Tamara Barnett

In the last decade, hepatitis C virus (HCV) has become a curable chronic viral infection, with excellent treatment and streamlined diagnostic testing. Canada and many other countries have adopted national elimination targets; however, reaching these goals will require changes in the way care is provided. Standard of care HCV treatment is all-oral daily medication for 8 or 12 weeks and all provinces in Canada have mechanisms for public coverage. Unfortunately, vertical transmission continues to be the predominant reason for paediatric infection, but if diagnosed, children can be treated as young as 3 years old. Early paediatric diagnosis and cure are of the utmost importance to prevent complications such as adverse mental health outcomes and advanced liver disease early in life. One major barrier to paediatric diagnosis and cure is poor antibody screening uptake, as low as 23% by 18 months among children born to positive persons. In the United States, a landmark study showed a temporal decrease in screening rates from 91% at 2 months to 59% at 18 months. As such, the American Association for Study of the Liver/Infectious Disease Society of America, and very recently, the Centres for Disease Control and Prevention, now recommend screening by all children born to positive person for HCV RNA at 2-6 months of age. While antibody testing could still be completed at 18 months to determine serostatus, understanding if a child has active infection in infancy supports early linkage to care and decreases paediatric loss to follow-up.

BackgroundMpox was identified in many previously non-endemic countries, including Canada, as of May 2022. In response to the increase in cases in Canada, and more specifically the province of Ontario, the vaccine Imvamune was rolled out. Eligibility was governed by provincial health authorities, and the response varied by region. In addition, because eligibility language was describing certain types of sexual activity, there was potential for harm. The aim of this study was to further explore the experiences of vaccine recipients as it pertained to obtaining the vaccine, access to information and vaccination, self-assessment of risk, perspectives on vaccine rollout, stigma, and community support.MethodsAs a part of care, a clinic in downtown Toronto, Ontario, began hosting mpox immunizations clinics between July of 2022 and March of 2023 with a standard set of clinical intake questions. Following this period, we conducted a retrospective chart review of 113 Imvamune vaccine recipients. Both descriptive quantitative data and thematic qualitative analysis was completed.ResultsOne hundred thirteen patients received one or two doses of Imvamune between July 2022 and March 2023. The average age was 49 (range 17-78). Patients were not asked sex or gender; however, 111 patients had a male sex listed on their health card and three female sex, one of whom self-identified as a transwoman, with the remainder not having had their sex inputted into their medical records. Through descriptive thematic analysis, this study found the following recurrent themes mentioned by patients in the data set: 1) eligibility, 2) rollout and access, 3) mis/information in the media, 4) stigma.ConclusionsThere is little Canadian data on mpox vaccine rollout beyond epidemiologic and cohort information. Understanding the difficulties and stigma that were faced by vaccine recipients is crucial to ensure that when a public health initiative is initiated, that past traumas are not replicated. This study provides valuable patient perspectives in how to improve ongoing rollout, as well as how a campaign that includes a sexual health component may be more sensitively considered in the future.

Background: Canada is currently on target to reach the 2030 WHO goal of HCV elimination. Continued high rates of treatment are required to meet this goal. Novel models such as Tayside, Scotland pharmacy-based HCV screening and treatment have proven successful to engage people who use drugs (PWUD) in HCV therapy with a simplified, task-shifted cascade of care. This study seeks to determine whether these successes can be replicated at community pharmacies in Victoria BC. Methods: Four pharmacies who work with PWUD and provide opioid agonist therapy were trained to provide consent and perform point-of-care HCV antibody screening. They were supported by study nurse to link to HCV RNA testing when antibody positive patients were identified, with HCV treatment offered to RNA positive participants. Qualitative interviews were conducted with five pharmacy staff to explore experiences and feasibility of pharmacists in HCV care cascade. Results: Pharmacy staff completed 200 HCV OraQuick tests between October 2020 and June 2022: 65 HCV antibody positive, 29 HCV RNA negative (25 previously treated and 4 self-cleared). Of the 26 RNA positive participants, one is awaiting treatment, 25 people have started treatment, 22 achieving SVR. Although the onset of the COVID-19 pandemic was a fundamental barrier incorporating HCV testing at pharmacies, stigma related to HCV and illicit drug use continues to impact this process. Conclusions: This innovative pharmacy-based approach found people with limited connection to primary health care to test and treat HCV but requires more training and support to be more widely feasible.

Background: Canada is currently on target to reach the 2030 WHO goal of hepatitis C virus (HCV) elimination. Continued high rates of treatment initiation are required to meet this goal. People who use drugs (PWUD), account for the majority of new HCV cases in BC and continue to have many barriers to accessing DAA therapies, despite demonstrated high SVR rates in clinical trials. Improved elimination efforts including innovative outreach testing and treatment with this population are essential. Novel models have proven successful to engage PWUD in HCV therapy with a simplified, task-shifted cascade of care. Peer-based testing and support models have been piloted in other communities and may help connect to marginalized populations. People with lived and living experience of HCV treatment and drug use (peers) are seen as trusted sources of knowledge. Peers can vouch for the efficacy, minimal side effects and ease of HCV treatment that now exist in the current DAA era. Purpose: The Peer HCV Point of Care (POC) testing project developed within our long standing nurse-led HCV treatment program seeks to determine whether an outreach peer model of HCV POC testing can be successful in Victoria, BC. The peer program focuses on finding populations who use drugs without regular access to primary care still living with HCV. This task shifting approach is the next phase of local micro-elimination efforts and has not been attempted previously. Method: Six peers have been trained to provide HCV POC antibody and dried blood spot RNA tests. Our goals are to pilot the program, learn from our experiences, specifically from the direct input of peers to develop effective and supportive testing and treatment strategies. Peers have worked with nursing and research staff in two-hour blocks and are paid $26 per hour for these shifts. They provide testing at local supportive housing, shelters, social service sites and special events. Each client tested is offered a $10 incentive. Our peers are able to offer both POC antibody testing and, for those who have been exposed to HCV (currently infected, treated or cleared), RNA testing by dried blood spot. Serology by nursing from our mobile outreach van is collected as needed. Result(s): Within the first 4 months of the project peers and staff tested 304 people: 251 people with HCV POC antibody tests (227 negative and 24 positive results), 41 people with HCV dried blood spot RNA tests and 28 with nurse RNA serology. To date 12 people tested RNA+ (11 with previously unknown HCV have active RNA that require treatment), 7 people have been started on treatment. Conclusion(s): This innovative and novel approach to HCV therapy in PWUD was able to successfully use a peer-based approach to find people with limited connection to primary health care to test and treat HCV. We still have much to learn from the valuable knowledge, established relationships and novel perspectives of peers in our efforts to reduce barriers and reach PWUD and others who remain untreated. Please acknowledge all funding agencies by checking the applicable boxes below: None Disclosure of Interest: T. Barnett Grant / Research support from: AbbVie, Gilead, Merck, M. Selfridge Grant / Research support from: Kirby Institute, AbbVie, Gilead, Merck, ViiV, A. Drost Grant / Research support from: Abbvie, Gilead, Merck, K. Guarasci Grant / Research support from: Gliead, Abbvie, Merck , K. Lundgren Grant / Research support from: Abbvie, Gilead, Merck , C. Fraser Grant / Research support from: Abbvie, Gilead, Merck, Kirby Institute, ViiV, F. Boothman : None Declared

To achieve the World Health Organization's goal of eliminating hepatitis C (HCV) by 2030 requires enhanced HCV testing and treatment among people who use drugs (PWUD). Micro‐elimination of HCV is a strategy to target HCV testing and treatment efforts to specific segments of the population. From February to December 2018 nurses initiated a “seek & treat” micro‐elimination approach, increasing outreach and removing barriers to accessing HCV treatment in a clinic setting by testing and treating individuals, including PWUD, where they live. The aim of this study was to evaluate the proportion of clients with HCV antibodies and HCV RNA and the response to direct acting agent (DAA therapy) among people who live at or have social connections to local supportive housing sites through this nurse‐led micro‐elimination project in Victoria, Canada. A chart review of electronic medical records and case management documentation was used to collect relevant data of participants treated with DAA therapy, identified through specific housing site testing and outreach interventions. In total, 180 people were tested for HCV antibodies, 72 (40%) were antibody positive: 51 (28%) were RNA positive, 13 (7%) had spontaneously cleared and 8 (4%) had been previously treated. Of the 51 that were currently living with HCV, 43 people were started on treatment, 39 have achieved sustained virologic response (SVR). By providing treatment to clients in their homes and with their friends, clinicians have been able to treat clients, including those with limited contact with the health care system.

Objectives: Gay, bisexual, and other men who have sex with men (gbMSM) are 131 times more likely to acquire HIV compared with other Canadian men. Pre‐Exposure Prophylaxis (PrEP) for HIV has the potential to reduce or eliminate disparities in HIV acquisition among key affected populations. This paper aims to discuss the feasibility and utility of a nurse‐led PrEP program administered by the Cool Aid Community Health Centre (CACHC) in Victoria, British Columbia as a public health PrEP program was initiated.Design, Sample and Measurements: A retrospective chart review of 124 gbMSM patients accessing PrEP at CACHC in 2018 collected information on patient demographics, STI testing results, and PrEP prescription pick‐ups at 3 time points.Results: Ninety‐nine (79.8%) patients have continued on PrEP, as defined as having picked up their second 90‐day PrEP prescription. Both older age and having an Sexually Transmitted Infection after PrEP enrolment were significantly associated with staying on PrEP; decreased risk perceptions contributed most to clinic‐level discontinuance. Very few patients who stayed on PrEP have transitioned to their own General Practitioner.Conclusions: Patients appear to recognize their risk and are continuing on PrEP to reduce their risk of HIV. As evidenced by ability to recruit and maintain patients, we conclude that nurse‐led PrEP at community health centres supports access and uptake of essential health services to optimize individual and population health.