Epidemiology and Public Health Oral Abstract Session #1
| Wednesday, May 5, 2021 |
| 2:30 PM - 4:00 PM |
Overview
Épidémiologie et santé publique séances de présentation orale d’abrégés #1
Speaker
Mr. Steven Winkelman
Practicum Student
Ontario HIV Treatment Network
At-Home HIV Self-Testing during COVID: Overview of the GetaKit Initiative in Ottawa
Abstract
Background: Access to HIV testing in Ontario continues to be limited as a result of COVID-19. However, people continue to engage in sexual contact with new partners, presenting the risk of increased HIV transmission. To close this gap, a team of nurses at the University of Ottawa and Ottawa Public Health and staff from Ottawa ASOs and the OHTN launched a mail-out HIV self-testing project.
Objectives: 1) To assess the feasibility and accessibility of an HIV self-test kit in the Ottawa region, and 2) to determine the impact of the GetaKit program on HIV diagnosis rates and linkage to care.
Methods: The research team obtained Health Canada’s Special Access approval April 23, 2020 to distribute bioLytical’s INSTI HIV self-test in Ottawa. The team received REB approval May 15, 2020. As of July 20, 2020, eligible participants (≥18 years old, HIV-negative, not on PrEP, not in a HIV vaccine trial, living in Ottawa, no bleeding disorders) could register via www.GetaKit.ca to order kits.
Results: As of December 2020, 825 persons completed the eligibility screener; 63.9% (n=527) were eligible. Of eligible participants, 275 completed baseline surveys and 259 ordered a test. Approximately 26% (n=68) of participants had no prior HIV testing or were unsure of testing history. Approximately 66% (n=171) of participants belonged to a priority group for HIV testing. We have results for approximately 70% (n=182) of participants who ordered a kit: none were positive, 143 were negative, 36 were invalid, and 2 “preferred not to say”. 61.3% (n=159) patients were referred for PrEP.
Conclusions: Our results show that HIV self-testing is an effective strategy to ensure access to HIV testing and prevention among regular and new testers. Lessons learned include the need for increased guidance on the self-collection of blood samples, ASO staff support, and flexible communication strategies for clients.
Objectives: 1) To assess the feasibility and accessibility of an HIV self-test kit in the Ottawa region, and 2) to determine the impact of the GetaKit program on HIV diagnosis rates and linkage to care.
Methods: The research team obtained Health Canada’s Special Access approval April 23, 2020 to distribute bioLytical’s INSTI HIV self-test in Ottawa. The team received REB approval May 15, 2020. As of July 20, 2020, eligible participants (≥18 years old, HIV-negative, not on PrEP, not in a HIV vaccine trial, living in Ottawa, no bleeding disorders) could register via www.GetaKit.ca to order kits.
Results: As of December 2020, 825 persons completed the eligibility screener; 63.9% (n=527) were eligible. Of eligible participants, 275 completed baseline surveys and 259 ordered a test. Approximately 26% (n=68) of participants had no prior HIV testing or were unsure of testing history. Approximately 66% (n=171) of participants belonged to a priority group for HIV testing. We have results for approximately 70% (n=182) of participants who ordered a kit: none were positive, 143 were negative, 36 were invalid, and 2 “preferred not to say”. 61.3% (n=159) patients were referred for PrEP.
Conclusions: Our results show that HIV self-testing is an effective strategy to ensure access to HIV testing and prevention among regular and new testers. Lessons learned include the need for increased guidance on the self-collection of blood samples, ASO staff support, and flexible communication strategies for clients.
Dr. Trevor Hart
Professor
Ryerson University
Is PrEP associated with bacterial STIs among gay, bisexual and other men who have sex with men (GBM)? PrEP and sexual risk behaviours in Montreal, Toronto and Vancouver
Abstract
Background: Although Pre-Exposure Prophylaxis (PrEP) is a proven biomedical intervention to prevent HIV acquisition, GBM PrEP users may be more likely to engage in sexual behaviours that could lead to increased bacterial STIs. We examined the associations between PrEP use, CAS, MSP and laboratory-confirmed bacterial STI diagnosis among HIV-negative GBM living in Montreal, Toronto, and Vancouver.
Methods: Using the baseline data from the HIV-negative GBM in Engage (N=2,449), a cohort study of GBM recruited using respondent-driven sampling based study of GBM, we fit a structural mediation model (with weighted least squares means and variance-adjusted estimator) of the associations between any PrEP use (No/Yes) in the past 6 months (P6M), any multiple sex partners (MSP) in the P6M, any condomless anal sex (CAS) in the P6M, and any bacterial STI diagnosis (syphilis, gonorrhea, chlamydia) at the study visit. We estimated direct and indirect paths from PrEP use to STI via 1) CAS, and 2) MSP. Models were adjusted for age, race/ethnicity, income, marital status, sexual orientation, city and RDS-recruitment related clustering.
Results: Of 2,007 self-reported HIV-negative/unknown GBM, 18% reported PrEP P6M and 17% were diagnosed with a bacterial STI. The initial model without CAS and MSP demonstrated a direct effect of PrEP use to STI diagnosis (β=.15; p=.002). In the mediated model, the direct path from PrEP use was non-significant (β=.02; p=.75). The indirect path from PrEP use to STI via CAS was significant (β=.10; p=.003) and the indirect path via MSP was non-significant (β=.03; p=.34),
Conclusion: PrEP use may be associated with bacterial STI diagnosis partially because PrEP users may be more likely to engage in CAS than non-PrEP users. The results underscore the importance of providing counselling to PrEP users about bacterial STIs, and ongoing efforts to test PrEP users for bacterial STIs or consider bacterial STI PrEP/dual PrEP.
Methods: Using the baseline data from the HIV-negative GBM in Engage (N=2,449), a cohort study of GBM recruited using respondent-driven sampling based study of GBM, we fit a structural mediation model (with weighted least squares means and variance-adjusted estimator) of the associations between any PrEP use (No/Yes) in the past 6 months (P6M), any multiple sex partners (MSP) in the P6M, any condomless anal sex (CAS) in the P6M, and any bacterial STI diagnosis (syphilis, gonorrhea, chlamydia) at the study visit. We estimated direct and indirect paths from PrEP use to STI via 1) CAS, and 2) MSP. Models were adjusted for age, race/ethnicity, income, marital status, sexual orientation, city and RDS-recruitment related clustering.
Results: Of 2,007 self-reported HIV-negative/unknown GBM, 18% reported PrEP P6M and 17% were diagnosed with a bacterial STI. The initial model without CAS and MSP demonstrated a direct effect of PrEP use to STI diagnosis (β=.15; p=.002). In the mediated model, the direct path from PrEP use was non-significant (β=.02; p=.75). The indirect path from PrEP use to STI via CAS was significant (β=.10; p=.003) and the indirect path via MSP was non-significant (β=.03; p=.34),
Conclusion: PrEP use may be associated with bacterial STI diagnosis partially because PrEP users may be more likely to engage in CAS than non-PrEP users. The results underscore the importance of providing counselling to PrEP users about bacterial STIs, and ongoing efforts to test PrEP users for bacterial STIs or consider bacterial STI PrEP/dual PrEP.
Dr Rachael Milwid
Postdoc
McGill University
HIV Transmission Dynamics Among Gay, Bisexual, And Other Men Who Have Sex With Men In Montreal Between 1975-2017: A Mathematical Modelling Study
Abstract
Background
In 2017, Montreal became the first Canadian Fast-track city, adopting the goal of HIV elimination (zero new infections) by 2030. Gay, bisexual, and other men who have sex with men (gbMSM) are disproportionately affected by HIV. To inform elimination efforts, we describe how HIV transmission dynamics evolved among Montreal gbMSM over 1975-2017.
Methods
Key biobehavioural surveys were reviewed. The time-location Argus surveys (2005; n=1,957; 2008; n=1,873) were standardized to the respondent-driven sampling Engage survey (2017; n=1,179). We developed, parameterized, and calibrated (using an ABC-SMC algorithm) an agent-based model of HIV dynamics among gbMSM in Montreal. Partnership dynamics, HIV transmission/progression, and the scale-up of condoms, testing, treatment, and prophylaxis were modelled.
Results
The modelled incidence peaked in 1985 at 2.0% (90%CrI: 0.9-2.9%) and decreased to 0.2% (90%CrI: 0.02-0.4%) in 2017. Between 1975 and 2017, HIV acquisition was 5-11 times greater in the higher-activity group (>10 partners year^(-1)) than the lower-activity group (<5 partners year^(-1)) and 2-3 times greater among men aged 35-44 years than 15-24 years. Over 1990-2017, higher-sexual activity gbMSM transmitted ~90% of all HIV infections annually. Furthermore, the annual proportion of infections from those in the primary stage of infection increased from 12% (90%CrI: 5-22%) to 18% (90%CrI: 0-43%). Finally, our results suggest that between 1996-2017, among gbMSM living with HIV, the undiagnosed fraction was reduced from 73% to 5%, the untreated fraction from 60% to 4%, and the proportion who discontinued ART from 6% to 3%. Transmissions from those undiagnosed fell from 66% to 35% but rose among those who had discontinued ART at the time of transmission from 2% to 27%.
Conclusions
HIV incidence in Montreal has decreased to low levels with the strengthening of the HIV care cascade. HIV elimination, however, requires a focus on core subgroups and to address remaining prevention needs.
In 2017, Montreal became the first Canadian Fast-track city, adopting the goal of HIV elimination (zero new infections) by 2030. Gay, bisexual, and other men who have sex with men (gbMSM) are disproportionately affected by HIV. To inform elimination efforts, we describe how HIV transmission dynamics evolved among Montreal gbMSM over 1975-2017.
Methods
Key biobehavioural surveys were reviewed. The time-location Argus surveys (2005; n=1,957; 2008; n=1,873) were standardized to the respondent-driven sampling Engage survey (2017; n=1,179). We developed, parameterized, and calibrated (using an ABC-SMC algorithm) an agent-based model of HIV dynamics among gbMSM in Montreal. Partnership dynamics, HIV transmission/progression, and the scale-up of condoms, testing, treatment, and prophylaxis were modelled.
Results
The modelled incidence peaked in 1985 at 2.0% (90%CrI: 0.9-2.9%) and decreased to 0.2% (90%CrI: 0.02-0.4%) in 2017. Between 1975 and 2017, HIV acquisition was 5-11 times greater in the higher-activity group (>10 partners year^(-1)) than the lower-activity group (<5 partners year^(-1)) and 2-3 times greater among men aged 35-44 years than 15-24 years. Over 1990-2017, higher-sexual activity gbMSM transmitted ~90% of all HIV infections annually. Furthermore, the annual proportion of infections from those in the primary stage of infection increased from 12% (90%CrI: 5-22%) to 18% (90%CrI: 0-43%). Finally, our results suggest that between 1996-2017, among gbMSM living with HIV, the undiagnosed fraction was reduced from 73% to 5%, the untreated fraction from 60% to 4%, and the proportion who discontinued ART from 6% to 3%. Transmissions from those undiagnosed fell from 66% to 35% but rose among those who had discontinued ART at the time of transmission from 2% to 27%.
Conclusions
HIV incidence in Montreal has decreased to low levels with the strengthening of the HIV care cascade. HIV elimination, however, requires a focus on core subgroups and to address remaining prevention needs.
Mark Gilbert
Medical Director
BC Centre For Disease Control
Accessing needed sexual health service during the initial phases of the COVID-19 pandemic in British Columbia (BC)
Abstract
Background:
The COVID-19 pandemic impacts on sexual health services access have not been fully examined. We sought to identify factors associated with unmet sexual health needs and access barriers during BC’s initial phases of the pandemic.
Methods:
An anonymous online survey about sexual health service needs and access was administered from July 21-August 4, 2020 to clients ≥ 16 years old who had visited the BC Centre for Disease Control’s sexually transmitted infections (STI) clinic and/or GetCheckedOnline testing service in the year prior to March 2020. We used logistic regression to identify factors associated with unmet sexual health needs (i.e., not accessing needed services) during March–July 2020, and report unadjusted odds ratios (OR) with 95% confidence intervals [95% CI].
Results:
Of 1198 respondents, 59% (n=706; median age: 32 years, 71% White, 47% women, 27% men having sex with men only (MSM)) reported needing sexual health services since March 2020, of which 52% (365/706) did not access needed services. Women (OR=1.37 [1.01-1.86]) were more likely to have unmet sexual health needs, while MSM (OR=0.37 [0.23-0.61]) were less likely to. Participants needing routine STI testing were more likely to report not accessing services (OR=2.49 [1.64-3.79]), whereas those needing birth control (OR=0.48 [0.30-0.75]), HIV pre-exposure prophylaxis (OR=0.39 [0.22-0.66]), or treatment for a new STI (OR=0.40 [0.21-0.76]) were less likely to report not accessing services. Most common reasons for avoiding/delaying service access were: concern about getting COVID-19 while at or traveling to a clinic/lab (249/689, 36%), public messaging against seeking non-urgent healthcare (239/689, 35%), and closure of usual place of service (182/689, 26%).
Conclusion:
Many existing sexual health service clients in BC did not access needed sexual health services during the COVID-19 pandemic. Offering alternative service delivery methods and more nuanced public health messaging may help address the identified barriers to improve access.
The COVID-19 pandemic impacts on sexual health services access have not been fully examined. We sought to identify factors associated with unmet sexual health needs and access barriers during BC’s initial phases of the pandemic.
Methods:
An anonymous online survey about sexual health service needs and access was administered from July 21-August 4, 2020 to clients ≥ 16 years old who had visited the BC Centre for Disease Control’s sexually transmitted infections (STI) clinic and/or GetCheckedOnline testing service in the year prior to March 2020. We used logistic regression to identify factors associated with unmet sexual health needs (i.e., not accessing needed services) during March–July 2020, and report unadjusted odds ratios (OR) with 95% confidence intervals [95% CI].
Results:
Of 1198 respondents, 59% (n=706; median age: 32 years, 71% White, 47% women, 27% men having sex with men only (MSM)) reported needing sexual health services since March 2020, of which 52% (365/706) did not access needed services. Women (OR=1.37 [1.01-1.86]) were more likely to have unmet sexual health needs, while MSM (OR=0.37 [0.23-0.61]) were less likely to. Participants needing routine STI testing were more likely to report not accessing services (OR=2.49 [1.64-3.79]), whereas those needing birth control (OR=0.48 [0.30-0.75]), HIV pre-exposure prophylaxis (OR=0.39 [0.22-0.66]), or treatment for a new STI (OR=0.40 [0.21-0.76]) were less likely to report not accessing services. Most common reasons for avoiding/delaying service access were: concern about getting COVID-19 while at or traveling to a clinic/lab (249/689, 36%), public messaging against seeking non-urgent healthcare (239/689, 35%), and closure of usual place of service (182/689, 26%).
Conclusion:
Many existing sexual health service clients in BC did not access needed sexual health services during the COVID-19 pandemic. Offering alternative service delivery methods and more nuanced public health messaging may help address the identified barriers to improve access.
Dr Angela Kaida
Simon Fraser University (SFU)
Intention to Vaccinate and Key Population Membership for Early COVID-19 Immunization by HIV status among a Provincial Sample of Women and Gender Non-binary Individuals in British Columbia, Canada
Abstract
Background: Among people living with HIV (LWH), risks of SARS-CoV-2 infection and outcome severity may be driven by social disparities and comorbidities. The National Advisory Committee on Immunization considers such disparities in prioritizing key populations for early COVID-19 immunization. Among a provincial (BC) sample, we examined the distribution of social disparities, comorbidities, and intention to receive the COVID-19 vaccine by HIV status.
Methods: Individuals (25-69y) recruited from large province-wide research cohorts completed an online survey examining COVID-19 impacts (August 20-December 15, 2020). Among women and gender non-binary respondents, we measured disparities, comorbidities, and intention to receive a recommended COVID-19 vaccine (Very likely/Likely vs Neutral/Unlikely/Very Unlikely) by self-reported HIV status. Multivariable logistic regression assessed the independent effect of HIV status on vaccine intention.
Results: Of 5031 respondents (mean age=51 [SD=11]), 67 (1.33%) were LWH, of whom 82.1% were on antiretroviral therapy and 76.1% reported an undetectable viral load. Compared to those not LWH, individuals LWH were significantly more likely to identify as Black, Indigenous, or other People of Colour (41.8% vs 16.3%;p<0.0001), report a household income <$20,000/year (17.9% vs 2.2%;p<0.0001), and report living with ≥1 comorbidity in addition to HIV (82.1% vs 50.6%;p<0.0001). Respondents LWH and not LWH did not differ by age or essential worker employment (26.9% vs 32.3%;p=0.43). Intention to vaccinate was significantly lower among respondents LWH (67.2% vs 78.9%; p=0.017. OR:0.53; 95%CI:0.29-0.96). However, after adjustment for ethnicity, income, and comorbidities, LWH was not significantly associated with intention to vaccinate (Adjusted OR:0.90; 95%CI:0.49-1.64).
Conclusions: In adjusted analyses, HIV status was not associated with COVID-19 vaccine intention. However, only two-thirds of respondents LWH reported intending to vaccinate, despite a higher proportion belonging to populations prioritized for early COVID-19 immunization. An equity lens and better understanding of vaccine hesitancy are critical for prioritizing and promoting COVID-19 vaccine uptake among key populations.
Methods: Individuals (25-69y) recruited from large province-wide research cohorts completed an online survey examining COVID-19 impacts (August 20-December 15, 2020). Among women and gender non-binary respondents, we measured disparities, comorbidities, and intention to receive a recommended COVID-19 vaccine (Very likely/Likely vs Neutral/Unlikely/Very Unlikely) by self-reported HIV status. Multivariable logistic regression assessed the independent effect of HIV status on vaccine intention.
Results: Of 5031 respondents (mean age=51 [SD=11]), 67 (1.33%) were LWH, of whom 82.1% were on antiretroviral therapy and 76.1% reported an undetectable viral load. Compared to those not LWH, individuals LWH were significantly more likely to identify as Black, Indigenous, or other People of Colour (41.8% vs 16.3%;p<0.0001), report a household income <$20,000/year (17.9% vs 2.2%;p<0.0001), and report living with ≥1 comorbidity in addition to HIV (82.1% vs 50.6%;p<0.0001). Respondents LWH and not LWH did not differ by age or essential worker employment (26.9% vs 32.3%;p=0.43). Intention to vaccinate was significantly lower among respondents LWH (67.2% vs 78.9%; p=0.017. OR:0.53; 95%CI:0.29-0.96). However, after adjustment for ethnicity, income, and comorbidities, LWH was not significantly associated with intention to vaccinate (Adjusted OR:0.90; 95%CI:0.49-1.64).
Conclusions: In adjusted analyses, HIV status was not associated with COVID-19 vaccine intention. However, only two-thirds of respondents LWH reported intending to vaccinate, despite a higher proportion belonging to populations prioritized for early COVID-19 immunization. An equity lens and better understanding of vaccine hesitancy are critical for prioritizing and promoting COVID-19 vaccine uptake among key populations.
Mr. Tsegaye Bekele
Senior Lead, Research And Analytics
The Ontario Hiv Treatment Network
Increased Economic Hardship due to the COVID-19 Pandemic among Participants of the OHTN Cohort Study (OCS)
Abstract
Background: Public health measures introduced to combat the COVID-19 pandemic have resulted in increased economic hardship (i.e., loss of employment or reduction of work hours, loss of housing, or increased difficulty meeting basic needs of life) for people living with HIV in Ontario. We examined the characteristics of people living with HIV who experienced increased economic hardship due to the pandemic.
Methods: The OCS is a cohort of people receiving HIV care at 13 clinics across Ontario. Clinical data is collected through chart abstraction and linkage with the Public Health Ontario Laboratory database. Participants also complete an annual interviewer-administered questionnaire; since May 2020, questions were added to assess the economic and social impacts of the COVID-19 pandemic. We used multivariable logistic regression to identify demographic characteristics associated with increased economic hardship.
Results: Between May and December 2020, 1149 people (median age: 53 years) were interviewed. Most were men (76%), White (61%), born in Canada (63%), and gay/bisexual/lesbian/queer (67%). One-fourth (n=287) experienced increased economic hardship with significantly (p<0.05) higher percentage among women than men (30.7% vs. 23.1%) and among Latin American (38.9%), East Asian/South East Asian/South Asian (28.6%), and African/Caribbean/Black (28.1%) than White (21.8%) participants. In multivariable analyses, immigrant women were more likely to experience economic hardship (aPR=1.65, 95% CI: 1.08-2.53, p=0.021) than Canadian-born women; whereas, among men, gay/ bisexual/queer sexual identity was associated with higher odds (aPR=1.56, 95% CI: 1.04-2.35, p=0.033) and older age was associated with lower odds of economic hardship (aPR=0.74, 95% CI: 0.68-0.81, p<0.001).
Conclusions: Among people living with HIV in Ontario, immigrant women, younger men, and men who identified as gay, bisexual, or queer men experienced increased economic hardship due to the COVID-19 pandemic. Linking people experiencing economic hardship with available economic support programs should be considered as part of HIV care and services.
Methods: The OCS is a cohort of people receiving HIV care at 13 clinics across Ontario. Clinical data is collected through chart abstraction and linkage with the Public Health Ontario Laboratory database. Participants also complete an annual interviewer-administered questionnaire; since May 2020, questions were added to assess the economic and social impacts of the COVID-19 pandemic. We used multivariable logistic regression to identify demographic characteristics associated with increased economic hardship.
Results: Between May and December 2020, 1149 people (median age: 53 years) were interviewed. Most were men (76%), White (61%), born in Canada (63%), and gay/bisexual/lesbian/queer (67%). One-fourth (n=287) experienced increased economic hardship with significantly (p<0.05) higher percentage among women than men (30.7% vs. 23.1%) and among Latin American (38.9%), East Asian/South East Asian/South Asian (28.6%), and African/Caribbean/Black (28.1%) than White (21.8%) participants. In multivariable analyses, immigrant women were more likely to experience economic hardship (aPR=1.65, 95% CI: 1.08-2.53, p=0.021) than Canadian-born women; whereas, among men, gay/ bisexual/queer sexual identity was associated with higher odds (aPR=1.56, 95% CI: 1.04-2.35, p=0.033) and older age was associated with lower odds of economic hardship (aPR=0.74, 95% CI: 0.68-0.81, p<0.001).
Conclusions: Among people living with HIV in Ontario, immigrant women, younger men, and men who identified as gay, bisexual, or queer men experienced increased economic hardship due to the COVID-19 pandemic. Linking people experiencing economic hardship with available economic support programs should be considered as part of HIV care and services.
