Sean Yaphe

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.

Objectives: Sexual dysfunction (SD) is common among gay, bisexual and other men who have sex with men (GBM) with HIV, yet little is known about their views on SD care. We explored these views to inform patient‐centred SD care to improve care delivery and sexual health outcomes. Methods: Semi‐structured interviews were conducted in 2024 with 31 Montreal‐based GBM with HIV who experienced SD in the last 5 years (reduced libido, erectile dysfunction, premature/delayed ejaculation and/or pain during sex), covering SD care experiences and preferences. Thematic analysis was applied to interview transcripts. Results: Participants mostly reported reduced libido (83.9%) and erectile dysfunction (ED(80.6%), with over half (58.0%) experiencing multiple SDs concurrently. Themes regarding SD care experiences were (1) costs and benefits of ED medication, (2) limited benefits of testosterone replacement therapy, (3) mixed views on talk therapy (and a preference for group therapy), and (4) not seeking care due to questions of SD definition and normalcy. SD care preferences concerned both provider characteristics (identity, approach to patients and expertise) and care delivery (information provision, involvement and respect and access to diverse resources). Conclusions: Irrespective of the approach to SD care sought (medication or talk therapy), participants experienced limited success. For some, doubts about the severity of their SD impeded help‐seeking. SD care preferences for the provider (e.g., expertise) and care provided (e.g., information, patient involvement) offer paths to more patient‐centred care.

Background: COVID-19, a novel respiratory illness caused by SARS-CoV-2, has become a global pandemic. As of December 2020, 4.8% of the 941 people living with HIV in our Ryan White clinic have tested polymerase chain reaction positive for SARS-CoV-2. The aim of our study was to estimate the seroprevalence of COVID-19 in our Ryan White people living with HIV, irrespective of known past infection. Methods: We conducted a cross-sectional study that recruited people living with HIV in the Ryan White program at Henry Ford Hospital in Detroit, Michigan, from September 2020 through May 2021. All Ryan White patients were offered participation during clinic visits. After informed consent, patients completed a survey, and had blood sampled for SARS-CoV-2 antibody testing. Results: Of the 529 individuals who completed the written survey, 504 participants were tested for SARS-CoV-2 antibody and 52 people living with HIV were COVID-19 immunoglobulin (Ig) G positive resulting in a seroprevalence of 10.3%. Among 36 persons with PCR-confirmed COVID-19, 52.8% were IgG negative. Inclusion of PCR positive but IgG-negative people living with HIV yields a COVID-19 infection prevalence of 14.1%. Conclusions: These findings suggest that passive public health-based antibody surveillance in people living with HIV significantly underestimates past infection.

Sternoclavicular joint osteomyelitis is extremely rare, with only 225 reported cases in the last 45 years. We present an unusual case in an otherwise healthy 55-year-old man with a history of well-controlled type 2 diabetes mellitus and hypertension. He presented to the emergency department after a week of left knee pain that worsened to full-body joint pain with left sternoclavicular swelling. He was started on antibiotics with multiple washouts of the left knee and treated for septic arthritis. By MRI and CT, he was found to have left sternoclavicular joint osteomyelitis and abscess and underwent debridement and resection. We believe that the initial joint injection resulted in haematogenous spread to the left sternoclavicular joint, stressing the importance of a sterile field for joint procedures.

Infections are important complications of end-stage renal disease (ESRD) with few studies having investigated oral antibiotic use. Inappropriate antibiotic prescribing can contribute to multi-drug resistant organisms (MDRO) and Clostridioides difficile (CDI) infections seen in ESRD. This study investigates antibiotic prescribing practices in ESRD across New York State (NYS). Retrospective case-control study from 2016 to 2017 of NYS ESRD and non-ESRD patients analyzing Medicare part B billing codes, 7 days before and 3 days after part D claims. Frequencies of each infection, each antibiotic, dosages, and the antibiotics associated with infections were assessed using chi-square analysis. A NYS small dialysis organization comprising approximately 2200 patients was also analyzed. Outcomes measured were the frequencies of infections and of each antibiotic prescribed. Incidence measures included antibiotics/1000 and individuals receiving antibiotics/1000. 48,100 infections were treated in 35,369 ESRD patients and 2,544,443 infections treated in 3,777,314 non-ESRD patients. ESRD patients were younger, male, and African American. ESRD and non-ESRD patients receiving antibiotics was 520.29/1000 and 296.48/1000, respectively (p<0.05). The prescription incidence was 1359.95/1000 ESRD vs 673.61/1000 non-ESRD patients. In 36%, trimethoprim-sulfamethoxazole dosage was elevated by current ESRD guidelines. Top infectious categories included non-specific symptoms, skin, and respiratory for ESRD; and respiratory, nonspecific symptoms, and genitourinary in non-ESRD. This study Identifies issues with appropriate antibiotic usage stressing the importance of antibiotic education to nephrologist and non-nephrologist providers. It provides support for outpatient antibiotic stewardship programs.