Alexandra de Pokomandy

Background: We compared the prevalence of vaccine-preventable anal human papillomavirus (HPV) types among gay, bisexual, and other men who have sex with men (GBM) living in large cities in Canada from 2019 to 2021 by age and human immunodeficiency virus (HIV) status. Methods: Sexually active GBM ≥16 years were recruited in Montreal, Toronto, and Vancouver using respondent-driven sampling (RDS). Participants self-reported HPV vaccination and self-collected anal HPV specimens. We estimated the prevalence of vaccine-preventable types for participants during the 2019–2021 period. We report RDS-II-weighted prevalence and confounder-adjusted prevalence ratios (aPRs) comparing vaccinated (≥1 dose) and unvaccinated GBM using multivariable Poisson regression. Results: Among 1519 participants aged 18–83 (median 35 years), 17.6% had HIV, and 62.2%, 40.2%, and 15.0% were vaccinated in the 16–26-, 27–45-, and ≥46-year groups, respectively. Among GBM 16–26 years, HPV6/11/16/18 prevalence was lower among those vaccinated ≤23 years (aPR = 0.40, 95% CI: .20–.77), ≥3 years since first dose (aPR = 0.39; 95% CI: .18–.85), and those with ≤5 years of sexual activity before vaccination (aPR = 0.47; 95% CI: .25–.89). HPV6/11/16/18/31/33/45/52/58 prevalence was lower among those vaccinated ≤26 years in GBM aged 27–45 years (aPR = 0.81, 95% CI, .61–1.08), though this did not reach statistical significance. Conclusions: Five years after implementation of Canadian HPV vaccination programs for younger GBM, anal HPV prevalence was lower among those vaccinated at younger ages and near sexual debut.

Objectives: Material deprivation (MD), the inability to afford essentials, is linked with poorer HIV clinical outcomes. In Canada, migrants living with HIV are a growing group, yet little is known about their experience of MD, especially early in treatment. This study examined the prevalence, nature, sociodemographic and clinical correlates and longitudinal changes in MD among migrants living with HIV initiating antiretroviral therapy (ART). Methods: Analyses used data from 56 ART‐naïve migrants enrolled in the Antiretroviral Speed Access Program (ASAP), a cohort at the McGill University Health Centre, Montreal, Canada receiving access to rapid, no‐cost and onsite bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF). MD was assessed at Weeks 4 and 48 using the 17‐item Canadian Material Deprivation Index (CMDI), with deprivation defined as checking ≥2 items. Statistical tests included Fisher's exact, Wilcoxon signed‐rank, McNemar's exact and correlation coefficients. Results: At Week 4, 48 (85.7%) participants were materially deprived, most commonly reporting inability to cover an unexpected expense (87.5%), afford dental care (73.2%) or buy small gifts (73.2%). Week 4 MD was significantly associated with occupation ( p = 0.020) and migration status ( p = 0.016). No statistically significant associations were observed between MD and HIV clinical outcomes. Between Weeks 4 and 48, MD scores declined significantly (median: 7.5 to 4.0; p < 0.001), although 67.9% of participants remained deprived. Conclusions: Associated with occupation and migrant status, MD was highly prevalent and persistent among migrants living with HIV, despite partial improvement over time, underscoring the need for structural supports. Short‐term HIV clinical outcomes appeared unaffected, which may reflect access to rapid, no‐cost and onsite ART delivery.

Objectives: Migrants are disproportionately affected by HIV and face inequities in accessing care. This study examined the HIV care cascade among newly registered adults at the Chronic Viral Illness Service (CVIS). Methods: We conducted a retrospective cohort study of adults (≥18 years) living with HIV and newly registered at the CVIS, in Montréal, Canada, between January 1st, 2022, and December 31st, 2024. Sociodemographic, clinical and care cascade data were extracted from electronic records. Multivariable logistic regression models, adjusted for age, gender, region of birth and diagnosis type, examined associations between seven migration status categories and cascade outcomes. Results: Among 695 patients, 664 (95%) were born outside Canada and 528 (76%) were refugees/asylum seekers. Of these, 281/695 (40%) had a new HIV diagnosis. Among newly diagnosed refugees/asylum seekers, median time from diagnosis to linkage to care was 28 days (interquartile range [IQR]: 18–42). Median time from linkage to antiretroviral therapy (ART) prescription ranged from 0 (IQR: 0–0) to 18 (IQR: 9–27) days across groups. At 6 months, 618/695 (89%) were retained in care and 603/618 (98%) were on ART. At 12 months, 530/603 (88%) were in care and 511/530 (96%) were virally suppressed. In exploratory adjusted analyses, Canadian citizens had lower odds of retention (aOR 0.32, 95% CI 0.14–0.75) and viral suppression (aOR 0.33, 95% CI 0.15–0.75) at 12 months. Conclusions: Among newly diagnosed refugees/asylum seekers, linkage to care delays appear to have increased since pre‐pandemic estimates. Meaningful heterogeneity across migration groups highlights the limitations of treating migrants as a homogeneous population in HIV care.

Background: Transgender (trans) women living with HIV often face barriers to accessing inclusive and comprehensive primary and HIV care. Objectives: We aimed to (1) describe differences in trans women’s disclosure of their trans identity and comfort discussing trans identity and trans-specific healthcare needs, based on physician type, and (2) report on the prevalence of negative trans-specific experiences with HIV physicians and any provider-related factors associated with comfort. Design: Data of trans participants in the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS) were analyzed across three waves (2013–2018). Methods: Descriptive statistics explored disclosure of trans identity and comfort discussing trans-specific healthcare needs with family physicians versus HIV physicians. Fisher’s exact tests of association explored the relationship between provider-related factors and self-reported comfort. Prevalence of negative trans-specific experiences with HIV physicians was reported. Results: At baseline, of 54 trans women, 39 (72.2%) had a physician who supervised their HIV care in the year preceding (HIV physician). Among this subset, 94.9% had disclosed their trans identity and 82.1% reported feeling comfortable discussing trans-specific healthcare needs with this physician. Of the 27 (50.0%) who reported having a regular family physician other than their HIV care provider, 92.6% had disclosed their trans identity and 88.9% were comfortable discussing trans-specific healthcare needs. The most prevalent negative trans-specific experience with HIV physicians reported cumulatively was being told by the physician that they did not know enough about trans-related care to provide care (16.7%). Conclusion: Our findings demonstrate a high prevalence of disclosure of trans identity to physicians among our trans participants. Our findings suggest trans women have similar comfort discussing trans-specific healthcare needs with their family and HIV physicians; however, negative experiences with HIV providers indicate the need for gender-affirming, trans-specific provider training.

Introduction: Experiencing childhood abuse elevates risks for long-term mental health challenges (MHCs); this complex relationship is underexplored among women with HIV. Informed by the “chains of risk” life-course approach, we examined pathways from childhood abuse to mental health among women with HIV. Methods: Using longitudinal data from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study, we examined associations between childhood abuse history (sexual, physical, and verbal) and current poverty (income, food insecurity, and housing insecurity) at time 1 (T1, August 2013–May 2015), substance use and past 3-month violence at time 2 (T2, June 2015–January 2017), and MHC (depression, post-traumatic stress disorder, and mental functioning) at time 3 (T3, from February 2017). We conducted path analysis to examine direct and indirect effects from childhood abuse to adult MHC through poverty, substance abuse, and violence. Findings: Most participants (68%) with reported data (n = 1315) experienced childhood abuse. Childhood abuse was associated with adulthood poverty, violence, substance use, and MHC. T1 poverty was associated with T2 substance use and violence, and T3 MHC. Violence was associated with T3 MHC. The total standardized effect of childhood abuse on T3 MHC was 0.27 (P < 0.001). Half of this effect was indirect (β = 0.13, P < 0.001), with poverty accounting for 43% of the total indirect effect (β = 0.06, P = 0.003). Conclusions: Among women with HIV in Canada, childhood abuse was associated with poorer adulthood mental health; this association was mediated by poverty, violence, and substance use in adulthood. The findings emphasize the need for life-course approaches in women-centered violence and trauma-aware HIV care.

The progression of metabolic dysfunction-associated steatotic liver disease (MASLD) to severe forms, including metabolic dysfunction-associated steatohepatitis (MASH) and liver fibrosis, involves metabolic dysfunction, genetics, and gut dysbiosis. People with HIV (PWH) represent a high-risk group for MASLD, but the role of gut microbiota alterations in disease severity within this population remains poorly understood. We prospectively recruited PWH with MASLD, defined as the controlled attenuation parameter (CAP) ≥ 238 dB/m, and excluded those with viral hepatitis coinfection or alcohol abuse. Severe MASLD was defined as the presence of MASH (cytokeratin-18 ≥ 130.5 U/L) and/or significant liver fibrosis (liver stiffness ≥ 7.1 kPa). Stool samples were collected for 16S rRNA gene sequencing to characterize gut microbiota composition. Functional predictions were generated using PICRUSt. The differential abundance of bacterial taxa and predicted functions were analyzed using a generalized linear model with a negative binomial distribution. Among 34 PWH with MASLD, 18 (53%) met the criteria for severe MASLD. Microbiota profiling revealed significant differences in bacterial genera between the PWH with and without severe MASLD. Enrichment was observed in the Ruminococcus gnavus group, Negativibacillus, Holdemanella, Subdoligranulum, the Eubacterium hallii group, and Butyricicoccus, while depletion was seen in Prevotella, Alloprevotella, Dialister, Catenibacterium, the Christensenellaceae R 7 group, Clostridium sensu stricto, Olsenella, Oscillospiraceae UCG-005, Libanicoccus, and the Eubacterium siraeum group. Predicted functional pathways related to fatty acid degradation, folate biosynthesis, and amino acids metabolism did not differ between groups. MASLD severity in PWH is associated with a distinct gut microbiota signature, though not with functional pathway alterations. Microbial profiling may complement existing non-invasive biomarkers for risk stratification in this high-risk population.

Background: Traditionally, ≥95% adherence was recommended for viral suppression (VS). Newer antiretroviral therapy (ART) is now being increasingly prescribed and may be more forgiving of lower adherence. The lifelong nature of ART presents adherence challenges, particularly for women living with HIV. We aimed to describe ART use and examine the association between adherence and VS.Methods: The Canadian HIV Women's Sexual and Reproductive Health Cohort, which included 1422 participants, was used. Data was collected three times, at 18‐month intervals, between 2013 and 2018. A Sankey diagram illustrated longitudinal ART trends among participants who reported their ART use. Cross‐sectional analysis using 2017–2018 data included participants who self‐reported their regimen, ART adherence, and viral load. Utilizing logistic regression models, self‐reported adherence (percentage of ART taken in the past month) and self‐reported VS (most recent n = 1187), integrase inhibitor use increased from 13.6% (n = 162) to 30.6% (n = 363), while other classes decreased. Among 617 participants assessed between 2017 and 2018, <70% adherence levels (adjusted odds ratio [aOR]: 0.06, 95% confidence interval [CI]: 0.01–0.27), 70%–79% adherence (aOR: 0.29, 95% CI: 0.05–1.77) and 80%–89% (aOR: 0.21, 95% CI: 0.05–0.86) were associated with lower odds of reporting VS compared with ≥95% adherence, although statistically not significant for 70%–79% adherence. No difference was found for 90%–94% adherence (aOR: 1.04, 95% CI: 0.20–5.32) compared with ≥95%.Conclusion: Our findings suggest that ART adherence levels lower than 90% are associated with a lower likelihood of VS among women living with HIV.

Background: Social determinants of health (SDoH) can significantly impact overall well‐being. While existing research has explored SDoH as predictors of well‐being among women living with HIV, longitudinal studies examining these relationships over time remain limited. We examined SDoH typologies among women living with HIV in Canada and longitudinal associations with well‐being.Methods: Using longitudinal survey data collected at three time points from women living with HIV in Canada (2013–2018), we conducted latent class analysis (LCA) to identify subgroups of SDoH indicators, including income, experiences of violence, food security, substance use, housing stability, HIV‐related stigma and social support at baseline (Time‐1). Multivariable linear and logistic regression examined associations between SDoH classes and well‐being (depression, discrimination [gender, racial] and HIV clinical outcomes [viral load, adherence, HIV care barriers]) at Time‐3.Results: We identified three distinct SDoH classes among participants (n = 1422, mean age = 42.8): high (n = 435; 30.6%), medium (n = 377; 26.5%) and low SDoH adversity (n = 610; 42.9%). In multivariate regression analyses, the high SDoH adversity class had lower odds of achieving an undetectable viral load (adjusted Odds Ratio [aOR] = 0.46; 95% CI: 0.21, 1.01; p = 0.050) and higher probability of facing barriers to accessing care (aβ = 0.32; 95% CI: 0.19, 0.45; p < 0.001), depression (aOR = 2.52; 95% CI: 1.71, 3.71; p < 0.001), racial discrimination (aβ = 3.42; 95% CI: 1.72, 5.12; p < 0.001) and gender discrimination (aβ = 3.14; 95% CI: 1.42, 4.87; p < 0.001), compared with the low SDoH adversity class at 5‐year follow‐up.Conclusions: SDoH adversities were associated with poor wellbeing among women living with HIV in Canada. Integrated, comprehensive person‐centred care approaches that address SDoH are needed to improve health and wellbeing.

Background: While the negative effects of mental health issues on HIV clinical outcomes have been well‐documented, the impact of mental health treatment on the HIV care cascade is largely uncharacterized. The objective of this study was to describe the engagement of women with mental health conditions and symptoms, who reported using mental health services, across the HIV care cascade and to assess the relationship between mental health service use and HIV care steps. Methods: Longitudinal data were analysed from participants enrolled in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS) (2013–2018) who had clinically significant depressive symptoms or reported a mental health diagnosis at baseline. Among this subset, four states of HIV care were defined at baseline, 18 months and 36 months: (1) unengaged in care (did not visit an HIV provider in the past year), (2) not on antiretroviral therapy (ART) (visited an HIV provider in the past year but did not report current ART use), (3) detectable (reported current ART use but a detectable viral load) and (4) optimal (reported current ART use and an undetectable viral load). Sankey diagrams were used to illustrate the engagement of women across the HIV care cascade over 3 years based on their self‐reported use of mental health services at baseline. The association between mental health service use and care state at baseline was analysed using multinomial logistic regression models. Results: Of the 898 women in the cohort with significant depressive symptoms or mental health conditions at baseline, 3.8% ( n = 34) were unengaged in care , 10.9% ( n = 98) were not on ART , 12.4% ( n = 111) were detectable and 72.9% ( n = 655) were optimal . Over the 36 months, 51.0% of women transitioned between states at least once. When stratified by service use, women who reported use of mental health services at baseline had better engagement across the care cascade and had fewer transitions between states over the 3 years, 37.2% of which were to better states of care. The use of mental health services at baseline was also significantly associated with greater odds of engagement in the optimal state compared with not on ART (adjusted odds ratio [aOR]: 1.72, 95% confidence interval [CI]: 1.07–2.77). A similar but statistically insignificant association was found with the detectable care state (aOR: 1.67, 95% CI: 0.92–3.03). Conclusions: Our findings demonstrate that linkage to mental health care has a positive impact on HIV care outcomes among women. Accessible mental health services may serve to improve both mental well‐being and progression of these patients along the HIV care cascade, thereby achieving individual and public health goals.