidemic, the concept of pre-exposure prophylaxis (PrEP) has gained considerable traction since demonstrating efficacy in 2012 and approval in Canada in 2016. Unfortunately, this HIV prevention method has not been taken up ubiquitously by those most at risk for many reasons, including difficulty in accessing care. Innovation, and necessity during the COVID pandemic, has increased the use of technology with new care models providing 100% of PrEP care virtually.

This presentation will focus on the impacts and early findings of Freddie, a novel and entirely virtual PrEP care model in Canada focused on gender and sexual minority communities. This online health program connects those most at risk of HIV transmission with affirming prescribers across multiple provinces to break down physical and social barriers to PrEP initiation and ongoing use.

Presenters will discuss the innovative components of Freddie’s virtual care model, explore findings as they relate to PrEP uptake and initiation by speaking to its initial successes and challenges, as well as how it addresses PrEP access barriers in Canada. This includes Freddie’s focus on LGBTQ2S+ Canadians who are known to be at higher risk of HIV and historically have faced extraordinary barriers accessing sexual health care in inclusive settings. The intervention explored in this presentation continues to address such barriers through an innovative and accessible care model.

View Poster PDF

Background
The legacy of civil war in Northern Uganda continues to impact health and wellbeing, despite cessation of hostilities in 2006. Syndemic HIV and mental illness are a consequence of war-related traumas; yet, little is known about longer-term impacts following the immediate post-conflict period.

Methods
Cango Lyec (Healing the Elephant) cohort involves conflict-affected populations in mid-Northern Uganda. Individuals aged 13-49 at baseline returned for two follow-ups. Longitudinal data (2011-2015) were collected on socio-demographics, war-related experiences, mental health, and sexual vulnerabilities. Cox proportional hazards regression models were applied separately to those free of probable depression (n=1929) and of probable PTSD (n=1877), respectively, at baseline.

Results
We observed 99 incident cases of depression and 65 of PTSD, over two rounds of follow-up; 54 individuals developed both outcomes. Incidence of depression and PTSD were 27.4 (95%CI:22.2-33.5) and 17.3 (95%CI:13.3-22.2) per 1,000 person-years, respectively. Living with HIV was associated with incident depression (aHR:1.97;95%CI:1.13-3.41) but not PTSD. Other factors associated with incident depression included: older age (aHR:1.04;95%CI:1.01-1.07); PTSD (aHR:15.30;95%CI:8.51-27.54); suicide ideation (aHR:11.27;95%CI:6.43-19.75); attempted suicide (aHR:2.84;95%CI:1.45-5.56); ill health without medical care (aHR:2.18;95%CI:1.33-3.58); and genital ulcers (aHR:2.06;95%CI:1.11-3.80). Associations with incident PTSD included: having lived in ≥2 camps (aHR:2.62;95%CI:1.12-3.45); visiting ones’ home community <1 time per month (aHR:2.62;95%CI:1.31-5.24); depression (aHR:2.67;95%CI:1.39-5.14); rape or sexual abuse (aHR:2.84;95%CI:1.35-5.96); and suicide ideation (aHR:16.98;95%CI:9.68-29.78).

Conclusion
We observed high incidence of probable depression and PTSD, despite time that has passed since the end of war in Northern Uganda. Lack of access to medical care and negative health outcomes, including HIV/STIs, were associated with depression, indicating need for wholistic care responding to both physical and mental health and wellbeing. Disconnection from home communities and sexual violence were associated with PTSD, highlighting importance of land-based cultural healing programs that address legacy of war on land tenure and socioeconomic conditions, contributing to predation.

View Poster PDF

Background: Resiliency is associated with improved health outcomes for people living with HIV (PLWH). Our objective assessed the impact of vulnerability, stigma and trauma during the coronavirus pandemic on PLWH’s resiliency.

Methods: The Ontario HIV Treatment Network Cohort Study is a community-driven, multi-site clinical cohort of PLWH. A COVID-19-specific module was added to the virtual interviewer-administered questionnaire between May-December 2020. Composite variables examined correlations between subpopulations with perceptions of vulnerability to COVID-19, HIV stigma in healthcare compounded by COVID-19, trauma (traumatic reoccurring thoughts) and resiliency (positive adaptation), chi-square tests were performed.

Results: Analysis includes 1153 participants: 273 women (32% White, 57% Black) and 880 men (69% White, 11% Black). Median age 53, 66% identifying as gay/lesbian/bisexual/queer. More women than men believed PLWH had increased chances of catching COVID-19 (52%-vs.-42%, p=0.015) and that PLWH are more likely to be denied a ventilator (28%-vs.-12%, p<0.001). More men than women (85%-vs.-72%, p<0.001) believed PLWH would not receive equivalent care. 68% believed PLWH were more likely to get seriously ill with COVID-19 (p>0.05 by sex). Women reported significantly more trauma (more than once a week) about: the loss of family/friends (38%-vs.-25%), past experiences of isolation (18%-vs.-11%), dying (19%-vs.-10%), people lost due to HIV/AIDS (10%-vs.-6%). Resiliency was high including: employed creative ways to alter difficult situations (74%), controlled their reactions (81%) and believed they could grow in positive ways by dealing with difficult situations (87%). Among people perceiving stigma, there was a greater experience of trauma (45%-vs.-31%, p<0.001). Among people experiencing trauma, there were greater perceptions of vulnerability (74%-vs.-66%, p=0.012) and stigma (28%-vs.-18%, p<0.001).

Discussion: Despite feeling vulnerable, perceiving stigma in healthcare, and experiencing traumatic recurring thoughts, PLWH reported strong resiliency beliefs and behaviours. Resiliency during crisis is a powerful resource in fostering positive adaptation among PLWH and could be essential for effective psychosocial interventions.

View Poster PDF

Background: Ontario’s laboratory-based HIV surveillance utilizes laboratory record linkage and clinician reported test history to determine whether a person is retesting or learning their status for the first time. In 2017-18, 31% of first-time HIV diagnoses were missing data on race/ethnicity and 47% were missing data on test history. Accounting for missingness allows for more accurate reporting of first-time HIV diagnoses in Ontario.

Methods: We modelled average annual first-time HIV diagnoses in 2017-18 by accounting for the rate of out-of-province diagnoses and test history missingness by sex and race/ethnicity. Information from initial HIV test and follow-up clinician reporting for positive HIV cases was used to assess re-test vs. first-time diagnosis status based on completed test history. If no test history is indicated, a diagnosis could be inaccurately categorized as a “first-time” diagnosis. Missing race/ethnicity was modelled by applying the proportions of race/ethnicity by sex among known cases, assuming data missing at random. Missing test history was modelled by applying the proportions of previous positive test history by race/ethnicity, sex and year. Sensitivity analyses (range) included assuming 100% or 0% of diagnoses missing test history would have indicated a previous positive test.

Results: There were 649 (488-687) estimated average annual first-time HIV diagnoses in Ontario in 2017-18; 533 (410-557) among males and 115 (86-128) among females. White males accounted for the largest number of first-time HIV diagnoses-254 (188-262), followed by Black males-95 (70-103), Black females-62 (49-73), East/Southeast Asian males-60 (47-62), Latin American males-55 (45-59) and White females-35 (25-36). All other counts by sex and race/ethnicity each represented less than 5% of first-time HIV diagnoses.

Conclusions: For the first time in Ontario, we modelled a more accurate number of first-time HIV diagnoses by race/ethnicity which accounted for missing data. Understanding first-time HIV diagnoses by race/ethnicity and sex better informs targeted prevention programs.

View Poster PDF

Supervised injection services (SIS) help prevent HIV infection among people who use drugs by providing a space to use pre-obtained drugs and access to sterile injection equipment and health and social services. Due to public controversy regarding SIS, organizations may benefit from conducting feasibility studies to capture stakeholder views to inform their implementation process. However, research shows feasibility studies can be challenging to conduct if participants are hesitant to provide opinions because they lack basic knowledge regarding SIS or have mixed views. In our experience with three SIS feasibility studies, participants remained hesitant to offer their opinions even after hearing verbal descriptions and seeing pictures of SIS. These experiences led us to pilot test the use of “grounding aids,” or tools, objects, and methods used before qualitative data collection to provide research participants with knowledge and experience of SIS to improve their ability and willingness to offer their opinions. In a SIS feasibility study for a specialty HIV hospital conducted in 2019, we introduced focus group (n=70) and interview participants (n=8) to three grounding aids, the focal point of which was a physical mock-up of an SIS (i.e., that they could walk through and touch), and we evaluated the pilot by asking for their opinions about this experience. Participants were less hesitant overall sharing opinions about SIS than in our previous feasibility studies where we did not employ grounding aids and generally agreed that they did not perceive these tools as an effort by researchers to sway their opinions regarding SIS. Future studies evaluating SIS and other controversial facilities may want to consider using grounding aids to reduce participant hesitancy to express their opinions and improve research on concerns related to the implementation of SIS, a valuable tool that reduces HIV infection rates among people who use drugs.

View Poster PDF

Introduction: HIV is the second leading cause of death among young people globally and adolescents are the only group where HIV mortality is not declining. A rise in new HIV infections in the MENA since 2001 has placed it among the regions with the fastest growing HIV epidemic globally. In Canada, the number of newcomers from the MENA is expected to increase rapidly between 2006 and 2031 and more than triple in the next 25 years. Canadian MENA youth bear a disproportionate burden of STIs including HIV due to war displacement, poverty and homophobia. There is a major gap in sexual health services to this vulnerable group. Objective: Funded by the Canadian Institutes of Health Research (CIHR), the purpose of this scoping review is to identify epidemiological HIV risk factors and underlying risk context for youth residing in or originating from MENA. Methods: Bibliographic databases were searched from 1990 to 2019 to identify HIV risk factors among youth aged 16 to 29 residing in or originating from the MENA and scoping review methods were used. Results: Screening of 5,853 citations resulted in 57 studies from 18 MENA countries. “Risk behaviours” themes, included: overlapping risky behaviours among youth who inject drugs, lack of access to HIV testing, condomless sex, multiple sex partners among young men who have sex with men , and overlapping risk behaviours among young sex workers. “Challenges” included: peer pressure, inhibition about discussing sexual health, limited sex education, low condom use, and lack of access to HIV prevention services, especially testing. Conclusion: Scarcity of rigorous studies limit what is known about HIV epidemiology among MENA youth. Homophobia, transphobia, stigma around drug use, and illegal status of sex work promote risk behaviours. In Canada, a need for developing culturally-relevant resources and interventions for this emerging youth community is paramount.

View Poster PDF

Background
Mycoplasma genitalium (MG) infection causes persistent/recurrent urethritis and may contribute to HIV transmissibility. Screening is not routine; test availability is limited. Population-based prevalence data are lacking. We estimated MG prevalence and examined related correlates among GBM.

Methods
Using respondent-driven sampling (RDS), we recruited cisgender and transgender men, ≥16 years, sexually active, and residing in greater Montreal. Participants completed a computer-assisted self-interview and HIV/STI testing. Pharyngeal samples were collected by research nurses, urine and rectal samples by participants. Specimens collected at cohort study visits between 11/2018-11/2019 were analyzed using Allplex™ CT/NG/MG/TV Assay,Seegene Inc. Correlates of MG were identified using logistic regressions and Akaike information criteria (AIC) for model selection. All estimates are RDS-II-adjusted.

Results
Specimens from a total of 717 participants were analyzed. The RDS-adjusted prevalence (95% CI) of MG infection at rectal, urethral, pharyngeal, and at least one anatomical site was: 3.0 (1.5-4.5), 1.9 (0.7-3.1), 0.5 (0.2-0.9), 4.7 (2.9-6.6), respectively. The RDS-adjusted prevalence (95% CI) (at least one site) of Neisseria gonorrhoeae (NG), Chlamydia trachomatis (CT) and Trichomonas vaginalis (TV) infection were: 5.2 (3.3-7.2), 2.4 (0.6-4.2) and 0.5 (0.1-0.8), respectively. Correlates of MG infection are summarized (Table 1).

Conclusions
Prevalence of MG (at least one site) was twice the level of CT infection and comparable to the level of NG infection. This finding and the information on various correlates (younger age, a greater number of sexual partners and recent CT infection but not HIV status or PrEP use), may be useful for the development of MG screening guidelines.

View Poster PDF

Background

We investigated temporal trends (2003-2019) in HCV treatment uptake and efficacy, injection behaviours, and access to harm reduction services among HIV-HCV coinfected people who inject drugs (PWID) in Canada to identify gaps that need to be addressed for reaching HCV elimination by 2030.

Methods

We used data from the Canadian Coinfection Cohort (N=2,004). We included 1,090 participants who injected at least once over 2003-2019. Trends were examined using three time periods based on HCV treatment guidelines: 2003-2010: interferon/ribavirin-based; 2011-2013: first-generation direct-acting antivirals (DAAs); 2014-2019: second-generation DAAs. The harm reduction services assessed include needle and syringe programs (NSP), opioid agonist therapy (OAT), and supervised injection sites (SIS), for which data were available from 2014 to 2019.

Results

Median age at cohort entry was 44 years (69% male; 33% Indigenous). HCV treatment uptake and efficacy increased substantially from 2003-2010 to 2014-2019 (Table). The frequency of cocaine injection decreased from 84% of visits (2003-2010) to 57% (2014-2019), and opioid injection increased from 50% to 60% over time. Reported needle/syringe sharing declined from 12% (2003-2010) to 5% (2014-2019). Paradoxically, reported NSP use also decreased, potentially reflecting fewer daily injections due to reduced cocaine use. OAT engagement among opioid users was low and 9% of participants accessed SIS over 2014-2019.

Conclusions

HCV treatment access and outcomes have improved among coinfected PWID. Yet, exposure to injection-related risks continues and is increasingly related to opioid use. Maximizing access to proven harm reduction strategies to prevent HCV re-infection and overdose, and ultimately achieve HCV elimination, is required.

View Poster PDF

Context: PrEP, available and free of charge in France, is gaining popularity among gbMSM, but is still
underused in this at-risk population.

Objective: To investigate factors that predict PrEP use among an eligible sample (PrEP users vs. non-users).

Methods: Data was collected through an online questionnaire completed by 10,853 French participants (Net
Gay Barometer, 2018). Amongst 8,411 HIV-negative gbMSM and trans people living in France, 3,251 (38.7%) were considered eligible to PrEP according to French guidelines, out of which 445 (13.7%) were already PrEP users. Univariate and multivariate logistic regression were used.

Results: Although similar in many aspects to other eligible participants, PrEP users tend to engage in riskier sexual practices with their casual male partners than their non-user counterparts. Our multivariate model accounted for nearly 53% of the variance of the probability to take PrEP when eligible (pseudo-R2=0.53). After controlling for their more advantageous sociodemographic profile, it seems that concerns with HIV prevention and a high perceived efficacy of PrEP to protect against HIV are key predictors of PrEP use.

Conclusion: The proportion of gbMSM and trans people eligible to PrEP that do not use it is high. In the context where PrEP is free in France and will soon be made accessible through general practitioners, efforts must be made to recommend it to these people. PrEP use appears to be associated with more abundant and diverse sexuality and a higher prevalence of STIs. PrEP follow-up facilitates early detection and prompt treatment of STIs, when treatment is available.

View Poster PDF

Background: A unique initiative in Canada and internationally, Correctional Service Canada implemented an Overdose Prevention Service (OPS) at Alberta’s Drumheller Institution June 24th 2019; first inmate participated 10th July. Goals of service include: prevention of overdoses; facilitating entry into psychosocial and drug-treatment services; reduction in needle sharing and in HIV and HCV transmission.
This paper reports on the acceptability of the service from the perspectives of the Institution’s inmates.
Methodology: Following informed consent, confidential anonymous semi-structured interviews held with: inmates currently accessing OPS; inmates who had applied and awaiting approval; Chairs of the Inmate Committee; and inmates who wanted to express an opinion on the service.
Results: OPS used 798 times by 30 individuals July 10th 2019 - 28th February 2020. Significant outcomes include (i) Reduction in needle-sharing: OPS participants compared benefits of sterile equipment distribution with previous experiences of attempting to obtain needles: “I no longer have to trust that someone else’s needle is clean”; “A clean needle. I don’t use a dirty rig no more – a jail rig.”; “It’s a safe place. It’s supervised. It’s not in the cells, not in the units.”; (ii) Inmates shared their perception that OPS a catalyst in removing stigma around drug use and had opened up discussions around responding to addiction issues: “OPS has made people aware of addiction, its normalising and we’re talking about addiction”; “Now OK to admit that I have an addiction, not a secret anymore”; “It’s bringing the problem of addiction to the surface”; “Addiction was previously looked negatively upon…… The problem of addiction can now be responded to”.
Conclusion: Demonstrated HIV- and HCV-related harm reduction health benefits and movement towards addressing and responding to addiction as a health issue in a safe clinical environment augur well for the ongoing Pan-Canadian scale up of this novel intervention.

View Poster PDF

Background:
Since the start of Canada’s COVID-19 pandemic, challenges in delivering sexually transmitted and blood-borne infection (STBBI) prevention, testing and treatment services, including harm reduction services have been reported. A national survey was conducted to describe the impact of the pandemic on the ability to provide STBBI-related services.

Methods:
From November to December 2020, an anonymous online survey was conducted among community-based organizations, public health units and other service providers who directly deliver STBBI services in Canada. Information collected included how service delivery and demand for services were impacted during the pandemic. Preliminary results are presented.

Results:
416 service providers participated from across the country. Demand for services and ability to provide services varied by type of service (Table 1). Almost 40% of service providers noted an increased demand for harm reduction and drug treatment services, while 66.3% noted a decrease in the demand for STBBI prevention and testing services. Almost half (44.0%) of service providers noted a decreased ability to deliver STBBI prevention and testing services. Of service providers that provided remote services prior to the pandemic, 45.5% reported increases in demand for these services, while 36.6% increased their ability to provide such services. 66.1% of service providers created new remote services as a result of the pandemic.

Conclusions:
The decreased ability to provide testing will need to be considered when interpreting STBBI trends in 2020-21. Development of new remote services demonstrates service providers’ resilience and innovation to pivot delivery models to meet the challenges created by the pandemic.

View Poster PDF

Background
Psychiatric illness was a major barrier for HCV treatment during the interferon (IFN) era due to medication-related neuropsychiatric side effects. While direct acting antivirals (DAA) are better tolerated, patient-level barriers to treatment initiation persist. We assessed the effect of depressive symptoms on time to HCV treatment initiation among HIV-HCV co-infected persons during the IFN (2003-2010) and second-generation DAA eras (2013-2020).

Methods
We used data from a multicentre prospective cohort, the Canadian Co-infection Cohort and its associated food security sub-study. We developed marginal structural Cox proportional hazards models with inverse weighting for competing risks (death) to assess effect of predicted depressive symptoms on time to treatment initiation among HCV RNA+ participants. Depressive symptoms were predicted by a random forest classifier derived using the Center for Epidemiologic Studies Depression Scale-10. Exposure misclassification was addressed using predictive value-based record-level correction.

Results
We included 535 and 1,127 participants, from the IFN and DAA eras respectively, with 51% and 64% reporting depressive symptoms at baseline. Treatment initiation rates increased from 9 (95%CI:8-11) to 21 (95%CI:19-22) per 100 person-years. Results (Table 1) indicate lower treatment initiation among those with depressive symptoms compared to those without in the IFN era and higher initiation among those with depressive symptoms in the DAA era, with effect attenuation after misclassification correction.

Conclusions
Depression may no longer be a barrier to HCV treatment in the DAA era. The relatively higher rates of treatment initiation in patients with depressive symptoms suggest those previously unable to tolerate IFN are now accessing treatment.

View Poster PDF

Background: The association between body mass index (BMI) and viral load (VL) suppression and rebound among people living with HIV (PLHIV) remains inconclusive; however studies suggest individuals with higher BMI experience better virological response and that sex may be a potential effect modifier. This study explored the association of baseline BMI with time to VL suppression and rebound among PLHIV by sex in the Canadian HIV Observational Cohort (CANOC).

Methods: Data were obtained from CANOC which includes treatment-naïve individuals initiating cART between 2000-2016. Participants ≥18 years with ≥12 months clinical follow-up, baseline CD4 and VL recordings and ≥2 consecutive follow-up CD4 and VL measurements were eligible. Baseline BMI was recorded within 90-days before or after cART initiation and stratified into underweight (<18.5 kg/m2), normal (18.5-24.9 kg/m2), overweight (25-25.9 kg/m2), obese (>30 kg/m2), and no BMI recording. VL suppression was defined as ≥2 consecutive VL measures <200copies/mL. VL rebound was defined as ≥2 consecutive VL measures >200copies/mL after VL suppression. Multivariable Cox proportional hazards modelling examined the associations overall and by sex and adjusted hazard ratio (aHR) and 95% confidence intervals (CI) were reported.

Results: Of the 11,238 eligible participants (83% men), 2% were underweight, 17% were normal, 9% were overweight, 3% were obese and 70% had no BMI recording. Compared to women with normal BMI, obese women (aHR1.34,95%CI:1.05,1.70) were more likely to achieve VL suppression, however no association was seen among men. Overweight men were less likely to experience VL rebound compared to men with normal BMI (aHR0.69,95%CI:0.55,0.86).

Conclusions: We found that obese women were more likely to achieve VL Suppression compared to women with a normal baseline BMI, but this association was not seen among men, suggesting sex is an effect modifier. However, BMI is likely one element in a multitude of inter-related factors that can influence virologic response.

View Poster PDF

Introduction
Changes in combination antiretroviral therapy (cART) treatment guidelines have occurred over time. By 2015, consensus was reached: all people living with HIV (PLWH) should be prescribed cART regardless of CD4 count. This study aimed to examine trends in cART utilization, CD4 cell counts, and viral loads among PLWH from 2000 to 2016.

Methods
PLWH were included in CANOC if (1) aged ≥18 years on naïve initiation of cART on or after January 1, 2000, (2) initiated cART consisting of 3+ antiretroviral medications, (3) resided in Canada, and (4) at least one plasma viral load and CD4 count within one year of initiating cART. Baseline CD4 counts were categorized as <100, 100-299, 300-500, >500 cells/mm3 yearly and by province. Similarly, viral load was categorized as supressed (<50 copies/mL), low (≥50 and <200 copies/mL), and high detectable (≥200 copies/mL) yearly and by province. cART regimen type was classified by third agent and reported yearly and by province.

Results
All 13 040 CANOC participants were included. Overall, 27% and 42% of PLWH had baseline CD4 <100 and 100-299 cells/mm3, respectively, in 2000 compared to 13% and 26% in 2016. In terms of mean viral load, 11% and 22% of PLWH were suppressed and low in 2000, respectively, compared to 83% and 6% in 2016. From 2000-2003 and 2014-2015, non-nucleoside reverse transcriptase inhibitors was the most common 3rd agent class whereas protease inhibitors were most common from 2004-2012. In 2016, integrase inhibitors became the most common. Similar trends were seen among individuals living in British Columbia, Ontario, and Quebec.

Conclusion
Substantial improvements in immunological and virologic responses have been observed among CANOC participants from 2000 to 2016, in line with evolving guidelines. Also in line with recommendations and the release of new agents, 3rd agent cART class evolved over time.

View Poster PDF

Background
Resource allocation and planning among people living with HIV (PLWH) can be facilitated, in part, by population-based descriptions of HIV-related healthcare utilization. Using linkages of data housed at the British Columbia Centre for Excellence in HIV/AIDS (BC-CfE), the BC Centre for Disease Control (BCCDC), and the BC Ministry of Health, we describe HIV-related testing, outpatient physician visits, and hospitalizations in BC.

Methods
The Seek and Treat for Optimal Prevention (STOP) of HIV/AIDS Study is composed of population-based linkages between HIV-related clinical and treatment data from the BC-CfE, HIV testing data from the BCCDC, and provincial administrative health datasets. HIV-related physician visits (defined by ICD-9 and ICD-9-CM diagnostic codes, Medical Services Plan) and hospitalizations (ICD-9 and ICD-10-CA, Discharge Abstract Database) were identified between April 1-1996 and March 31-2017. Tabulations of HIV-related testing, outpatient physician visits, and hospitalizations are presented.

Results
At any point between April 1-1996 and March 31-2017, 47% (7,344 of the 15,599 PLWH in BC) had a positive HIV test result recorded at the BCCDC. Among the 7,344 people with a positive HIV test, 4,346 (59%) had a single positive test and 2,998 (41%) had one positive test and at least one prior negative test. Of the 15,599 PLWH, 86% of people had at least one HIV-related physician visit and 73% of all HIV-related visits were with general practitioners. Lastly, 58% of people had at least one HIV-related hospitalization over the period. Overall, the most responsible diagnosis for HIV-related hospitalizations was for the management of one (or more) manifestations of HIV followed by cellulitis then pneumonia.

Conclusion
Describing HIV-related healthcare utilization increases our understanding of the burden of HIV in BC. However, given the nature of secondary data, administrative coding may over- or under-estimate tabulations. Further descriptions of healthcare utilization, particularly over time, are needed among PLWH.

View Poster PDF

Background: GetCheckedOnline, BC’s internet-based testing program for HIV, Hepatitis C, and other sexually-transmitted infections, launched in Vancouver in 2014 and expanded in 2016 to six additional communities in Interior and Island Health regions. We sought to measure post-expansion awareness and identify associated factors among gay, bisexual, and other men who have sex with men (gbMSM).

Methods: Sex Now 2019 was an online health survey of gbMSM aged ≥15 years in Canada. BC residents were asked questions related to GCO implementation outcomes. Participants were categorized by Forward Sortation Area into regions with sites offering GetCheckedOnline, by health authority (i.e., Greater Vancouver, Island, Interior, and all other regions of BC). We used logistic regression modelling including all significant factors to quantify associations with awareness and report adjusted odds ratios and 95% confidence intervals (AOR [95%CI]).

Results: Among BC participants (n=1500, median age: 40 years), 33.5% were aware of GetCheckedOnline. Compared with awareness among Greater Vancouver participants (36%, n=336/932), Island participants were more aware (50%, n=77/155, AOR=2.49 [1.56-4.02]), Interior participants were similar (40%, n=18/45, AOR=1.60 [0.69-3.68]) and other BC regions were less aware (17%, n=47/269, AOR=0.45 [0.29-0.70]). Greater GetCheckedOnline awareness was also associated with identifying as queer (AOR=1.50 [1.05–2.13]), being out to healthcare providers (AOR=2.12 [1.33–3.43]), using ≥3 geolocation-based sex-seeking apps (AOR=1.95 [1.32–2.91]), and past-year involvement in LGBTQ-specific activities (AOR=1.53 [1.09–2.17]). Awareness was lower among participants who had never tested previously (AOR=0.21 [0.07–0.55]) and who usually tested through their family doctor (AOR=0.53 [0.35–0.81]).

Conclusion: Awareness of GetCheckedOnline was highest in areas where it was available and promoted. Increasing GetCheckedOnline promotion to gbMSM who are not out to their healthcare provider, do not usually test at sexual health clinics, or are less connected with LGBTQ communities may improve program reach.

View Poster PDF

Background: Gay, bisexual and other men who have sex with men (GBM) bear a disproportionate burden of HIV and STIs in Canada. We examined racial/ethnic differences in HIV, bacterial STIs, and related behaviors among GBM in Montreal (M), Toronto (T), and Vancouver (V).
Methods: Using baseline data from the Engage cohort study (N=2,449; 440 self-reported living with HIV), a respondent-driven sampling (RDS) study of GBM in MTV, we compared RDS-adjusted proportions of laboratory-confirmed HIV, STIs (syphilis, gonorrhea, and chlamydia), preventive- behaviors (HIV/STI testing: never/ever, within 6 months; and PrEP use, within 6 months) and risk-behaviours (sero-discordant condomless anal sex: SDCAS, within 6 months), by 9 racial/ethnic categories (white, Black, Latino/Latinx, East/Southeast Asian, Indigenous, South Asian, West Asian/North African, Unidentified/Others, and Mixed race/ethnicity) within-city (white as reference) and between-cities using non-parametric tests for unequal sample sizes and low cell counts.
Results: Montreal recruited the highest number of non-white GBM (RDS-adjusted 50%) followed by Vancouver (29%) and Toronto (22%). Differences by race/ethnicity within-city as well as across cities were observed. For example, HIV prevalence among West Asian/North African (3.9%) was lower compared with white GBM (15.9%; p=.02) in Montreal, but higher (50.5% vs. 23.9%; p=.02) in Toronto. Black GBM were less likely to report SDCAS in Toronto (11.2% vs. 41.1%; p=.004) and in Vancouver (15.2% vs. 44.5%; p=.001), but more so in Montreal (59.2% vs. 37.5%; p=.01). Regarding HIV testing, Black GBM were more likely to report testing in Toronto (79.9% vs. 49.4%; p=.01) and in Vancouver (96.6% vs. 57.3%; p=.002) than white GBM.
Conclusion: HIV, STI prevalence, preventive, and risk-behaviours differ by race/ethnicity within-city as well as between-cities in the three largest cities of Canada. Despite limited statistical power related with low cell counts for some ethno-racial categories, findings suggest local, culturally-grounded, targeted efforts for diverse ethno-racial GBM are needed.

View Poster PDF

Objectives:Hepatitis C (HCV) therapy has evolved from interferon and ribavirin-based treatment to more effective and safer direct-acting antiviral (DAA) regimens, offering a promising way to control the epidemic. In British Columbia (BC), DAAs are publicly funded; however, treatment uptake has reportedly remained low; thus, the objectives of this study are to assess access to HCV treatment uptake in a population-based cohort of people living with HIV (PLWH) and HCV.

Methods: We utilized data from the Seek and Treat for Optimal Prevention of HIV/AIDS cohort of PLWH diagnosed between April 1996 and March 2017 in BC, Canada. PLWH aged ≥ 19 years old who were diagnosed with HCV were included in this analysis with provincial HCV treatment data available from 2003-2016. We used logistic regression to model odds of HCV treatment uptake by key characteristics.

Results: A total of 3318 HCV-positive PLWH were included in the study; 900 (27.1%) were women, 2681 (80.8%) had a history of injection drug use, and 746 (22.5%) were men who have sex with men. A total of 723 (21.8%) participants received HCV treatment at least once over the study period; 426 (12.8%) ever received interferon-based treatment, 41 (1.2%) received early DAAs, and 371 (11.2%) received modern DAAs in 2015 or later, of which 94.6% achieved SVR-12. In the multivariate model, women had lower odds of ever having received HCV treatment [aOR=0.74, 95% CI=0.60-0.90], as did people with a history of injection drug use [aOR=0.78, 95% CI=0.63-0.97], after controlling for age and health authority.

Discussion: Our findings indicate that women and PLWH with a history of injection drug use were less likely to be treated for HCV. The needs and realities of women and people who use drugs must be considered in health service delivery to ensure equitable care and treatment for all PLWH and HCV.

View Poster PDF

Introduction: With the approval of Canada’s first HIV self-test in November 2020, there is an urgent need to identify the degree to which HIV self-testing (HIVST) can be supported by front-line agencies to reach key populations. This survey examined service provider knowledge of HIVST, their perspectives on access, usability, supports and barriers for HIVST in Canada, and the potential impact on HIV services in the context of COVID-19.

Methods: REACH Nexus conducted an anonymous national survey of individuals involved in frontline work for HIV support, treatment and care from all 10 provinces (n = 308) from August 6, 2020 to September 1, 2020. The survey was distributed through email to those who registered for a series of webinars on self-testing hosted by REACH Nexus.

Results: 32% of respondents thought they were well informed about HIV self-testing, however reporting varied by province. Survey respondents believed ordering through online (37%) and mobile platforms (26%) was the preferred method of accessing HIVST kits. Approximately 60% of the respondents thought that clients would be comfortable connecting with front-line workers or peers through a telehealth platform. Most thought that HIVST kits should be offered alongside linkage to counselling (98%), or prevention services such as pre-exposure prophylaxis (PrEP) (94%). A large majority (86%) of survey respondents indicated that HIVST should cost under $20.00 CAD, and 86% indicated that governments should pay for HIVST. Survey respondents believed that COVID-19 significantly reduced uptake in HIV testing services, PrEP, and HIV counselling.

Conclusions: These findings highlight the need for use of technology and telehealth-based solutions to reach key populations, and for HIV self-testing to be affordable and/or accessible through government subsidies or insurance. Supports are needed to ensure front-line agency and organizational readiness for HIV self-testing in Canada.

View Poster PDF

Background: Estimating trends in national HIV incidence among key populations can provide a more accurate picture of the epidemic and help to tailor the development and evaluation of prevention programs.

Methods: The estimated annual number of new HIV infections among gay, bisexual and other men who have sex with men (gbMSM), people who inject drugs (PWID) and heterosexuals was estimated using the bespoke Canadian HIV modelling approach. The model back-calculates HIV incidence from HIV surveillance data on diagnosed cases from each jurisdiction across Canada and from data on the HIV testing behaviour of these populations.

Results: Annual estimated new HIV infections among gbMSM increased sharply from the beginning of the HIV epidemic, peaking in 1983 (3,870). After a steady decrease down to approximately 750 infections per year between 1994 and 1998, the average number of estimated new infections among gbMSM ranged between 1,000 and 1,100 per year from 2000 to 2018. Annual new HIV infections among PWID increased moderately from the beginning of the epidemic and peaked in 1993 (841), followed by a decrease to 241 in 2013. However, since 2013, the number of new infections among PWID has increased by 55.3% (372 in 2018). Annual estimated new HIV infections among heterosexuals increased slowly from the beginning of the epidemic and peaked in 2003 (945), then decreased until 2013 (500). The number of new HIV infections among heterosexuals increased by 52.5% since 2013 (761 in 2018).

Conclusion: The historical trends of annual estimated HIV infections among key populations varied, showing peaks at different times during Canada’s HIV epidemic. In recent years, the estimated number of new HIV infections has been relatively stable among gbMSM but has increased among PWID and heterosexuals. These estimates can provide evidence to more effectively monitor the HIV epidemic in Canada and to guide prevention programs.

View Poster PDF

Understanding HIV incidence and prevalence by jurisdiction allows public health and policy makers to monitor trends and inform planning of HIV prevention and care services.

The Canadian HIV model generated estimates of annual HIV incidence for each jurisdiction. HIV prevalence was calculated as cumulative incidence plus diagnosed cases who moved into a jurisdiction minus diagnosed cases who moved out of a jurisdiction and estimated total mortality among people living with HIV (PLHIV). Each jurisdiction provided input data for the model (surveillance data, death counts, and migration estimates. Data from Saskatchewan, Alberta, and the Territories were not included.

The 2018 estimated HIV incidence rates ranged from 2.4 per 100,000 (Atlantic Provinces) to 8.1 per 100,000 (Quebec). Manitoba (6.0 per 100,000) and Ontario (5.8 per 100,000) had similar rates compared to the national level (6.0 per 100,000), while British Columbia’s (BC) rate was lower, at 3.3/100,000. The highest proportion of incident cases (47.6%) in Manitoba was attributed to heterosexual sex. In contrast, gay, bisexual and other men who have sex with men (gbMSM) made up the majority of incident cases (50.8% to 64.2%) in the remaining provinces.

Estimated HIV prevalence varied across the country: Quebec and BC were the highest (202 and 195 per 100,000, respectively), while Ontario (164 per 100,000) had a rate similar to the national level (167 per 100,000). Manitoba’s prevalence was lower than the national rate (138 per 100,000), and the Atlantic provinces were the lowest at 60 per 100,000. Approximately half of PLHIV (51.0% to 54.4%) in most provinces were gbMSM, while over half of PLHIV (59.5%) in Manitoba were among people who reported heterosexual sex only.

HIV incidence and prevalence, including among key populations, varied by jurisdiction across Canada. These estimates help guide prevention programs and monitor progress towards ending the impact of HIV in Canada.

View Poster PDF

Background
Availability and public funding of pre-exposure prophylaxis (PrEP) for HIV may vary by provincial policies in Canada. We conducted a prospective longitudinal study to assess trends and correlates of PrEP awareness and use among gay, bisexual and other men who have sex with men (GBM) in Vancouver, Toronto and Montreal.

Methods
Sexually-active GBM, aged ≥16 years, were recruited through respondent-driven sampling (RDS) from February 2017 to August 2019. Participants completed a Computer-Assisted Self-Interview to assess PrEP awareness and use. Analyses were limited to HIV-negative GBM with data collected to March 2020. We used generalized estimating equations accounting for two levels of clustering (RDS recruitment chain; participant) to evaluate temporal trends (monthly prevalence) of awareness and past six-month usage of PrEP among HIV-negative participants. Multivariable models were built to identify correlates of PrEP awareness and use and used backward selection to minimize QIC.

Results
We recruited 2008 HIV negative GBM (N=622 from Vancouver, N=418 from Toronto, and N=968 from Montreal). Awareness of PrEP increased significantly in all three sites: Montreal, 81.2% during the first 6-month period to 91.4% during the last 6-month period (p<0.001); Toronto, 94.2% to 96.6% (p=0.036) Vancouver, 90.2% to 98.3% (p<0.001). Use of PrEP also increased significantly in all three sites: Montreal, 14.2% during the first 6-month period to 39.3% during the last 6-month period (p<0.001); Toronto, 21.4% to 31.4% (p<0.001); Vancouver, 21.7% to 59.5% (p<0.001). Multivariable models also found that GBM in Vancouver had greater odds of PrEP awareness (aOR=1.94 95%CI=1.32-2.87) and PrEP use (aOR=2.05, 95%CI=1.60-2.63) compared to GBM Montreal; results from Toronto were not significantly different from Montreal.

Conclusions
PrEP awareness was very high among GBM in all three cities, but uptake was much higher in Vancouver. Full public funding and active health promotion for PrEP in BC may have accounted for these differences.

View Poster PDF

Introduction. Kenya has one of the largest HIV epidemics in the world. Although HIV incidence in Kenya has shown signs of recent decline, more targeted interventions are needed for key populations, including female sex workers (FSWs), to decrease incidence further. One approach is to target interventions at geographic ‘hotspots’ where FSWs meet their clients. In order to inform such approaches, we aimed to understand heterogeneity in the distribution of HIV prevalence by hotspots and by residence within Nairobi.

Methods. Data were collected as part of enrolment in the Sex Workers Outreach Program (SWOP) in Nairobi, Kenya from 2014 to 2017. Median age of FSWs was 29 years (IQR: 24-35), with a median of 5 clients (IQR: 3-10) in the previous week. The geographic unit of analysis was constituency (n=17); thus, hotspots and residences were aggregated to the constituency level. Inequality in the geographic distribution of HIV prevalence by sex work hotspot and residence was measured using the Gini coefficient; coefficient scores range from 0 to 1, with a score closer to 1 indicating perfect inequality. 95% confidence intervals (95% CI) were generated using 1000 bootstrapped estimates in Stata.

Results. A total of 11,899 FSWs were included. Overall HIV prevalence was 16%, with a range between 7%-52% between the constituencies. The Gini coefficient was 0.41 (95%CI: 0.25-0.58) for hotspot constituency, indicating a high degree of heterogeneity in the distribution of HIV prevalence. Approximately 55% of HIV positive FSWs worked in 4 constituencies. In contrast, constituency of residence had a Gini coefficient of 0.08 (95% CI: 0.06-0.10), suggesting minimal heterogeneity by residence.

Conclusion. HIV prevalence in FSW is heterogeneous by place of work within Nairobi. As HIV declines in Kenya, tailoring interventions to FSWs at highest HIV risk becomes increasingly important, in order to reduce HIV incidence toward UNAIDS 2030 targets.

View Poster PDF

Objective: Advances in the availability and effectiveness of antiretrovirals during pregnancy has led to a significant reduction in perinatal HIV transmission. Recent guideline changes suggest that initiating antiretrovirals prior to conception can lead to an overall negligible risk of transmission. Achieving this possibility necessitates that all women living with HIV know their HIV status prior to pregnancy. In this study, we aimed to determine the proportion of women in Ontario diagnosed with HIV prior to conceiving and to identify the timing of HIV diagnoses made during pregnancy.

Methods: A retrospective population-level cohort study was performed using linked health administrative databases at ICES and the Ontario HIV database to establish maternal HIV status and timing of HIV diagnosis. All women living with HIV in Ontario who gave birth between April 2006 and March 2018 were included and demographics were assessed. Additionally, our sample was stratified into three-year intervals to assess trends in diagnosis timing across years.

Results: Our findings demonstrate a significant proportion of women living with HIV (87.9%) were diagnosed prior to pregnancy. Among diagnoses of HIV made during pregnancy, the majority (55%) occurred in the second trimester.

Conclusion: Using an Ontario perspective, we highlight the importance of diagnosing HIV prior to pregnancy rather than relying on prenatal HIV screening during the first or second trimester, which is typically the standard of care globally. We call for a global strategy to aid with pre-conception screening for women of reproductive age and specifically for women at high risk for HIV.

View Poster PDF

Objectives: To describe demographics, antiretroviral treatment during pregnancy, and vertical transmission (VT) rates in the Canadian perinatal HIV surveillance cohort of births to women living with HIV (WLWH) and to assess the impact of COVID-19 on access to optimal therapy and transmission.

Methods: 23 Canadian pediatric and HIV centres report data yearly, including maternal characteristics, pregnancy combination antiretroviral treatment (cART) and infant outcome. Data from each province is entered in January. The results reported in this abstract will reflect 2019 but will be updated to include 2020 results on presentation.

Results: The number of HIV exposed infants each year has increased over time, with 249 infants born in 2019. In 2019, 34% came from Ontario, 20% from Alberta, 16% from Quebec, 12% from Saskatchewan, 10% from BC and 8% from Saskatchewan; 58% were black, 20% were indigenous, and 13% were white; 63% of women acquired HIV heterosexually, 14% through injection drug use (IDU) and 2.4% perinatally, and 18% were of unknown origin; the proportion of pregnant WLWH receiving less than 4 weeks of continuous cART prior to birth was 2.8%.

Since 2015, there have been 1-5 infants (average=3.2) confirmed infected with HIV; VT dropped from 15% in 1997 to 0.4% in 2019. The proportion of pregnant WLWH receiving less than 4 weeks was 5.7% in 2019, (average of 6.5% over the last 5 years).

Conclusions: VT rates of HIV in Canada remain very low. There continues to be a substantial proportion of WLWH who were on suboptimal cART, thus increasing the probability of transmission. Barriers to adequate access to cART may have been amplified by the COVID-19 pandemic in 2020.

Objectives
The recently changed Canadian policy as of May 2019 is to defer GBM from donating blood if they have engaged in oral or anal sex with another man in the past 3 months. We examined attitudes among HIV-negative GBM toward time-deferral based policies and potential behaviour-based policies.
Methods
The Engage cohort study used respondent-driven sampling (RDS) to recruit GBM who reported sex with another man in the past six months in the three largest cities in Canada: Montreal, Toronto, and Vancouver. These data are from the 1-yr follow-up (May 2019-Dec 2020) of Engage with HIV-negative GBM (n=1062), where questions were asked about the acceptability of blood donation policy options/alternates, and willingness to comply with each policy.
Results
Although 69.5% of HIV-negative GBM would comply with a 3-month blood donation deferral policy, only 9.9% of GBM would donate blood under the current time-based deferral. Only 20.3% of men agreed that the new 3-month deferral policy was acceptable and only 9.9% agreed that they would be willing to abstain from sexual activity for 3 months in order to donate blood. Half (52.6%) agreed that sexually active HIV-negative men on PrEP should be eligible to donate blood. Approximately 37.8% agreed that HIV-negative men who have sex with HIV-positive partners with an undetectable viral load should be eligible to donate blood. A smaller proportion (15.3%) agreed that men living with HIV who have an undetectable viral load should be able to donate blood.
Conclusion
Our quantitative findings extend previous qualitative research showing low acceptability and interest in donating blood under the current 3-month deferral policy. Health Canada should consider adopting behaviour-based policies that do not require complete abstinence from sexual activity, such as policies that already exist in the UK and Italy.

View Poster PDF

Background: Consistent with the Canadian Drug and Substance Strategy and approaches to harm reduction, Correctional Service Canada implemented a prison-based needle exchange program (PNEP) in June 2018. The objectives of the program are to reduce the sharing of non-sterile needles, to provide opportunities for health teaching and treatment, to reduce HIV and HCV transmission, and to reduce the incidence of skin infections related to drug use.

Program Elements: Participation in PNEP is voluntary. The program builds on a Threat and Risk Assessment (TRA) model that has proven successful in managing medical sharps in the correctional environment (insulin cartridges, lancets and EpiPens®). The TRA process ensures that security staff are able to assess and mitigate potential security risks in the units.

Participants sign a contract outlining program expectations and are issued a “PNEP kit” which includes a sterile syringe and needle, a sterile mixing cup, filters, sterile water, and vitamin C. PNEP kits and consumables are exchanged at health services as required.

Progress: Following an initial launch at two sites, by Dec 2020 PNEP was available at 11 sites (5 women’s and 6 men’s). As of October 2020, 185 inmates have expressed interest in the program (24, or 13% wanted information only). Of these 6 were streamed into alternate treatment programs. Of 130 TRA completed, 112 (86%) were supported via the TRA. Of the 112, 38 were active participants and 9 (8%) had left the program for alternate treatment programs.

Conclusions: While barriers remain to program implementation across the country, PNEP is a viable harm reduction program in CSC in order to reduce the sharing of non-sterile needles and prevent HIV/HCV transmission. In addition, by facilitating non-judgemental clinical discussions on drug use in healthcare, PNEP has been successful at streaming patients with addictions into alternate modes of care.

View Poster PDF

Background:
Experiences of stigma among people living with HIV (PLWH) are pervasive; however, there is limited data on whether experiences change with age and HIV lived experience. We sought to examine whether PLWH diagnosed in different treatment eras experience varying levels of self-reported HIV-related stigma.

Methods:
Between January 2016 to September 2018, we used purposive sampling to enrol PLWH aged ≥19 years across British Columbia (BC) into the STOP HIV/AIDS Program Evaluation (SHAPE) study. Participants completed an HIV-related health questionnaire which included the 10-item Berger HIV Stigma Scale, with higher scores indicating higher perceived HIV stigma. We conducted bivariate analyses between key sociodemographic characteristics and HIV stigma. Multivariable linear regression modelled the association between year of diagnosis by treatment era (defined as pre-1996, 1996-1999, 2000-2009, and 2010-present) and mean HIV stigma score.

Results:
We enrolled 644 participants with a median age at enrolment of 50 years (Q1-Q3:42-56). The median age at diagnosis was 34 years (Q1-Q3:27-40) with 37.4% (n=241) diagnosed before the year 2000. The mean HIV stigma scores (Q1-Q3:13-25; range:0-40) stratified by treatment era was: 17.6 (pre-1996), 19.2 (1996-1999), 19.9 (2000-2009), 19.1 (2010-present). In unadjusted analyses, year of HIV diagnosis by HAART era was associated with higher HIV stigma scores (p-value=0.03) but was not associated in adjusted analyses controlling for age, gender, HIV risk group, ethnicity, and ever having a mental health disorder diagnosis.

Conclusion:
We did not find that HIV stigma scores varied by era of treatment engagement, suggesting that HIV-related stigma remains a problem even for PLWH diagnosed in recent years. However, our results may be confounded by the relative older age of this cohort, who may have additional protective factors that contribute to living longer with HIV.

View Poster PDF

In 2012, pre-exposure prophylaxis (PrEP) was approved as an HIV-prevention intervention. PrEP is a highly effective strategy for reducing the risk of HIV acquisition, particularly in populations at high risk of contracting the virus. In 2015, the World Health Organization released treatment guidelines recommending PrEP for all populations at substantial risk of HIV infection. While several countries and jurisdictions cover the cost for PrEP, barriers to access remain and influence the potential impact on the number of new HIV infections. In this integrative review of 48 studies, we explored the current barriers and facilitators to PrEP access among 11 key populations. The barriers included stigma, lack of PrEP knowledge, cost, side effects, PrEP compliance and adherence, low-risk perception, provider barrier, medication mistrust, and shame. The facilitators that can mitigate PrEP access barriers included cost, availability of a healthcare provider and insurance, knowledge and trusted source of information about PrEP, safer sexual practices, side effects, availability of services, and social support. Lastly, we provided potential interventions and recommendations that stakeholders and decision-makers can utilize to advance practice guidelines and health policies that will improve PrEP access among high-risk populations in Canada.

View Poster PDF

Background: Antipsychotics, i.e. first generation (FGA) dopamine D2 antagonists or second-generation (SGA) dopamine D2 and serotonin 5HT-2 antagonists, are mainstays in treatment of psychotic disorders. Yet, treatment pathways among people living with HIV (PLWH) is not well understood. Our objective was to characterize treatment trajectories in a population-based cohort of PLWH with incident psychosis.

Methods: We utilized data from the Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) cohort, identifying all PLWH (aged ≥19) between April 1996 and March 2017 in British Columbia. We assessed the uptake of antipsychotics between April 1998 and March 2017, including the proportion of individuals receiving first prescription from the time of psychosis diagnosis, and proportion of people who advanced to second prescription. Further, time to prescription was assessed.

Results: We identified 613 PLWH with incident psychosis, who were primarily male 446 (72.8%). Median age at psychosis diagnosis was 42 (Q1, Q3: 35, 49). A total of 486 (79.3%) received their first prescription,
within a median of 21 days after diagnosis; the majority of whom were on quetiapine (n=157; 32.3%). Of these who received first prescription, 303 (62.3%) advanced to second prescription, a median of 217 days later; the majority were on risperidone (n=91; 30.0%). Table 1 describes prescription trajectory by regimen.

Conclusion: Nearly three-quarters of PLWH are dispensed antipsychotics shortly after their psychosis diagnosis, the majority of which are advanced to second prescription almost six months later indicating the need to explore retention in care and potential for treatment failures.

View Poster PDF

Background: Cisgender (cis) and transgender (trans) women living with HIV (WLWH) experience numerous barriers to stable housing, with limited evidence available for developing safe housing programs. This study is the first to apply the Canadian Definition of Homelessness (CDOH) to the housing status reported by WLWH with the objective to investigate the prevalence and correlates of housing status.
Methods: This study was informed by a longitudinal community-based open cohort of cis and trans WLWH aged 14+. The main outcome of housing status was a four-category variable derived based on CDOH, and included the following categories, measured in the last six months: unsheltered, unstable, supportive housing, and stably housed (reference). The relationship between social-structural correlates and housing status were analyzed using bivariate and multivariable logistic regression models using generalized linear mixed model (GLMM) with random intercepts. Adjusted odds ratios (AOR) and 95% confidence intervals [95%CI] were reported.
Results: Our study followed 336 participants (1930 observations) in 2010-2019. At baseline, 24% participants were unsheltered; 47% had unstable housing; 12% stayed in supportive housing; 16% had their own stable housing. Our cohort includes disproportionately high representation of Indigenous (57%) and other racialized women (9%) compared to general population in BC. Multivariable analysis revealed that recent (last six months) hospitalization was associated with being unsheltered (AOR=4.89, 95%CI:2.64-9.04) and unstable housing (AOR=7.83, 95%CI:4.63-13.25); recent experience of violence was associated with being unsheltered (AOR=4.67, 95%CI:2.54-8.60) and unstable housing (AOR=3.00, 95%CI:1.75-5.12); recent stimulant use was associated with being unsheltered (AOR=2.73, 95%CI:1.59-4.69) and supportive housing (AOR=2.32 95%CI:1.42-3.76).
Conclusions: Complex social-structural inequities are associated with housing instability. In addition to meeting basic needs for living, future housing solutions for WLWH and other marginalized populations need to expand gender-responsive and trauma- and violence-informed principles, low-barrier requirements for membership, and strong connections with supportive harm reduction practices.

View Poster PDF

Background: Homelessness has been associated with limited access to HIV care and broader healthcare services in many populations. Limited research with cisgender (cis) and transgender (trans) WLWH has studied housing needs and its impact on healthcare access. Our study aims to examine the relationship between housing status and the HIV care continuum and broader healthcare access.
Methods: Data for this study came from a longitudinal community-based open cohort of cis and trans WLWH aged 14+. Outcomes measured in the last six months included: currently taking antiretroviral (ART), sub-optimal adherence (<95%), detectable viral load (>50 copies/mL), and being unable to access primary and dental care. ‘Housing status’ was the four-category explanatory variable aligned with the Canadian Definitions of Homelessness (CDOH). Bivariate and multivariable logistic regression models using generalized estimating equations (GEE) for repeated measures over time yielded adjusted odds ratios (AOR) and 95% confidence intervals [95%CIs] for the associations between housing and health outcomes.
Results: Our study included 336 participants (1930 observations) over ten years (2010-2019) of follow-up with disproportionate numbers of Indigenous (57%) and other racialized women (9%). At baseline, 82% reported currently on ART; among participants taking ART, 51% reported sub-optimal adherence and had detectable viral load, respectively; 16% were unable to access primary care; 26% were unable to access dental care. In multivariable analysis, being unsheltered was associated with not taking ART (AOR=2.11, 95%CI:1.33-3.36)), detectable viral load (AOR=1.86, 95%CI:1.29-2.67), and being unable to access primary care (AOR=2.06, 95%CI:1.20-3.55) and dental care (AOR=1.61, 95%CI:1.02-2.54).
Conclusions: Homelessness has substantial impacts on HIV outcomes and access to healthcare. Women’s healthcare models need to address social determinants of health, including housing, practice trauma- and violence-informed principles, and reduce structural inequities, in order to fulfill the basic right to housing and healthcare for all and improve women’s overall health and HIV outcomes.

View Poster PDF