SHAPE Study

BC’s success story shows strength of Treatment as Prevention

December 22, 2021

On December 1st we celebrate World AIDS Day, an opportunity to reflect on our challenges and successes four decades into the battle against HIV/AIDS. Around the world there are nearly 38 million people living with HIV and about 1.5 million new infections per year. A recent report by the World Health Organization estimates the number of people with the virus being treated with antiretrovirals had risen to 27.5 million – an increase of almost 10% over the last year. Encouraging but not enough.

In BC, we have much to be proud of given the success of the BC Centre for Excellence in HIV/AIDS’ (BC-CfE) Treatment as Prevention (TasP) strategy on the impact of HIV/AIDS, here and globally. On last year’s World AIDS Day, we were proud to announce, alongside BC’s Minister of Health Adrian Dix, that our province had surpassed the United Nations’ 90-90-90 Target; with 92 per cent of people living with HIV in BC diagnosed, 91 per cent of them on highly active antiretroviral therapy (HAART), and 95 per cent of those on HAART (approximately 7,500 people) achieving virological suppression, meaning they have undetectable levels of HIV in their blood and bodily fluids. Reaching these thresholds has played a key role in reducing AIDS related morbidity and mortality in BC by over 90% since the peak of the epidemic in the early 90’s. Furthermore, this success has also greatly reduced the likelihood of new HIV cases in BC, because people living with HIV who are virologically suppressed through HAART do not transmit the HIV virus.

Since January 2018, BC further expanded its HIV control efforts by adding fully subsidized pre-exposure prophylaxis (PrEP) to the TasP strategy. PrEP involves one pill (containing two specific antiretroviral drugs) taken daily by individuals who are at increased risk of contracting HIV, based on a set of pre-defined criteria.

Daily use of PrEP reduces the risk of acquiring HIV by over 95%. Today, the BC-CfE’s PrEP program has over 4,700 active participants across all of BC’s health authorities, and is among the largest in Canada and, indeed, the world. As a result of the combined impact of HAART and PrEP, BC is on track to see its lowest number of new HIV infections over three decades in 2021, at approximately 120 cases (a 20% decrease from the previous year). This proves once again that sustained investments in TasP (a strategy first proposed by the BC-CfE 15 years ago, and since widely adopted around the world) stops progression of HIV infection to AIDS, avoids premature deaths, and prevents HIV transmission, all within a cost-averting framework.

Continued fostering of BC’s fully subsidized HAART and PrEP programs, with adequate support and full involvement of all relevant stakeholders, will be critical to ensuring the long-term success of BC’s anti-HIV/AIDS strategy. The disruptions created by the COVID-19 pandemic illustrate this point. It has been widely reported that measures needed to address COVID-19, particularly lockdowns early in the epidemic, impacted nearly all aspects of everyday life as well as access to health care services. HIV care was no exception. The BC-CfE documented decreases in laboratory monitoring and access to HAART and PrEP in the first phase of the epidemic. These trends were confirmed with data from a survey of Vancouver’s gay and bisexual men whereby 33 per cent of participants reported avoiding health services because of concerns about COVID-19 exposure. However, prompt implementation of corrective measures allowed for these trends to be reversed within weeks without ill effects.

Earlier this year the United Nations called for a redoubling of the global efforts to “End AIDS as an epidemic by 2030”, defined as decreasing AIDS-related mortality and new HIV infections globally by 90%, using 2010 as the baseline. The campaign was launched in 2015 with a goal of reaching the BC-CfE-proposed 90-90-90 Target by 2020. However, by the end of 2020, most of the world had failed to meet the UN 90-90-90 Target for a variety of reasons, including weak political leadership, insufficient investments, and emerging challenges posed by COVID-19. As a result, UNAIDS estimates the failure to meet the 90-90-90 Target led to an additional one million AIDS-related deaths, and three million new HIV infections globally.

Despite these shortcomings, the United Nations successfully challenged the international community to expand the global effort by embracing the 95-95-95 by 2025 Target, as originally proposed by the BC-CfE. UNAIDS estimates that by meeting the 95-95-95 Target the number of people newly infected with HIV will fall from 1.7 million in 2019 to 370,000 by 2025, and the number of people dying from AIDS-related illnesses would be reduced from 690,000 in 2019 to 250,000 in 2025. “Ending AIDS as an epidemic by 2030” remains within reach. The question remains whether we have the political will and focus to deliver on the promise of the BC-CfE proven TasP strategy at a global level.

On this World AIDS Day, we encourage every British Columbian to join the BC-CfE as we commit to do our part to motivate our political leaders find the courage and resources to deliver on this promise. To not do so would represent an inexcusable failure.

Julio Montaner, OC, OBC, MD
Executive Director and Physician in Chief
BC Centre for Excellence in HIV/AIDS
Providence Health Care

ZForecast NewsletterPrinter Friendly

SIGN UP TO RECEIVE THE FORECAST NEWSLETTER BY EMAIL!

Receive the latest news and information on advances in research, treatment and education. Be the first to hear about upcoming events and conferences, and other opportunities to connect with researchers at the BC-CfE.

CLICK TO SIGN UP!

Tags:

Laboratory

SHAPE Study

CANOC

Momentum

Treatment as Prevention®

BC-CfE’s STOP HIV/AIDS Program Evaluation (SHAPE) Study members reflect ahead of World AIDS Day

posted on November 30, 2021

Ahead of World AIDS Day on December 1st, we asked several BC-CfE researchers about their work and how it relates to this year's World AIDS Day theme of ‘End Inequalities. End AIDS. End Pandemics’. Clara Tam, Tim Wesseling and Sean Grieve, BC-CfE's SHAPE Team.

Tell us about your role and the focus/study of your work?

Clara: I work as a Research Coordinator on the STOP HIV/AIDS Program Evaluation (SHAPE) study along with Tim and Sean. The SHAPE study aims to evaluate the impact of the STOP HIV/AIDS initiative of expanded testing and treatment across the province, as well as to better understand factors that influence access to and retention in HIV care. My work varies from day to day but mostly includes supporting data collection and managing data analysis and knowledge translation.

Tim: I work as a Peer Research Associate (PRA) on the STOP HIV/AIDS Program Evaluation (SHAPE) Study. My job has involved recruiting and interviewing eligible participants in this longitudinal study, which includes a baseline, and two follow-up surveys that launched in January of 2016 and concluded in September of 2021. I have also been actively involved in developing research questions based on themes that address inequalities in accessing care such as social supports and stigma.

Sean: I also work as a Peer Research Associate (PRA) on the SHAPE study and support recruitment and interviewing of participants throughout the three waves of the survey. I have also been involved in assisting research studies for many years before that.

What role does HIV play in your work and how does it impact your participants?

Tim: HIV is the common health issue in the lives of all the participants in this study, including my own! HIV continues to be part of my identity and therefore links me to all the study participants. We have a base connection which enables participants to share in a safe and understanding environment, thereby enriching the data collection.

Sean: HIV is the reason why I’m involved in research. As a peer researcher I also take on the role of an advocate to create change that can positively impact peers, and being involved in research is a way to influence change from within. If participants see me as a peer researcher, I hope it also encourages them to engage further in research beyond just being a participant.

(If your study involves HIV treatment/care) What are some concerns you hear from your study participants about accessing HIV care/treatment/testing?

Tim: There are a bunch of concerns that I have been aware of just from engaging in the in-person and phone interviews which account for more than 35 percent of the cohort. Most recently the COVID-19 pandemic has made it hard for many to get social supports and regular access to medical appointments. Regional and “rural vs urban” disparities are obvious when hearing about how people are accessing services outside of areas like Vancouver and Victoria. Stigma is also a big topic as HIV is still hidden in many geographical areas and social groupings. Lastly there’s funding and lack of political will which has seen a drop in focus and attention resulting in less “force of movement” and fewer community services.

Sean: Participants I’ve spoken to are worried about ageing, especially about heart, liver and kidney disease. More broadly they have expressed that they are afraid to die alone with recurring themes of stigma, loneliness and isolation particularly in areas outside Vancouver.

The theme of World AIDS Day this year is ‘End Inequalities. End AIDS. End Pandemics’. How do inequalities in HIV care influence your work and are there opportunities to address inequalities to HIV care in your work?

Tim: I feel that inequalities in HIV care are most notable on the community level. In my experience as a GBMSM, who has lived with HIV for 30 years, I have seen how a community can rise and be there for their own out of necessity. I see the need for other HIV community groups that are facing more stigma and less social supports to have similar peer and community driven action to be empowered and to address those inequalities. At my workplace and on my team we have been active in educating ourselves so that we can have a better understanding of those we serve, but still the direct involvement of those in the underserved communities of people living with HIV need to be included from A-Z in all aspects of HIV healthcare and research.

Clara: From a study perspective as Tim mentioned, we try to continuously educate ourselves on challenges our participants may face. Most recently, these challenges have been exacerbated through the COVID-19 pandemic as well as the poisoned drug supply. In response to these changes, and to ensure we accurately understand current participant experiences in our survey, we implemented a COVID-19 module to better capture how transitions to virtual health care services and impacts to the overall health care system affected their HIV care. In capturing these experiences alongside HIV care there is an opportunity to characterize and address inequalities that people living with HIV face today.

Can you share any examples of participants overcoming barriers to HIV care thanks to the work you do?

Sean: The biggest barrier to care for participants is not knowing details about their HIV care, especially when speaking with the doctor. Through administering the survey, we are able to informally encourage participants to be further engaged in their care and ask questions that may seem intimidating.

Tim: I think the best example of people overcoming barriers to HIV care is the part about connection building. Whether is me as a peer, the HIV specialist, the volunteer at the AIDS service organization (ASO), the graduate research student working on a study or the pharmacist where meds are picked up … we all need to be reminded that people living with HIV need to feel safe and welcome and respected.

Cohort profile: the STOP HIV/AIDS Program Evaluation (SHAPE) study in British Columbia, Canada

2020 | BMJ

Program(s): Epidemiology and Population Health |
Initiative(s): SHAPE Study |
Audience: General Public |

BMJ

Abstract:

Purpose The Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) Program Evaluation (SHAPE) study is a longitudinal cohort developed to monitor the progress of an HIV testing and treatment expansion programme across the province of British Columbia (BC). The study considers how sociostructural determinants such as gender, age, sexual identity, geography, income and ethnicity influence engagement in HIV care.

Participants Between January 2016 and September 2018, 644 BC residents who were at least 19 years old and diagnosed with HIV were enrolled in the study and completed a baseline survey. Participants will complete two additional follow-up surveys (18 months apart) about their HIV care experiences, with clinical follow-up ongoing.

Findings to date Analyses on baseline data have found high levels of HIV care engagement and treatment success among SHAPE participants, with 95% of participants receiving antiretroviral therapy and 90% having achieved viral suppression. However, persistent disparities in HIV treatment outcomes related to age, injection drug use and housing stability have been identified and require further attention when delivering services to marginalised groups.

Future plans Our research will examine how engagement in HIV care evolves over time, continuing to identify barriers and facilitators for promoting equitable access to treatment and care among people living with HIV. A qualitative research project, currently in the formative phase, will compliment quantitative analyses by taking a strengths-based approach to exploring experiences of engagement and re-engagement in HIV treatment among individuals who have experienced delayed treatment initiation or treatment interruptions.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

Countering complacency on path to an HIV cure

April 2, 2019

The BC-CfE applauds the news that emerged from CROI (Conference on Retroviruses and Opportunistic Infections) and captured global news headlines: an individual living with HIV has been in remission and off treatment for 18 months after receiving a bone-marrow transplant. The "London patient" is now the second individual to achieve HIV remission.

To briefly explain, as in the first case, this milestone was achieved through a bone-marrow transplant from a donor harbouring a rare mutation in the human CCR5 gene. Acting as a receptor, the CCR5 is necessary for HIV to enter cells in the human body.

It is important to note that HIV cure by bone-marrow transplantation is neither safe nor capable of being easily expanded. The reality is that we still don't know when an HIV cure will be achieved. There is currently no available solution for achieving a broadly applicable cure that could help those living with HIV worldwide.

News of the London patient does demonstrate the potential for eradicating HIV from the body, underlining the importance of continuing HIV cure and vaccine research.

Under the leadership of BC-CfE Laboratory Director Dr. Zabrina Brumme, the BC-CfE continues to seek to better understand dormant HIV cells that accumulate and persist in the body. While on sustained treatment, an individual can achieve a viral load that is undetectable by standard blood tests, at which point they cannot transmit to others. However, if treatment is stopped or interrupted, viral levels can rebound.

Grasping the diversity of HIV residing within an individual (known as the viral reservoir) is a key stepping stone to identifying a cure.

Unfortunately, good news of slow progress towards an HIV cure could contribute to misconceptions. Combined with impressive advances in HIV treatment, it could lead some to believe HIV is a resolved issue.Dr. Anthony Fauci, Director of the US National Institutes of Health, told attendees of CROI we have reached a point of "understandable but unacceptable complacency."

The bottom line is the HIV epidemic remains a public health concern. There are nearly 37 million people living with HIV in the world, including an estimated 13,000 in British Columbia and over 63,000 people in Canada. More than ever, health care providers, policymakers and the public must be on high alert for complacency. It is equally critical that we take every chance to implement the tools at our disposal to curb HIV and achieve an end to AIDS.

In the absence of a vaccine or a cure for HIV, providing early, widespread access to testing and sustained, universal treatment is the most effective means to stop HIV new infections. This is the concept supporting the proven successful, made-in-BC Treatment as Prevention (TasP) strategy that forms the foundation of the UNAIDS 90-90-90 Target to end AIDS by 2030. To meet this goal, by 2020, 90% of individuals living with HIV must be diagnosed, 90% of those diagnosed must be on treatment, and 90% of those on treatment must be virally suppressed.

In BC through the implementation of TasP, we have seen a steady increase in individuals accessing HIV testing and antiretroviral treatment, leading to a consistent decline in new HIV cases. HIV treatment today improves longevity and quality of life. However, there is still more we can do.

For example, a recent BC-CfE study published in PLOS-ONE uncovered new opportunities in the health care system to diagnose individuals living with HIV. Our study found one in seven individuals living with HIV in BC could have been diagnosed earlier—if health care providers had recognized certain key clinical conditions as triggers for HIV screening. Individuals aged 40 years or older, heterosexuals, people living in remote areas and people who had ever injected drugs were more likely to have had a missed opportunity for an earlier HIV diagnosis.

This data provides critical clues on how we can close gaps in access to HIV testing and treatment. It is also a useful reminder HIV does not discriminate. In BC, all individuals are recommended to ask their health care providers for regular HIV tests. We can all get tested for HIV.

While scientists and researchers worldwide continue to make remarkable advances in our understanding of HIV, it is too early to celebrate. As we approach the 2020 milestone towards ending AIDS by 2030, we need to accelerate investments and efforts. There is still much more to be done to support the needs of those living with HIV today and to reach our goal of ending AIDS.

Dr. Julio Montaner is the Executive Director and Physician-in-Chief of the BC-CfE

ZForecast NewsletterPrinter Friendly

SIGN UP TO RECEIVE THE FORECAST NEWSLETTER BY EMAIL!

CLICK TO SIGN UP!

Tags:

STOP HIV/AIDS

SHAPE Study

Treatment as Prevention®

Wesseling T

Tim Wesseling

Peer Research Associate

Program(s): Epidemiology and Population Health
Initiative(s): SHAPE Study

HIV testing increases in BC, but access to medical care emerging issue

published on July 16, 2017 by Ellen Coulter, in News 1130

VANCOUVER (NEWS 1130) – The number of HIV tests performed across British Columbia has doubled since 2011, but preliminary study results shows access to care is emerging as an issue for patients.

Rolando Barrios with the BC Centre for Excellence in HIV/AIDS says HIV testing episodes have increased for men and women since a 2011 recommendation that BC healthcare providers offer tests to anyone over 18. The largest increase in testing has been for people over 50, who are more likely to go to hospital, where there is routine testing.

“We have doubled the number of HIV tests across the province,” he says. “This routine testing has led to early engagement into care and treatment of people who are HIV positive and also the offer of therapy.”

While that’s good news, there is a concerning emerging trend that’s been identified in preliminary study results.

The STOP HIV/AIDS Program Evaluation (SHAPE) Study aims to find out more about what influences people’s decisions and attitudes toward accessing HIV health care and what helps people stay in care.

Early results show 79 per cent of the 454 participants always find it easy access HIV care. But 94 participants identified issues, particularly that they don’t know who to talk to about HIV care, and that services were too far away or not available.

Barrios says most people that have been part of the study so far come from outside Vancouver, which may explain why they’re reporting issues with appointment availability, waiting times and services being too far away.

“So that really tells you that geography might be an issue in terms of moving around and having to access care outside of their community,” says Barrios.

View the full article >>

Tags:

STOP HIV/AIDS

SHAPE Study

Treatment as Prevention®

Rolando Barrios

Salters KA

Kate Salters

Research Scientist

Program(s): Viral Hepatitis Research Program (VHRP)Epidemiology and Population Health
Initiative(s): COAST SHAPE Study THRIVE CANOC LISA

Kate is a Research Scientist with the Epidemiology and Population Health program. Her program of research focuses on health care engagement and health outcomes among people living with HIV and hepatitis C. She completed her PhD in health sciences from Simon Fraser University in 2017 and her scope of expertise includes reproductive health, HIV/AIDS, viral hepatitis, and health systems research. Kate is passionate about conducting clinical and epidemiologic studies that engages with community and helps to inform clinical practice and improve health service delivery.

BC Centre for Excellence in HIV/AIDS

Search form

SHAPE Study

SIGN UP TO RECEIVE THE FORECAST NEWSLETTER BY EMAIL!

Tags:

Tags:

SIGN UP TO RECEIVE THE FORECAST NEWSLETTER BY EMAIL!

Tags:

Tags:

Search form