Characteristics of the HIV cascade of care and unsuppressed viral load among gay, bisexual and other men who have sex with men living with HIV across Canada’s three largest cities

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dc.contributor.authorMoore, David M.
dc.contributor.authorCui, Zishan
dc.contributor.authorSkakoon-Sparling, Shayna
dc.contributor.authorSang, Jordan
dc.contributor.authorBarath, Justin
dc.contributor.authorWang, Lu
dc.contributor.authorLachowsky, Nathan J.
dc.contributor.authorCox, Joseph
dc.contributor.authorLambert, Gilles
dc.contributor.authorNoor, Syed W.
dc.contributor.authorGrace, Daniel
dc.contributor.authorJollimore, Jody
dc.contributor.authorApelian, Herak
dc.contributor.authorLal, Allan
dc.contributor.authorParlette, Abbie
dc.contributor.authorHart, Trevor A.
dc.date.accessioned2022-03-07T23:00:31Z
dc.date.available2022-03-07T23:00:31Z
dc.date.copyright2021en_US
dc.date.issued2021
dc.descriptionThe authors thank the Engage study participants, office staff and community engagement committee members, as well as our community partner agencies.en_US
dc.description.abstractIntroduction: Treatment as prevention strategies have been variously applied across provinces in Canada. We estimated HIV care cascade indicators and correlates of unsuppressed viral load (VL) among gay, bisexual and other men who have sex with men (GBM) recruited 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 and tests for HIV and other sexually transmitted infections (STIs). We conducted bivariate analyses comparing RDS-adjusted proportions across cities. We used multivariable logistic regression to examine factors associated with having a measured VL ≥ 200 copies/mL with data pooled from all three cities. Results: We recruited 1179 participants in Montreal, 517 in Toronto and 753 in Vancouver. The RDS-adjusted HIV prevalence was 14.2% (95% CI 11.1 to 17.2) in Montreal, 22.1% (95% CI 12.4 to 31.8) in Toronto and 20.4% (95% CI 14.5 to 26.3) in Vancouver (p < 0.001). Of participants with confirmed HIV infection, 3.3% were previously undiagnosed in Montreal, 3.2% undiagnosed in Toronto and 0.2% in Vancouver (p = 0.154). In Montreal, 87.6% of GBM living with HIV were receiving antiretroviral therapy (ART) and 10.6% had an unsuppressed VL; in Toronto, 82.6% were receiving ART and 4.0% were unsuppressed; in Vancouver, 88.5% were receiving ART and 2.6 % were unsuppressed (p < 0.001 and 0.009 respectively). Multivariable modelling demonstrated that participants in Vancouver (adjusted odds ratio [AOR]=0.23; 95% CI 0.06 to 0.82), but not Toronto (AOR = 0.27; 95% CI 0.07 to 1.03), had lower odds of unsuppressed VL, compared to Montreal, as did older participants (AOR 0.93 per year; 95% CI 0.89 to 0.97), those at high-risk for hazardous drinking (AOR = 0.19; 95% CI 0.05 to 0.70), those with a primary care provider (AOR = 0.11; 95% CI 0.02 to 0.57), and those ever diagnosed with other STIs (AOR = 0.12; 95% CI 0.04 to 0.32). Conclusions: GBM living in Montreal, Toronto and Vancouver are highly engaged in HIV testing and treatment and all three cities have largely achieved the 90-90-90 targets for GBM. Nevertheless, we identified disparities which can be used to identify GBM who may require additional interventions, in particular younger men and those who are without a regular primary care provider.en_US
dc.description.reviewstatusRevieweden_US
dc.description.scholarlevelFacultyen_US
dc.description.sponsorshipThe Engage Cohort Study is funded by the Canadian Institutes for Health Research (CIHR, #TE2-138299, FDN-143342, PJT-153139), the CIHR Canadian HIV/AIDS Trials Network (#CTN300), the Canadian Association for HIV/ AIDS Research (CANFAR, #Engage), the Ontario HIV Treatment Network (OHTN, #1051) and the Public Health Agency of Canada (#4500370314). DMM and NJL are supported with Scholar Awards from the Michael Smith Foundation for Health Research (#5209, #16863). SSS is supported by CTN and CIHR postdoctoral fellowship awards. TAH is supported by a Chair in Gay and Bisexual Men’s Health from the OHTN. DG is supported by a Canada Research Chair in Sexual and Gender Minority Health.en_US
dc.identifier.citationMoore, D. M., Cui, Z., Skakoon-Sparling, S., Sang, J., Barath, J., Wang, L., Lachowsky, N., Cox, J., Lambert, G., Noor, S. W., Grace, D., Jollimore, J., Apelian, H., Lal, A., Parlette, A., & Hart, T. A. (2021). “Characteristics of the HIV cascade of care and unsuppressed viral load among gay, bisexual and other men who have sex with men living with HIV across Canada’s three largest cities.” Journal of the International AIDS Society, 24, e25699. DOI: https://doi.org/10.1002/jia2.25699en_US
dc.identifier.urihttps://doi.org/10.1002/jia2.25699
dc.identifier.urihttp://hdl.handle.net/1828/13778
dc.language.isoenen_US
dc.publisherJournal of the International AIDS Society,en_US
dc.subjectantiretroviral therapy
dc.subjectHIV
dc.subjectmen who have sex with men
dc.subjectvirological suppression
dc.subject.departmentSchool of Public Health and Social Policy
dc.titleCharacteristics of the HIV cascade of care and unsuppressed viral load among gay, bisexual and other men who have sex with men living with HIV across Canada’s three largest citiesen_US
dc.typeArticleen_US

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