Suchergebnisse

IntroductionIdentifying appropriate pre‐exposure prophylaxis (PrEP) candidates is a challenge in planning for the safe and effective roll‐out of this strategy. We explored the use of a validated HIV risk screening tool, HIV Incidence Risk Index for Men who have Sex with Men (HIRI‐MSM), to identify "optimal" candidates among MSM testing at a busy sexual health clinic's community testing sites in Toronto, Canada.MethodsBetween November 2014 and April 2015, we surveyed MSM undergoing anonymous HIV testing at community testing sites in Toronto, Canada, to quantify "optimal" candidates for scaling up PrEP roll‐out, defined as being at high objective HIV risk (scoring ≥10 on the HIRI‐MSM), perceiving oneself at moderate‐to‐high HIV risk and being willing to use PrEP. Cascades were constructed to identify barriers to broader PrEP uptake. The association between HIRI‐MSM score and both willingness to use PrEP and perceived HIV risk were explored in separate multivariable logistic regression analyses.ResultsOf 420 respondents, 64.4% were objectively at high risk, 52.5% were willing to use PrEP and 27.2% perceived themselves at moderate‐to‐high HIV risk. Only 16.4% were "optimal" candidates. Higher HIRI‐MSM scores were positively associated with both willingness to use PrEP (aOR=1.7 per 10 score increase, 95%CI=1.3–2.2) and moderate‐to‐high perceived HIV risk (aOR=1.7 per 10 score increase, 95%CI=1.2–2.3). The proportion of men who were "optimal" candidates increased to 42.9% when the objective HIV risk cut‐off was changed to top quartile of HIRI‐MSM scores (≥26). In our full cascade, a very low proportion (5.3%) of MSM surveyed could potentially benefit from PrEP under current conditions. The greatest barrier in the cascade was low perception of HIV risk among high‐risk men, but considerable numbers were also lost in downstream cascade steps. Of men at high objective HIV risk, 68.3% did not perceive themselves to be at moderate‐to‐high HIV risk, 23.6% were unaware of PrEP, 40.1% were not willing to use PrEP, 47.6% lacked a family physician with whom they felt comfortable discussing sexual health, and 31.6% had no means to cover the cost of PrEP.ConclusionsA higher HIRI‐MSM cut‐off may be helpful for identifying candidates for PrEP scale‐up. Improving engagement in the PrEP cascade will require interventions to simultaneously address multiple barriers.

ObjectivesThe COVID-19 pandemic has necessitated access to large health system datasets to inform the public health response. To meet this need, the Provincial Health Services Authority and the British Columbia (BC) Ministry of Health collaborated to create a population-based platform that integrates COVID-19 datasets with sociodemographic and administrative health data.
ApproachA BC COVID Data Library proof-of-concept was created as a cloud-based, dynamic platform composed of de-identified datasets. The BC COVID-19 Cohort (BCC19C) represents a subset composed of people accessing COVID-19 health services (e.g., testing, vaccination) and linked health histories. Provincial COVID-19 datasets are updated daily and include COVID-19 lab tests, case surveillance, vaccinations and hospitalizations/deaths. These can be linked to administrative data holdings for the BC population, which are updated weekly/monthly and include vital statistics, medications, hospital admissions, medical visits, among others. A patient matching algorithm creates unique patient keys that allows the same individual to be linked across datasets.
ResultsThe BCC19C has been used provincially to 1) support ongoing surveillance, reporting, and modelling of COVID-19; 2) describe and characterize the epidemiology of COVID-19; and 3) inform acute care planning, public health interventions and health care services in BC. Ongoing and completed BCC19C analyses include assessment of vaccine safety, vaccine effectiveness, and characteristics associated with infection and severe outcomes; use of medical visit data for syndromic surveillance and monitoring of unintended outcomes of the pandemic (e.g., mental health visits); and characterization of long-COVID. Availability of linked administrative data holdings has been crucial for identifying non-COVID control groups, measuring sociodemographics and co-morbidities, and complementing COVID-19 datasets for more complete capture of health outcomes (e.g., deaths, hospitalizations).
ConclusionsThe large scope/breadth and timeliness of the linkable datasets integrated within the COVID Data Library and the BCC19C has supported the public health response in BC. Additional linkage to other data sources will further strengthen this data platform.

AbstractIntroductionPeople living with HIV (PLWH) and/or who inject drugs may experience lower vaccine effectiveness (VE) against SARS‐CoV‐2 infection.MethodsA validated algorithm was applied to population‐based, linked administrative datasets in the British Columbia COVID‐19 Cohort (BCC19C) to ascertain HIV status and create a population of PLWH and matched HIV‐negative individuals. The study population was limited to individuals who received an RT‐PCR laboratory test for SARS‐CoV‐2 between 15 December 2020 and 21 November 2021 in BC, Canada. Any history of injection drug use (IDU) was ascertained using a validated administrative algorithm. We used a test‐negative study design (modified case−control analysis) and multivariable logistic regression to estimate adjusted VE by HIV status and history of IDU.ResultsOur analysis included 2700 PLWH and a matched population of 375,043 HIV‐negative individuals, among whom there were 351 and 103,049 SARS‐CoV‐2 cases, respectively. The proportion of people with IDU history was much higher among PLWH compared to HIV‐negative individuals (40.7% vs. 4.3%). Overall VE during the first 6 months after second dose was lower among PLWH with IDU history (65.8%, 95% CI = 43.5–79.3) than PLWH with no IDU history (80.3%, 95% CI = 62.7–89.6), and VE was particularly low at 4–6 months (42.4%, 95% CI = −17.8 to 71.8 with IDU history vs. 64.0%; 95% CI = 15.7–84.7 without), although confidence intervals were wide. In contrast, overall VE was 88.6% (95% CI = 88.2–89.0) in the matched HIV‐negative population with no history of IDU and remained relatively high at 4–6 months after second dose (84.6%, 95% CI = 83.8–85.4). Despite different patterns of vaccine protection by HIV status and IDU history, peak estimates were similar (≥88%) across all populations.ConclusionsPLWH with a history of IDU may experience lower VE against COVID‐19 infection, although findings were limited by a small sample size. The lower VE at 4–6 months may have implications for booster dose prioritization for PLWH and people who inject drugs. The immunocompromising effect of HIV, substance use and/or co‐occurring comorbidities may partly explain these findings.