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Lima VD, Zhu J, Barrios R, Toy J, Joy JB, Williams BG, Granich R, Wu Z, Wong J, Montaner JSG. Longitudinal evolution of the HIV effective reproduction number following sequential expansion of treatment as prevention and pre-exposure prophylaxis in British Columbia, Canada: a population-level programme evaluation. Lancet HIV 2024; 11:e461-e469. [PMID: 38848736 DOI: 10.1016/s2352-3018(24)00094-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/27/2024] [Accepted: 04/04/2024] [Indexed: 06/09/2024]
Abstract
BACKGROUND Treatment as prevention and pre-exposure prophylaxis (PrEP) are key strategies in the control of HIV/AIDS. We aimed to characterise the longitudinal effects of antiretroviral therapy (ART), followed by treatment as prevention and the addition of PrEP, on the HIV effective reproduction number (Re) in British Columbia, Canada. METHODS This population-level programme evaluation used data from the Drug Treatment Program of the British Columbia Centre for Excellence in HIV/AIDS (Vancouver, British Columbia, Canada). We also used estimates of HIV incidence and prevalence from the Public Health Agency of Canada, data on the number of new HIV diagnoses per year from the British Columbia Centre for Disease Control, and mortality data from the British Columbia Vital Statistics Agency. Data were obtained from 1985 until 2022, depending on the database source. Outcomes were the annual HIV prevalence, HIV incidence, number of new HIV diagnoses, number of people living with HIV on ART, HIV/AIDS-related and all-cause mortality rates, the HIV incidence-to-all-cause-mortality ratio, and Re. We calculated the modified effective reproduction number (Rme) using two thresholds of viral suppression and compared these values with Re. FINDINGS We found a 95% decline in HIV/AIDS-related mortality and a 91% decrease in HIV incidence over the study period. The Re progressively declined from 1996 to 2022; however, from 1996 to 2017, Rme remained stable (>1) when calculated for people living with HIV with unsuppressed viraemia, suggesting that treatment as prevention reduces HIV incidence by decreasing the pool of individuals who are potentially able to transmit the virus. From 2018 to 2022, a decline in the estimated Re and Rme (<1) was observed regardless of whether we considered all people living with HIV or only those who were virologically unsuppressed. This finding suggests that PrEP decreases HIV incidence by reducing the number of susceptible individuals in the community, independently of viral suppression. INTERPRETATION Our results show the synergy between generalised treatment as prevention and targeted PrEP in terms of decreasing HIV incidence. These findings support the incorporation of longitudinal monitoring of Re at a programmatic level to identify opportunities for the optimisation of treatment-as-prevention and PrEP programmes. FUNDING British Columbia Ministry of Health, Health Canada, Public Health Agency of Canada, Vancouver Coastal Health, Vancouver General Hospital Foundation, Genome British Columbia, and the Canadian Institutes of Health Research.
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Affiliation(s)
- Viviane D Lima
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Jielin Zhu
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Junine Toy
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Jeffrey B Joy
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Brian G Williams
- South African Centre for Epidemiological Modelling and Analysis, University of Stellenbosch, Stellenbosch, South Africa
| | | | - Zunyou Wu
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jason Wong
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada; British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada; Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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Yazdani K, Dhillon N, Tung A, Ye M, Trigg J, Stanley C, Ni Gusti Ayu N, McLinden T, Lima VD, Barrios R, Hogg R, Montaner JSG, Salters K. Dynamics of overdose and non-overdose mortality among people living with HIV amidst the illicit drug toxicity crisis in British Columbia. AIDS Care 2024; 36:263-271. [PMID: 37094365 DOI: 10.1080/09540121.2023.2195605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/20/2023] [Indexed: 04/26/2023]
Abstract
We sought to characterize overdose and non-overdose mortality among PLWH amidst the illicit drug toxicity crisis in British Columbia, Canada. A population-based analysis of PLWH (age ≥19) in British Columbia accessing healthcare from April 1996 to March 2017 was conducted using data from the Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) cohort linkage. Underlying causes of deaths were stratified into overdose and non-overdose causes. We compared (bivariate analysis) health-related characteristics and prescription history between PLWH died of overdose and non-overdose causes between April 2009 and March 2017. Among 9,180 PLWH, we observed 962 deaths (142 [14.7%] overdoses; 820 [85.2%] other causes). Compared to those who died from other causes, those who died of overdose were significantly younger (median age [Q, Q3]: 46 years [42, 52] vs. 54 years [48, 63]); had an indication of chronic pain (35.9% vs. 27.1%) and hepatitis C virus (64.8% vs. 50.4%), but fewer experienced hospitalization in the year before death. PLWH who died were most likely to be prescribed with opioids (>50%) and least likely with opioid agonist therapy (<10%) in a year before death. These findings highlight the syndemic of substance use, HCV, and chronic pain, and how the crisis is unqiuely impacting females and younger people.
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Affiliation(s)
- Kiana Yazdani
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Nalin Dhillon
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Audrey Tung
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Monica Ye
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Jason Trigg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Cole Stanley
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Nanditha Ni Gusti Ayu
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Taylor McLinden
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - Viviane D Lima
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Vancouver Coastal Health, Vancouver, Canada
| | - Robert Hogg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Julio S G Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Kate Salters
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
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Yazdani K, Dolguikh K, Ye M, Trigg J, Joe R, Emerson SD, Montaner JS, Barrios R, Salters K. Characterizing opioid agonist therapy uptake and factors associated with treatment retention among people with HIV in British Columbia, Canada. Prev Med Rep 2023; 35:102305. [PMID: 37519440 PMCID: PMC10382920 DOI: 10.1016/j.pmedr.2023.102305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 06/21/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
Accidental overdoses are now the leading cause of death among people with HIV (PWH) in British Columbia (BC). We examined the utilization and retention of opioid agonist therapy (OAT). Adult PWH (≥19 years) with ≥ 1 OAT dispensation in BC between 2008 and 2020 were included (n = 1,515). OAT treatment episodes were formed based on specific criteria for slow-release oral morphine (SROM), methadone, injectable OAT (iOAT), and buprenorphine/naloxone. Retention in treatment was defined as any episode lasting ≥ 12 months. Logistic regression with generalized estimating equations modeled retention-associated factors. There was a 56.6% decline in OAT retention over time. Buprenorphine treatment exhibited significantly lower odds of retention (OR: 0.58; 95% CI: 0.36-0.92) compared to methadone. Conversely, no significant change in retention odds was observed for SROM (0.72; 0.33-1.54) and iOAT (0.81; 0.31-2.12). Factors associated with increased odds of retention included a 10-year increase in age (1.69; 1.46-1.95), previous retention history (1.96; 1.40-2.73), achieving OAT therapeutic dose (8.22; 6.67-10.14), and suppressed HIV viral load (1.35; 1.10-1.67). Individuals with a lifetime HCV diagnosis receiving iOAT were more likely to retain (3.61; 1.20-10.83). Each additional year on OAT during the study period was associated with a 4% increase in the odds of retention. A significant proportion of PWH had a history of OAT prescribing but experienced low retention rates. Retention outcomes were more positive for SROM and iOAT. The association between OAT medication type and retention odds may be particularly influenced by HCV diagnosis. Optimal management of opioid use disorder among PWH, with an emphasis on attaining the therapeutic dose is crucial.
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Affiliation(s)
- Kiana Yazdani
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Katerina Dolguikh
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Monica Ye
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Jason Trigg
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Ronald Joe
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Scott D. Emerson
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
| | - Julio S.G. Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Rolando Barrios
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- The University of British Columbia, Vancouver, British Columbia, Canada
- Vancouver Coastal Health, Vancouver, British Columbia, Canada
| | - Kate Salters
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
- Simon Fraser University, Burnaby, British Columbia, Canada
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Klein MB. Living longer with HIV: gains for some but not for all. Lancet HIV 2023; 10:e275-e276. [PMID: 36958366 DOI: 10.1016/s2352-3018(23)00060-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/08/2023] [Indexed: 03/25/2023]
Affiliation(s)
- Marina B Klein
- Division of Infectious Diseases and Chronic Viral Illness Service, Department of Medicine, McGill University Health Centre, Montreal H4A 3J1, Canada.
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Grebely J, Collins AB, Artenie AA, Sutherland R, Meyer JP, Barocas JA, Falade-Nwulia O, Cepeda JA, Cunningham EB, Hajarizadeh B, Lafferty L, Lazarus JV, Bonn M, Marshall AD, Treloar C. Progress and remaining challenges to address hepatitis C, other infectious diseases, and drug-related harms to improve the health of people who use drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 96:103469. [PMID: 34610884 DOI: 10.1016/j.drugpo.2021.103469] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/08/2021] [Accepted: 09/09/2021] [Indexed: 12/31/2022]
Affiliation(s)
- Jason Grebely
- The Kirby Institute, UNSW Sydney, Sydney, Australia.
| | | | | | - Rachel Sutherland
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Jaimie P Meyer
- AIDS Program, Yale School of Medicine, New Haven, United States; Chronic Disease Epidemiology, Yale School of Public Health, New Haven, United States
| | - Joshua A Barocas
- Divisions of General Internal Medicine and Infectious Diseases, University of Colorado School of Medicine, Aurora, United States
| | - Oluwaseun Falade-Nwulia
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, United States
| | - Javier A Cepeda
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health,Baltimore, United States
| | | | | | - Lise Lafferty
- The Kirby Institute, UNSW Sydney, Sydney, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Matthew Bonn
- Canadian Association of People Who Use Drugs, Dartmouth, Canada
| | - Alison D Marshall
- The Kirby Institute, UNSW Sydney, Sydney, Australia; Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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