Jason Wong

Objective: Public health surveillance (PHS) supports the detection of health threats, monitoring of population health, and coordinated public health action. While its core functions remain unchanged, Canada’s last national vision for PHS was articulated in 2016, and the public health landscape has since evolved considerably. These changes have been shaped by lessons from the COVID-19 pandemic, advances in data systems and technologies, evolving data governance expectations, and increasing demand for timely, integrated public health information. We therefore sought to develop a renewed vision for PHS in Canada through broad engagement, qualitative synthesis, and expert consensus. Methods: This work used a two-phase, multi-method approach. First, national engagement with public health interest holders was conducted between September 2023 and March 2024 through regional consultations, an expert meeting, and an online survey. Qualitative data were analyzed using reflexive thematic analysis to generate draft vision components and statements. Second, a three-round modified Delphi process with Canadian PHS experts was used to iteratively review, refine, and assess agreement on the draft statements. Results: Engagement activities captured input from 1740 participants across Canada, generating 38 draft statements organized within a conceptual framework. Through the Delphi process, experts refined statements based on quantitative agreement measures and qualitative feedback, achieving consensus on a final set of 30 statements. Conclusions: The resulting vision provides a shared reference point for public health professionals and partners to align efforts to strengthen and modernize PHS systems in Canada.

Background: Anal squamous cell carcinoma caused by human papillomavirus disproportionately affects people living with human immunodeficiency virus (HIV; PLWH), particularly gay, bisexual, and other men who have sex with men (GBM). New guidelines recommend screening and treatment of precancerous lesions. We aimed to estimate anal cancer incidence by HIV status, sex, and GBM status in British Columbia, Canada. Methods: Using administrative health databases, we assessed anal cancer stratified by HIV status, sex, and sexual orientation from 1990 to 2019. A phenotypic algorithm was used to classify GBM status. We evaluated the comparative incidence of anal cancer using Fine and Gray’s competing risks subdistribution hazards model. Hazard ratios (HR) were estimated and adjusted for age, healthcare utilization, urbanicity, and Charlson comorbidity index. Results: Among 571 anal cancer diagnoses assessed, the incidence was highest among GBM with HIV [78.09 per 100,000 person-years (PY); 95% confidence interval (CI), 61.24–99.58], followed by heterosexual males with HIV (44.49 per 100,000 PY; 95% CI, 29.56–66.95) and females with HIV (12.05 per 100,000 PY; 95% CI, 4.52–32.11). GBM with HIV experience a 76-fold increased anal cancer risk compared with heterosexual men without HIV (adjusted HR 76.08; 95% CI, 55.14–104.97). Conclusions: There is an unmet need in anal cancer prevention among PLWH. Screening strategies that are sensitive, specific, acceptable, and cost-effective are necessary. Impact: This study provides the first population-based estimates of anal cancer incidence by HIV and GBM status in British Columbia, highlighting disparities and rising trends. These findings support prioritizing targeted screening programs and improving access to care.

Background: Public health ethics provides a framework for navigating ethical dilemmas, distinguished from clinical bioethics by its focus on population health, prevention, and explicit acknowledgement of political context. While public health ethical frameworks have been developed, concerns are raised about lack of utility or integration of equity and Indigenous perspectives (First Nations, Inuit, Métis). This study aimed to engage groups impacted by public health decisions to identify ethical values and develop recommendations for public health ethics practice in British Columbia. Methods: A two-phase, community-engaged qualitative study was conducted from March 2024 to January 2025. 40 public health professionals and members of equity-deserving groups (people with disabilities, Indigenous Peoples, newcomer, seniors), were recruited for interviews or focus groups in phase one. Phase two involved follow-up surveys or interviews with 18 participants. Directed content analysis was utilized to identify themes. Results: Participants emphasized the importance of equity, humanization, Indigenous Cultural Safety, and wholistic wellbeing, as well as relational values of trust and transparency. Recommendations included increasing equity through addressing social determinants of health and developing accessible practice tools. Conclusions: Engaging equity-deserving groups generated insights and actionable recommendations to improve equity, strengthen public health ethics practice and build trust in public health.

Background: Previous research suggests the COVID-19 pandemic was associated with reductions in HBV testing early in the pandemic. However, impacts of the pandemic on HBV testing in the longer-term and among people who inject drugs (PWID) are unclear. We investigated the impact of the pandemic and related policies on HBV testing from 2020 to 2022, including among PWID, in British Columbia (BC), Canada. Methods: Using population data from the BC COVID-19 Cohort, we conducted interrupted time series analyses of HBV surface antigen (HBsAg), HBV DNA, and HBV e-antigen (HBeAg) testing. The study included a prepandemic period (January 2017–February 2020), a transition period (March–May 2020), and pandemic periods in 2020 (June–December), 2021, and 2022. Results: HBsAg testing decreased by 16.5% (95% CI 13.9–18.9) and HBV DNA testing decreased by 11.6% (95% CI 9.5–13.6) in June–December 2020 relative to predicted levels, and testing remained lower than predicted throughout 2021 and 2022. Percentage reductions in HBV DNA testing were greater for PWID compared with non-PWID in 2020 (30.0% vs 11.2%) and thereafter. Changes in HBeAg testing overall were less pronounced but varied by sex and age. Conclusions: The pandemic and related policies were associated with decreases in HBsAg and HBV DNA testing in 2020, and testing remained lower than predicted throughout 2021 and 2022. Additional efforts to increase HBV testing are needed, including strategies to ensure linkage to care for PWID.

Background: Men who have sex with men (MSM) and transgender women experience high sexually transmitted infection (STI) rates. This study evaluated the feasibility of doxycycline pre-exposure prophylaxis (doxyPrEP) for STI prevention in these key populations. Methods: Sexually-active MSM and transgender women without human immunodeficiency virus (HIV) with prior syphilis were recruited. Participants initiated HIV PrEP with tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) daily for 48 weeks and were randomized 1:1 to daily doxyPrEP for 48 weeks (immediate arm), or doxyPrEP initiated at 24 weeks (deferred arm). Primary outcomes included adherence, measured using questionnaires, along with tolerability; STI incidence (chlamydia, gonorrhea, syphilis) was a secondary outcome. Nasal carriage of Staphylococccus aureus was assessed serially for doxycycline resistance. Results: Fifty-two participants were enrolled into the immediate (n = 26) and deferred (n = 26) arms. At 48 weeks, self-reported adherence (≥95%) was 75.0% versus 66.7% (P = .538) for TDF/FTC, and 70.8% versus 61.9% (P = .526) for doxycycline in the immediate versus deferred arms, respectively. No doxyPrEP-related serious adverse events occurred. Incidence of any STI at 24 weeks was reduced in the immediate versus deferred arms, and over 48 weeks, being on doxycycline (vs being off; ie, first 24 weeks of deferred arm) was associated with STI reduction (adjusted odds ratio [aOR] 0.36; 95% confidence interval [CI]: .15–.89). Emergent doxycycline-resistant S. aureus was identified in six individuals, with five in the immediate arm (P = .077). Conclusions: Dual HIV/doxyPrEP is feasible and associated with a significant reduction in incident STI. Further evaluation of dosing strategies, efficacy and impact on antimicrobial resistance is warranted.

We investigated the impacts of the COVID-19 pandemic on hepatitis C (HCV) treatment initiation, including by birth cohort and injection drug use status, in British Columbia (BC), Canada. Using population data from the BC COVID-19 Cohort, we conducted interrupted time series analyses, estimating changes in HCV treatment initiation following the introduction of pandemic-related policies in March 2020. The study included a pre-policy period (April 2018 to March 2020) and three follow-up periods (April to December 2020, January to December 2021, and January to December 2022). The level of HCV treatment initiation decreased by 26% in April 2020 (rate ratio 0.74, 95% confidence interval [CI] 0.60 to 0.91). Overall, no statistically significant difference in HCV treatment initiation occurred over the 2020 and 2021 post-policy periods, and an increase of 34.4% (95% CI 0.6 to 75.8) occurred in 2022 (equating to 321 additional people initiating treatment), relative to expectation. Decreases in HCV treatment initiation occurred in 2020 for people born between 1965 and 1974 (25.5%) and people who inject drugs (24.5%), relative to expectation. In summary, the pandemic was associated with short-term disruptions in HCV treatment initiation in BC, which were greater for people born 1965 to 1974 and people who inject drugs.

Background Evidence of long-term impacts of COVID-19 related public health restrictions on digital sexually transmitted and blood borne infection (STBBI) testing utilization is limited. We assessed these impacts on GetCheckedOnline (a digital testing resource for STBBIs) relative to all STBBI tests in British Columbia (BC). Methods Interrupted time series analyses were conducted using GetCheckedOnline program data comparing monthly test episodes (STBBI tests per requisition) among BC residents, stratified by BC region, testers’ sociodemographic and sexual risk profiles, for the pre-pandemic (March 2018-February 2020) and pandemic periods (March 2020-October 2021). Trends in GetCheckedOnline testing per 100 STBBI tests in BC regions with GetCheckedOnline were analysed. Each outcome was modelled using segmented generalized least squared regression. Results Overall, 17,215 and 22,646 test episodes were conducted in the pre-pandemic and pandemic periods. Monthly GetCheckedOnline test episodes reduced immediately after restrictions. By October 2021(end of pandemic period), monthly GetCheckedOnline testing increased 21.24 test episodes per million BC residents (95%CI: -11.88, 54.84) and GetCheckedOnline tests per 100 tests in corresponding BC regions increased 1.10 (95%CI: 0.02, 2.17) above baseline trends. After initial increases among users at higher STBBI risk (symptomatic testers/testers reporting sexual contacts with STBBIs), testing decreased below baseline trends later in the pandemic, while monthly GetCheckedOnline testing increased among people ≥40 years, men who have sex with men, racialized minorities, and first-time testers via GetCheckedOnline. Conclusions Sustained increases in utilization of digital STBBI testing during the pandemic suggest fundamental changes in STBBI testing in BC, highlighting the need for accessible and appropriate digital testing, especially for those most affected by STBBIs.

Individuals unaware of their HIV seropositive status continue to represent a key “driver” of the HIV epidemic. Strategies to improve initiation into the HIV treatment cascade, including among young men, are required. This study assesses the acceptability of three HIV testing options among young cisgender men living in Vancouver, British Columbia. Using a modified grounded theory approach, we conducted semi-structured interviews with 45 young cisgender men ages 18–30 years to identify the factors influencing the acceptability of diverse HIV testing approaches. Participants ascribed value to non-nominal testing as a means of providing a secure pathway to HIV-related care for those who test positive while also safeguarding privacy. Anonymous HIV testing was problematized by participants as potentially creating difficulty in accessing ongoing HIV-related care. Most participants preferred non-nominal testing. Nevertheless, based on principles of equity, we argue that anonymous access to one's serostatus should be available, especially within a criminalized context.