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In addition to leading a number of ancillary events, researchers from the BC-CfE presented important findings at this year's CAHR Conference in Saskatoon—including several Peer Research Associates offering a community perspective. The 28th Annual Canadian Conference on HIV/AIDS Research is the premier gathering in Canada for those working in all disciplines of HIV/AIDS research, as well as policy makers, persons living with HIV and other individuals committed to ending the pandemic.

A full list of posters and presentations is available on our website. Listed below are just a few highlights of this year's exciting conference.

CANOC Update

Dr. Taylor McLinden, CANOC’s Postdoctoral Fellow at the BC-CfE presented an update on the largest longitudinal multi-province study of people with HIV on ART (antiretroviral therapy) in Canada. CANOC is comprised of over 11,000 participants and the study has enlisted people living with HIV on anti-retroviral therapy between 2000–2016. In the future, the study will leverage CANOC’s large sample size, considerable duration of follow-up and geographic representation to generate novel evidence to improve the clinical care of people living with HIV.

“What’s Race Got To Do With It?”

“What’s Race Got To Do With It?”, by BC-CfE Research Coordinator Gbolahan Olarewaju, looks at symptoms of anxiety and depression in Indigenous gay, bisexual and men who have sex with men (gbMSM) and gbMSM of colour in urban areas of Vancouver, Toronto and Montreal. Preliminary findings from the multi-site Engage Study confirm gbMSM differentially experience mental health challenges, but additional quantitative and qualitative research may help clarify how intersectional factors may be contributing to ethno-racial differences. Engage is a five-year Canadian collaboration between researchers (including from the BC-CfE and community-based organizations on HIV and sexual health among gay, bi, and queer men, including trans men and other men who have sex with men (gbMSM) in Canada.

Identifying HIV transmission risk factors, prioritizing health care

The BC-CfE’s extensive phylogenetic research introduces an alternative method to investigate HIV transmission risk factors in BC, based on patients’ viral diversification rates. Research presented at CAHR by the BC-CfE’s Angela McLaughlin suggests a high HIV diversification rate is positively associated with factors that include: being younger, using injection drugs, having hepatitis C virus and having a high recent viral load. In contrast, having ever had AIDS and identifying as black were both significantly associated with lower diversification rates.

By identifying risk factors associated with HIV transmission using the viral diversification rate among people living with HIV, the research provides a direction for more targeted treatment and prevention services for key groups. To add, HIV diversification rates can illuminate differences in individuals’ transmission activity.

Support programs in TasP

A cross-sectional analysis of women living with HIV in Canada amid growing awareness of the made-in-BC Treatment as Prevention strategy, presented by BC-CfE Research Coordinator Rebecca Gormley, finds even though many women living with HIV benefit from peer-led programs, few studies focus on peer leaders. The Undetectable=Untransmittable (UequalsU) campaign, based on principles of TasP. Within the context of the campaign, researchers assessed the prevalence of peer leadership engagement and whether it is associated with knowledge of HIV prevention benefits of an undetectable viral load with sustained ART, using survey data of 1,422 women living with HIV.

High rates of experiences of violence among women living with HIV in Canada

In Canada, approximately 80% of women living with HIV report experiencing violence in adulthood, according to research presented by BC-CfE Research Coordinator Rebecca Gormley and Peer Research Assistant Valerie Nicholson. Experiences of violence compromise mental health, impede engagement in HIV care and deter active participation in social and health advocacy. Support for women experiencing violence is critical, but little is known about factors associated with help-seeking among women living with HIV. Despite a high prevalence of violence among women with HIV in Canada, fewer than half seek support. Women who experienced mental health challenges, injection drug use, childhood violence and everyday sexism had higher odds of help-seeking, suggesting that women with co-occurring or syndemic health challenges may seek support for violence through existing support services. Care delivery models should incorporate trauma and violence aware care approaches.

Social support key to lowering HIV treatment interruption

Avenues for social connectivity are increasingly important for people living with HIV (PLWH). Previous research has not adequately evaluated how social support may improve clinical outcomes in addition to known psychosocial benefits, according to research presented by Tim Wesseling, a Peer Research Associate with the BC-CfE SHAPE Study. SHAPE investigates the relationship between social support and antiretroviral therapy (ART) treatment interruptions (TIs) among PLWH in BC. Among PLWH on ART in BC, social support is negatively associated with TIs. Since social support is integral to promoting social, emotional and physical well-being, findings suggest the importance of considering and evaluating interventions that foster social support for achieving optimal ART adherence in this setting. Future research must consider social support success factors among specific population groups.

The impact of loneliness and stigma on older adults living with HIV

Half of individuals living with HIV who are on treatment in BC are aged 50 or older. Similar trends are seen throughout North America. As BC-CfE Clinical Research Advisory Dr. Marianne Harris presented loneliness and stigma are common experiences for older adults with HIV and required and assessment of their impacts on cognition and emotional health. The associations between loneliness, stigma, cognition, and mental health are complex. While this analysis cannot sort out “causal” relationships, the results support that HIV-related stigma and loneliness both have negative consequences for cognition and emotional health. Interventions should be developed to engage people in socially meaningful activities and reduce consequences of stigma.

BC-CfE researcher receives New Investigator Award!

Congratulations to Jinny Choi who received CAHR’s New Investigator Award! At CAHR, Choi presented her work on “The impact of geographic location on HIV viral suppression and mortality among people who use injection drugs.” She also spoke to her work in knowledge translation and community engagement through Snack Chat. These low-barrier research chats are held regularly at Vancouver’s Dr. Peter Centre, in order to communicate research findings back to the community. A very well-deserved recognition of some great research initiatives!

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Monday, May 13, 2019
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In addition to leading a number of ancillary events, researchers from the BC-CfE presented important findings at this year's CAHR Conference in Saskatoon—including several Peer Research Associates offering a community perspective. The 28th Annual Canadian Conference on HIV/AIDS Research is the premier gathering in Canada for those working in all disciplines of HIV/AIDS research, as well as policy makers, persons living with HIV and other individuals committed to ending the pandemic. 

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BC-CfE Researcher Angela McLaughlin presents phylogenetic research at CAHR 2019.
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The 28th Annual Canadian Conference on HIV/AIDS Research is the premier gathering in Canada for those working in all disciplines of HIV/AIDS research, as well as policy makers, persons living with HIV and other individuals committed to ending the pandemic. The conference, also known as CAHR 2019, will be held May 9th-12th, 2019.

Would you like to know more about any of this research? If so, please reach out to Caroline Dobuzinskis, BC-CfE Communications Coordinator, at cdobuzin (at) cfenet.ubc.ca.

PRESENTERS TOPIC SESSION No. PDF
Orals
Angela McLaughlin Epidemiological Correlates of HIV Phylogenetic Diversification Rate in British Columbia EPH1.01
Silvia Guillemi High Levels Of Viral Suppression And Care Engagement Following Rapid Access To Antiretroviral Therapy (ART) Upon HIV Diagnosis CS1.05 N/A
Hanwei Sudderuddin Evolution of Nef-mediated CD4, HLA and SERINC5 Downregulation Activity over a Decade of Untreated HIV Infection: A Case Study BS2.02 N/A
Marianne Harris Loneliness and Stigma Impact Cognitive Function and Mental Health among HIV+ Older Adults in the Positive Brain Health Now (PBHN) Study CS2.05
Katrina Koehn Investigating Use of Home and Community Care Services Among Older Adults Living with HIV in British Columbia, Canada CS2.07 N/A
David Moore Trajectories of Frequent Methamphetamine Use Among HIV Positive and Negative Gay, Bisexual and Other Men Who Have Sex with Men (gbMSM) in Vancouver EPH2.05 N/A
Ji Hyun (Jinny) Choi Snack Chat: a Low-barrier, Community Knowledge Translation Series that Bridges the Gap Between Research and Research Users in an Aids Support Organization SS2.05 N/A
Valerie Nicholson and Rebecca Gormley Help-seeking After Experiences of Violence Among Women Living with HIV in Canada: What are We Missing? SS2.08 N/A
Andrea Bever Prospective Changes in Clinical Outcomes Among People Living with HIV Who Have Previously Achieved Virologic Suppression EPH3.07 N/A
Megan Marziali Relationship Between Social Isolation and Mortality Among People Living with HIV in British Columbia, Canada EPH3.08 N/A
Gbolahan Olarewaju What’s Race Got To Do With It?: Symptoms of Anxiety and Depression in Indigenous gbMSM and gbMSM of Colour in Vancouver, Toronto, and Montreal SS3.03
Megan Marziali Predictors of Social Isolation Among People Living with HIV in British Columbia, Canada SS3.04 N/A
Valerie Nicholson and Krista Shore “I found my voice”: Acts of Resilience and Resistance to the Criminalization of HIV Non-disclosure Among Women Living with HIV in Canada SS4.04 N/A
Bradley Jones Characterizing Latent HIV Sequences in CD4+ Subsets in Individuals on Long-term cART BS4.05 N/A
Posters
Jeffrey Joy A Phylogenetic Approach to Prioritizing HIV Transmission Clusters BSP9.07
Beverly Allen The impact of integrase strand inhibitors on creatine kinase levels in antiretroviral naive people living with HIV CSP2.06
Beverly Allen Comparison of dolutegravir and elvitegravir based antiretroviral therapy for antiretroviral naive people living with HIV CSP2.07
Marianne Harris Global Deficit Score (GDS) in Persons Living with HIV (PLHIV) and Mild Neurocognitive Disorder (MND) CSP6.01
Mark Hull Men Who Have Sex with Men (MSM) Prefer Self-Collection of Samples for Sexually Transmitted Infections (STI’s) at a Vancouver Sexual Health Clinic EPHP1.09
Junine Toy One Year of Population-Based HIV Pre-Exposure Prophylaxis (PrEP) in British Columbia (BC): Program Uptake and Participant Characteristics EPHP2.02
Mark Hull Prescribers of HIV Pre-Exposure Prophylaxis (PrEP) in British Columbia (BC) in the First Year of the Provincial Program EPHP2.05
Tim Wesseling Social Support is Associated with Lower Likelihood of HIV Treatment Interruptions in British Columbia, Canada EPHP4.01
Leo Rutherford HIV Status Disclosure During Sex: A Longitudinal Event-Level Analysis of Gay, Bisexual and other Men who have Sex with Men (GBM) EPHP4.04
David Moore Examining differential success in participant recruitment using respondent-driven sampling (RDS) in a Canadian multi-site study of gay, bisexual and other men who have sex with men (gbMSM) EPHP5.03
Mia Kibel Mental Health Diagnoses in a Population-based Cohort of People Living with HIV EPHP5.06
Mark Hull Hepatitis C knowledge and treatment willingness in individuals admitted to the Urban Health Unit, St. Paul’s Hospital, Vancouver EPHP6.08
Jinny Choi The Impact of Geographic Location on HIV Viral Suppression and Mortality among People Who Use Injection Drugs EPHP7.01
Katrina Koehn Aging with HIV vs. Aged with HIV: Profiling adults diagnosed with HIV after age 50 in British Columbia EPHP7.03
Taylor McLinden The Canadian Observational Cohort (CANOC): Canada's largest multi-province study of people living with HIV on antiretroviral therapy EPHP7.04
Nathan Lachowsky Recreational Sports League Participation and Impacts Among Gay, Bisexual, and Other Men Who Have Sex With Men in Metro Vancouver SSP13.04
Graham Berlin Chemsex Complications: Sexual health knowledge, access and behaviours for HIV-positive and HIV-negative sexual minority men who use crystal methamphetamine SSP16.04
Rebecca Gormley Is peer leadership engagement associated with awareness of the HIV prevention benefits of ART? A cross-sectional analysis of women living with HIV in Canada in the UequalsU era SSP9.01
Marcus Greatheart Cardiovascular Disease among Bear-identified Gay, Bisexual, and other Men who have Sex with Men (gbMSM) in Vancouver: Notice to Family Doctors SSP14.08
Date 
Wednesday, May 8, 2019
1
Excerpt 

The 28th Annual Canadian Conference on HIV/AIDS Research is the premier gathering in Canada for those working in all disciplines of HIV/AIDS research, as well as policy makers, persons living with HIV and other individuals committed to ending the pandemic. The conference, also known as CAHR 2019, will be held May 9th-12th, 2019.

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In April, the BC-CfE was honoured to host Dr. Steffanie Strathdee, Associate Dean of Global Health Sciences at the University of California, San Diego, to share her enthralling account of saving her own husband from a superbug—a bacteria pan-resistant to antibiotic treatment.

Using her training as an epidemiologist, Dr. Strathdee identified a potential tool for treatment commonly known as phages. The microscopic limbed creatures live in bacteria-ridden environments (yes, that means sewers), and are technically viruses that can destroy bacteria.

Working with other researchers and health care providers, Dr. Strathdee garnered approval from the US Food and Drug Administration to provide the innovative, experimental treatment to her husband, Dr. Tom Patterson. At the time, he was in a coma and holding on to life “by a thread”, said Strathdee. The phage treatment was seen as a Hail Mary pass (from a blind quarterback, said one doctor); nonetheless, Tom recovered. He may be the first person in the US to be successfully cured of a systemic multi-drug-resistant bacterial infection with cocktails of intravenous bacteriophages.

Drs. Strathdee and Patterson wrote their story in a new book, The Perfect Predator: A Scientist’s Race to Save Her Husband from a Deadly Superbug. The case captured international attention in the scientific community, with mentions in journals like JAMA and The Lancet. Intravenous phage treatment is now being used on a case-by-case basis to help others recover from bacterial infections, when antibiotics offer no recourse.

While Dr. Strathdee is now known as the “Superbug Slayer” due to her superhuman efforts to help her husband, the main focus of her impressive body of research has been HIV. It was at the BC-CfE that she got her start, working with researchers such as Drs. Julio Montaner and Robert Hogg. Her early work identified a major outbreak of HIV among injection drug users in Vancouver, despite the presence of one of North America’s largest needle exchange programs. In 1998, she published a study in JAMA showing only half of medically eligible drug users living with HIV in Vancouver were receiving antiretroviral therapy. Her work helped support advocacy for expanded access to both harm reduction services and HIV treatment.

In addition to her leadership role at UC San Diego, Dr. Strathdee continues to investigate HIV prevention in marginalized populations. For instance, alongside her husband, she leads several studies on HIV risk behaviours among drug users and sex workers in Tijuana, Mexico.

We are grateful to Dr. Strathdee for taking the time to recount her fascinating story to staff at the BC-CfE.  

Date 
Thursday, May 9, 2019
1
Excerpt 

In April, the BC-CfE was honoured to host Dr. Steffanie Strathdee, Associate Dean of Global Health Sciences at the University of California, San Diego, to share her enthralling account of saving her own husband from a superbug—a bacteria pan-resistant to antibiotic treatment. 

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Local youth interventions address HIV knowledge gap

There is a generation gap when it comes to knowing and understanding HIV prevention. Young gay and bisexual men and other men who have sex with men (YGBM) in BC are less likely to be aware of some HIV prevention and treatment options compared to older men, according to a recently published BC-CfE study.

The study looked at two Vancouver-based leadership programs for youth—MPowerment and Totally Outright. Both programs were found to be effective in increasing education around HIV prevention and treatment. Youth who participated in these programs were more likely to have a higher level of awareness of how HIV medications can be used. Specifically, youth who participated had higher levels of awareness of PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis), and held more treatment optimism (meaning they felt positively that HIV treatment could help prevent new HIV infections).

Awareness of and access to HIV treatment is an important part of HIV prevention. On sustained and consistent HIV antiretroviral treatment, an individual can achieve an undetectable viral load—at which point they cannot transmit HIV to others. This is the concept supporting the Treatment as Prevention (TasP) strategy in BC. Undetectable equals Untransmittable (U=U) is a campaign stemming from TasP, and based on its principles, to end stigma against those living with HIV. The aim of the campaign is to spread awareness that people living with HIV who take their medication as prescribed and have an undetectable viral load have effectively no risk of transmitting HIV to others.

PrEP is a daily oral antiretroviral medication that is highly effective in reducing new cases of HIV. PEP is an antiretroviral treatment provided following a possible HIV exposure in order to prevent infection. These game-changing prevention tools have been added to the Treatment as Prevention toolbox in BC, where they are available to medically eligible individuals at no cost to the patient.

The recent BC-CfE study, published in BMC Public Health, adds to mounting evidence showing education’s important role in ensuring HIV prevention strategies are being broadly accessed. Previous studies, such as a BC-CfE study published in the journal AIDS and Behavior, found YGBM who had low levels of awareness of PrEP also had less access to condoms and preferred receptive anal sex. These factors increase overall likelihood of contracting HIV.

In order to encourage informed decisions about sexual health through education and training, MPowerment and Totally Outright are tailored to young people in the LGBTQ community. These youth interventions build capacity at an individual and community level (more information about these programs below).

“Our study shows that spaces run by and for youth may be important avenues for effectively implementing sexual education not discussed within the educational system. With this in mind, it is important to look at ways in which schools and community groups can bridge the generational gap in HIV knowledge through education,” said Kalysha Closson, PhD Student and lead author on the study. “It is critical to ensure all in the LGBTQ community are engaged and aware of the HIV prevention resources available to them today.”

Across Canada, GBM continue to be disproportionately affected by HIV. There is still work to be done to empower YGBM to make informed decisions around their sexual health and wellbeing. Health service delivery should be implemented in spaces that are friendly to youth and LGBTQ individuals, supported by training for health care providers to serve as allies. The delivery of age-appropriate sexual health care and education could help reduce HIV transmission among youth.

“Sexual health education in schools, grounded in lived experiences, has the potential to improve attitudes and awareness towards HIV prevention and treatment,” added Closson. “If we are to continue to keep up momentum in reducing HIV transmission rates, we need to provide opportunities for YGBM to learn about the numerous HIV prevention strategies available to them.”

Further Information

Mpowerment is an evidence-based behavioral intervention developed at the University of California, San Francisco, in the early 2000s. Since 2012, this program has been implemented in Vancouver by YouthCO, a youth-led community-organization that works to reduce the impact of HIV stigma. YouthCO has adapted Mpowerment by incorporating values of anti-oppression and engaging a broader group of youth affected by HIV. Mpowerment is an HIV leadership program for queer and trans youth in Vancouver, the Fraser Region and Prince George. (www.youthco.org/mpowerment).

Totally Outright was launched in 2005 by the Community-Based Research Centre, a Vancouver-based non-profit organization working to strengthen health outcomes for gay and bisexual men. The program consists of a 40-hour leadership course to develop a corps of sex-savvy young gay and bisexual men. The aim is the program enable participants to educate others about sexual and mental health, HIV prevention (including seroadaptive strategies and harm reduction) and social justice issues.

For the research, as part of the BC-CfE’s Momentum Health Study, active gay and bisexual men (GBM) were recruited from February 2012 to February 2015. Participants completed an in-person computer-assisted self-interview every six months, up to February 2017, with questions on sociodemographic factors, awareness of biomedical HIV prevention strategies, and an HIV treatment optimism-skepticism scale. Participants were asked if they had ever attended either of two Vancouver-based HIV-leadership programs designed for youth who are gay and bisexual men (YGBM). Of 698 GBM who enrolled in the longitudinal study, 36.8% were less than 30 years old at the first study visit. After controlling for gender identification, sexual orientation, HIV status, and income in the past six months, younger GBM (257 out of 698 respondents) had lower awareness of biomedical HIV prevention strategies and less optimism towards HIV treatments compared with older GBM (441 out of 698 respondents). Among younger GBM who attended HIV-leadership programs, there was a greater awareness of biomedical HIV prevention strategies and higher HIV treatment optimism was reported, compared with non-attendees.

More information available at: https://www.ncbi.nlm.nih.gov/pubmed/31014296

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Thursday, May 9, 2019
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There is a generation gap when it comes to knowing and understanding HIV prevention. Young gay and bisexual men and other men who have sex with men (YGBM) in BC are less likely to be aware of some HIV prevention and treatment options compared to older men, according to a recently published BC-CfE study.

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Tim Wesseling and Sean Grieve are approachable, engaging and affable; more importantly, they are passionate and dedicated to making a difference in their communities. Both are peer research associates (PRAs) on the BC-CfE’s STOP HIV/AIDS Program Evaluation (SHAPE) study, which aims to uncover what factors influence individuals’ access to HIV health care and how people can best be supported to stay engaged in care.

Wesseling and Grieve each faced their own challenges after their HIV diagnoses. Now, these experiences allow them to contribute to research as they reflect on their respective journeys that led them to become PRAs. Their process for forming research questions is founded in lived experiences. “It’s not just a research question, it’s about us as well. We know what gave us success in our lives,” said Wesseling.

Grieve said that after his HIV diagnosis he had essentially stopped thinking about what he could do or be. He is now putting his years of experience to use, while building his resumé and picking up skills he might not have otherwise—from better understanding PowerPoint and Excel to bringing research findings back to the community. “There is a pride. We are not only supporting others, we are supporting ourselves,” added Grieve.

For Wesseling, being a PRA enables him to share with others the support and encouragement that he once received, which was instrumental in overcoming substance use and coming to terms with his HIV diagnosis. Until about five or six years ago, he had not engaged with peers or accessed social support through community organizations. “Meeting with peers and people who had gone through similar experiences was a way for me to connect. It was through the connection with peers that I was able to resolve issues in my life, ask for help, get treatment, move forward and go from where I was to where I am now,” said Wesseling.

Wesseling and Grieve are strong advocates for the power of human connection, and they apply this in all aspects of their work. They have often made the journey to meet individuals in person, to recruit SHAPE study participants and conduct interviews. They have observed stigma and heard about the fear of discrimination in communities they visited, particularly outside of urban centres. “The SHAPE study is doing a great job in looking at where people fall in and out of the cascade of care. And is it because of stigma, is it because of connectedness?” said Grieve.

The intuitiveness provided through lived experience is not something that can necessarily be picked up in a course or a textbook.

SHAPE PRAs play an important role in achieving the SHAPE study’s goals. They help with devising research questions, engaging participants and community partners, conducting interviews, presenting research and communicating research findings back to participants.

PRAs help to provide a more representative perspective on the challenges individuals living with HIV may face when trying to access care. According to Wesseling, the intuitiveness provided through lived experience is not something that can necessarily be picked up in a course or a textbook.

The SHAPE study is looking to understand what affects individuals’ transitions through the HIV cascade of care. By strengthening knowledge of the socio-structural factors that influence linkage and retention in HIV care, the SHAPE research team seeks to identity where specialized supports are needed. In doing so, the research will contribute to addressing health inequities among marginalized populations. Importantly, the SHAPE study is assessing the impact of exposure to the province-wide Seek and Treat for Optimal Prevention of HIV/AIDS, or STOP HIV/AIDS among people living with HIV in BC. STOP HIV/AIDS aims to better engage people living with HIV/AIDS and at-risk populations in HIV testing, treatment and care. Outreach teams throughout the province are dedicated to engaging clients—sometimes even knocking on doors. They take steps to help individuals overcome barriers to accessing HIV care, such as homelessness, unemployment, mental health or substance use issues.

Stay tuned: SHAPE study findings will be presented at upcoming conferences and events. For up-to-date information, please visit the study's webpage.

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Date 
Thursday, March 28, 2019
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Tim Wesseling and Sean Grieve are approachable, engaging and affable; more importantly, they are passionate and dedicated to making a difference in their communities. Both are peer research associates (PRAs) on the BC-CfE’s STOP HIV/AIDS® Program Evaluation (SHAPE) study, which aims to uncover what factors influence individuals’ access HIV health care and how people can best be supported to stay engaged in care.

Program(s) 
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L to R: SHAPE PRA Tim Wesseling, SHAPE Study Coordinator Andrea Bever and SHAPE PRA Sean Grieve
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Top researchers from around the world gathered in Seattle last week to share the latest in the ongoing battle against HIV/AIDS and related infectious diseases.

The annual Conference on Retroviruses and Opportunistic Infections (CROI) is a pre-eminent HIV research meeting and attracts more than 4,000 HIV/AIDS research leaders. Among them were scientists from the BC-CfE, who presented research on PrEP, HIV and aging, phylogenetics and more.

One significant study from the BC-CfE found no link between antiretroviral treatment for HIV and osteoporosis-related fractures, offering a counterpoint to concerns the HIV treatment tenofovir increases the likelihood of bone fractures. In fact, the research found earlier access to HIV treatment and healthy lifestyle habits may reduce the odds of fractures.

Another study observed HIV and aging in terms of conditions affecting overall health and wellbeing. BC-CfE researchers looked at a number of age-associated and mental-health-related comorbidities finding that individuals living with HIV experienced significantly earlier diagnoses. Studied co-morbidities included cardiovascular, kidney, lung and liver diseases, as well as mood, anxiety and personality disorders.

Highlighting the ongoing success of the made-in-BC Treatment as Preventionstrategy, the BC-CfE provided data demonstrating a strong uptake of HIV pre-exposure prophylaxis (PrEP) following the launch of a publicly-funded program in BC. In the first year of the program more than 3,300 people were prescribed the preventative treatment for HIV by 550 prescribers province-wide, largely at-risk men who have sex with men living in urban areas.

Treatment as Prevention (TasP) was pioneered by the BC-CfE’s Dr. Julio Montaner and has been implemented in BC, leading to a consistent decline in new HIV cases in the province. The TasP model has also been implemented in many countries worldwide. The strategy is based on the proven concept of providing earlier access to HIV testing and immediate, universal access to sustained HIV treatment, thus resulting in improved quality of life for individuals living with HIV and, importantly, reduced new cases of HIV. It forms the foundation of the UNAIDS 90-90-90 Target to end AIDS globally by 2030. Mathematical modelling by the BC-CfE has shown that PrEP, combined with TasP, could advance progress towards ending AIDS as an epidemic.

Researchers from the BC-CfE presented work on a number of other issues related to HIV cure research and phylogenetic data. Meanwhile at the conference, University College London researchers announced that an HIV-positive man remains in HIV remission 19 months after receiving a bone marrow transplant from a CCR5 negative donor for Hodgkin’s lymphoma. This is the second case of a person being cleared of HIV after a bone-marrow transplant. The news made headlines around the world and was applauded by the scientific community.

While it’s too early to say this is a case of HIV cure, BC-CfE Executive Director and Physician-in-Chief Dr. Julio Montaner said it does provide some hope. “This encouraging advance has impressed on the scientific community the importance of continuing research in this area,” he said. “Meanwhile, in the absence of a vaccine or a cure for HIV, early, widespread access to testing and sustained treatment and care is the most effective means to curb HIV new infections. This is the concept supporting the proven successful Treatment as Prevention strategy.”

 

Check out the posters BC-CfE researchers presented at CROI.

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Date 
Thursday, March 14, 2019
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Excerpt 

Top researchers from around the world gathered in Seattle last week to share the latest in the ongoing battle against HIV/AIDS and related infectious diseases. The annual Conference on Retroviruses and Opportunistic Infections (CROI) is the preeminent HIV research meeting and attracts more than 4,000 HIV/AIDS research leaders. Among them were scientists from the BC-CfE, who presented research on PrEP, HIV and aging, phylogenetics and more.

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The annual Conference on Retroviruses and Opportunistic Infections (CROI) brings together top basic, translational, and clinical researchers from around the world to share the latest studies, important developments, and best research methods in the ongoing battle against HIV/AIDS and related infectious diseases. CROI 2019 will be held from March 4 to March 7, 2019, at the Washington State Convention Center in Seattle, Washington.

The CROI Foundation partners with the International Antiviral Society–USA (IAS–USA) for organization of the conference.

PresentersTopicPDF Downloads
Angela McLaughlinEpidemiological Correlates of HIV Lineage-Level Diversification Rate
Junine ToyRapid uptake of HIV pre-exposure prophylaxis (PrEP) in a publicly funded popula>on-based program in Bri>sh Columbia, Canada
Ni Gusti Ayu NandithaEarlier Age of Onset and Higher Prevalence of Comorbidities in People Living with HIV: A Population-Based Cohort Study in British Columbia, Canada
Bradley R. JonesGenetic and Age Distributon of Latent HIV Sequences in CD4+ T cell Subsets
Monica YeFactors associated with non-alcoholic hepatic steatosis among hepatitis C (HCV) monoinfected and HIV/HCV co-infected adults
Date 
Wednesday, March 13, 2019
1
Excerpt 

The annual Conference on Retroviruses and Opportunistic Infections (CROI) brings together top basic, translational, and clinical researchers from around the world to share the latest studies, important developments, and best research methods in the ongoing battle against HIV/AIDS and related infectious diseases.

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On February 16th, the BC Government announced $1 billion in funding for the new St. Paul’s Hospital, set to open in 2026 at 1002 Station Street. The business case for the new hospital has been approved by the government, cementing the future of the innovative facility to serve as model for hospital care in the province.

“For over 125 years, people in Vancouver and across British Columbia have benefited from the health care provided by St. Paul’s Hospital,” said BC Premier John Horgan. “Today, we are safeguarding these life-saving services by taking action to build a brand new St. Paul’s Hospital that will serve more people and offer better access to the specialized care people need.”

The new $1.9 billion facility will provide integrated, innovative and patient-centred care. Carried forward from the current St. Paul’s, research and innovation will play key roles. Specialized HIV care will continue to be offered, along with chronic disease management, mental health and substance use disorders, end-of-life care, Indigenous health, community care and outreach programs, and more.

“We are very excited to see how a new St. Paul’s facility with cutting-edge technology will build the capacity of the BC-CfE to provide clinical care and medical research,” said Dr. Julio Montaner, Executive Director and Physician-in-Chief with the BC-CfE.

The new hospital will be located in Vancouver’s False Creek Flats area, three kilometres from the current hospital site on Burrard Street. It will continue to serve residents of Vancouver and BC, with a capacity for up to 548 beds. The site will be home to several leading provincial programs and referral centres, including for heart and lung care, renal, eating disorders and specialty surgeries and transplants.

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Date 
Wednesday, March 6, 2019
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On February 16th, the BC Government announced $1 billion in funding for the new St. Paul’s Hospital, set to open in 2026 at 1002 Station Street. The business case for the new hospital has been approved by the government, cementing the future of the innovative facility to serve as model for hospital care in the province.

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BC-CfE Executive Director Dr. Julio Montaner with BC Premier Hon. John Horgan at the February 16th announcement event.
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BC-CfE’s provincial BOOST Collaborative is following on the heels of the successful Vancouver-based BOOST Collaborative. BOOST is inspired by the made-in-BC Treatment as Prevention strategy and supports a Targeted Disease Elimination (TDE®) approach. This means using tools and strategies that have been proven through the work of the BC-CfE in curbing HIV transmissions. The TDE® strategy can address contagious diseases and diseases with a social contagion factor, such as substance use disorders. The first phase of the BOOST Collaborative doubled retention rates in the lifesaving opioid agonist treatment (OAT) for substance use disorders.

Among participating Vancouver Coastal Health (VCH) clinics, the number of individuals retained at three months made a significant jump — from three out of ten to seven out of ten.

The provincial expansion of BOOST has its eye on even greater goals, aiming to ensure that 95% of people with opioid use disorder have an active OAT prescription and 95% of those on OAT are retained at three months (or longer).

On February 14th, BOOST Collaborative teams from across the province—including Prince George, Kelowna, Chilliwack, Victoria, Nanaimo, Surrey and Vancouver’s Downtown Eastside—met for the first learning session in Vancouver. Teams have been tasked with creatively generating tactics and strategies, and even morale-boosting team names, in order to enhance their OAT treatment programs.

Dr. Laura Knebell was part of the pilot BOOST team at the Downtown Community Health Clinic (DCHC) in the heart of the Downtown Eastside. There was trepidation among her staff in the early days of the initiative. Quality improvement tasks, while only intended to take less than 10% of a clinic’s staff time, seemed overwhelming given competing demands.

Looking back on the year-long pilot, Dr. Knebell said the data collected for its quality improvements efforts helped pinpoint needs, while also showing encouraging signs of success. After finding that about half of DCHC clients did not have active OAT prescriptions, clinicians worked to identify a number of clients that could possibly be re-engaged in treatment. DCHC staff are now applying the learnings from BOOST to help clients with other conditions.

BOOST Lead and BC-CfE Senior Medical Director Dr. Rolando Barrios urged teams to take small steps wherever they saw opportunity, rather than waiting for reams of data. “You don’t need perfect data to act,” said Dr. Barrios.

Research supports the BOOST approach, showing the risk of morbidity and mortality decreases by 80% for individuals on effective OAT. Further, access to OAT has also been shown to drastically reduce levels of crime associated with drug use.

The concept of BOOST is reminiscent of the fable about the tiny mouse who pulled the thorn out of the elephant’s foot. The provincial BOOST Collaborative Teams are taking on the work of implementing small programmatic changes to improve access to and sustainment in care—and these can have a big impact. This could include administrative tasks of improving intake forms or adding reminder calls to clients.

 

Provincial BOOST Collaborative

In 2010, the BC-CfE launched the STOP HIV/AIDS® Structured Learning Collaborative (the “Collaborative”) to improve the quality of HIV care and services, improve patient engagement & increase sustainment in care, and strengthen partnerships in care. As a result of the BC-CfE’s Collaborative, all participating teams saw improvements: namely, they implemented their learnings to deliver proactive and organized needs-based HIV care, with supports for patient self-management. The STOP HIV/AIDS® Collaborative provided the model for the BC-CfE’s BOOST Collaborative to work with provincial Health Authorities to help engage more individuals in treatment for opioid use disorder through opioid agonist treatment.

Date 
Wednesday, March 6, 2019
1
Excerpt 

BC-CfE’s provincial BOOST Collaborative is following on the heels of the successful Vancouver-based BOOST Collaborative. BOOST is inspired by the made-in-BC Treatment as Prevention strategy and supports a Targeted Disease Elimination (TDE® ) approach. This means using tools and strategies that have been proven through the work of the BC-CfE in curbing HIV transmissions. The TDE® strategy can address contagious diseases and diseases with a social contagion factor, such as substance use disorders.

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This article was originally posted on the website for the Saskatchewan Medical Association.

 

A Saskatchewan primary-care physician has a simple message for doctors who are thinking of expanding their capacity to care for people with HIV.

“Do it!” said Dr. Laura Marshall, a La Ronge family physician.

“It's rewarding work, and clinically it is very interesting, but at the same time fairly straightforward. You can make a big difference in a patient’s health and wellness.”

Dr. Marshall was one of three Saskatchewan primary-care physicians or family medicine grads who received scholarships to participate in the British Columbia Centre for Excellence in HIV/AIDS' Intensive Preceptorship Program. The five-day clinical placement, which was completed in November 2018 at St. Paul’s Hospital in Vancouver, was open to physicians who have a strong interest in caring for people living with HIV and who want to mentor their colleagues as their knowledge and experience grows. (The BC Centre for Excellence in HIV/AIDS offers a range of online and offline training programs.)

The scholarships were offered by the Saskatchewan Infectious Disease Care Network in conjunction with the Ministry of Health and the Public Health Agency of Canada.

Dr. Marshall has been a physician in La Ronge for seven years and has been working with HIV patients for five years. Dr. Tasha McNamara, a second-year family medicine resident in Saskatoon, and Dr. Sarafa Tijani of Regina were also selected for the program.

Dr. McNamara told the SMA that as a soon-to-be family physician she wants to incorporate HIV care as part of her practice, but didn’t feel prepared until participating in recent workshops and the preceptor program in BC.

“As family physicians, I feel we are fortunate to develop continuity with our patients and often act as their first contact to health services,” she said. “I believe we are situated in one of the best positions for infectious disease prevention, diagnosis and management.”

Multidisciplinary approch effective

In Saskatchewan, treatment for HIV need not have to wait for a referral to a specialist, she added. “Family physicians should bridge the gap in initiating treatment and assist in the ongoing monitoring and continuity to their care, including aspects unrelated to their HIV diagnosis.”

Both physicians took note of the multidisciplinary approach taken by the BC-CfE. That collaboration included infectious disease specialists, family doctors, pharmacists, nurses, social worker, to name a few. The range of resources provided by staff and the programming available to patients helps them stay the course in their treatment plans, Dr. McNamara said.

“Providing this network of continuity, in a comfortable setting for patients, contributes to successful retention in care to the point where the majority of the family medicine clinic visits I observed at the centre mainly focused on common presenting complaints as seen at any clinic,” said Dr. McNamara. “HIV wasn’t the forefront of their visit. Engagement in treatment is key, along with helping patients overcome the initial concerns and barriers of diagnosis.”

Dr. Marshall also observed that “there isn’t the same stigma around HIV, or at least not to as great of a degree” as there is in Saskatchewan. “At the BC-CfE, testing is done routinely, people are knowledgeable about the disease and the risk of transmission. I feel Saskatchewan still has a ways to go for that.” The preceptor program in BC showed the Saskatchewan physicians that a family doctor can only do so much, Dr. Marshall said. “The most challenging part of providing primary care is helping patients with all the aspects of their life that aren’t medical,” she said. “A lot of people are marginalized, have addictions issues and food and housing insecurity. Many of the social determinants of health are not met and helping with these are a big challenge and needs a lot of work on the provincial level.”

Treatment has come a long way

Dr. McNamara said as a family medicine resident, the most intimidating part is the feeling that initiating HIV treatment is beyond her scope. The number of combinations of medications can seem daunting. But she said HIV treatment has come a long way and the options are simpler than she had expected.

“As family physicians we wouldn’t be expected to treat complex patients and therefore I think HIV from a primary care perspective is much less of a challenge than I assumed,” she added. “Personally, the challenging part I think will be to find ways to engage patients with HIV living chaotic lifestyles.” Family physicians are well-positioned to help HIV-positive people who are leading high-risk lifestyles to receive the care they need, where they need it. Doctors can help patients lead full lives – even if the patient doubts that is possible, Dr. McNamara said.

The week at the BC Centre for Excellence in HIV/AIDS showed her that managing a patient with HIV can be routine, so much so that family physicians can turn their attention to all aspects of that person’s health. “

Maybe that is the reward,” she said, “that if as family physicians we can make their care more accessible and continuous, then their disease doesn’t differ from any other chronic illness, and doesn’t define the person or their health.”

 

Find out more about the BC-CfE's Education and Training Programs. 

Featured Image 
Date 
Monday, January 14, 2019
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Excerpt 

Saskatchewan primary-care physician has a simple message for doctors who are thinking of expanding their capacity to care for people with HIV. “Do it!” said Dr. Laura Marshall, a La Ronge family physician.

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Image Caption 
Drs. Sarafa Tijani, Natasha McNamara, and Laura Marshall visited the BC-CfE's offices at St. Paul's Hospital as part of the Intensive Preceptorship Program.
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