ONGOING

REACH 3.0

NPA: Dr. Sean Rourke (St. Michael’s Hospital)
Atlantic Team Leads: Dr. Jacqueline Gahagan (Dalhousie University) , Dr. Lois Jackson (Dalhousie University), Dr. Deborah Kelly (Memorial University of Newfoundland ), and Michelle Proctor-Simms (Nova Scotia Advisory Commission on AIDS)
Status: Ongoing to 2024
The CIHR Centre for REACH 3.0 will further advance the national success of the CIHR
REACH 1.0/2.0 Centres and continue to enhance/strengthen an innovative, nation-wide interdisciplinary collaborative platform and network for implementation science, intervention research, and participatory evaluation focused on testing, reaching the undiagnosed, linkage and retention in care and stigma reduction
for people living with HIV, HCV and STBBIs in order to: reduce new infections (especially those at high risk); improve the health and wellbeing of people living with HIV; and demonstrate the importance of having the health/social services available and accessible where people need them in their communities.

Testing, Reaching the Undiagnosed and Linkages to Care: “REACHing” for Impact

NPA: Dr. Sean Rourke (St. Michael’s Hospital)
Atlantic Team Leads: Dr. Jacqueline Gahagan (Dalhousie University) , Dr. Deborah Kelly (Memorial University of Newfoundland), and Michelle Proctor-Simms (Nova Scotia Advisory Commission on AIDS)
Status: Ongoing to 2023
The major aim of this CIHR Team in “REACHing” for Impact will be to bring together national leadership network of interdisciplinary experts. This includes biomedical scientists and clinical investigators, public health practitioners, policy-makers, industry partners, and community-based organizations. Our innovative research will address major “knowledge to action” gaps in testing, reaching the undiagnosed, and linkages to care. We propose five complementary biomedical and clinical/public health implementation and evaluation research projects: 1) accuracy, usability and acceptance of INSTI and OraQuick HIV self-tests, and validation for HCV and other tests; 2) HIV self-testing strategies in clinic and community-based settings using innovative App technology; 3) dried blood spot testing with Indigenous communities and gbMSM through targeted scale-out, peer linkage to biomedical prevention, and self-testing at home; 4) community-based intervention with peers to diversify HIV testing for gbMSM and ACB; and 5) pharmacy-based STBBI testing through integration with existing infrastructure. Our team is focused on new STBBI testing being available, accessible and implemented, specifically for hard-to-reach priority populations. We will formalize linkage to care to improve biomedical and clinical prevention/public health impacts. Through this team grant, we can significantly reduce, and eventually eliminate, the burden and impact of
STBBIs on Canadians.

The REACH CBR Collaborative Centre in HIV/AIDS

NPA: Dr. Sean Rourke (St. Michael’s Hospital)
Atlantic Team Leads: Dr. Susan Kirkland (Dalhousie University) and Gerard Yetman (AIDS Committee of Newfoundland & Labrador)
Status: Ongoing to 2022
The REACH CBR Collaborative Centre in HIV/AIDS began in July of 2012, and received funding in 2017 for the “CBR Collaborative 2.0” for another a five-year term. The goal of the Centre is to build and promote HIV-related community based research (“CBR”) in Canada. We are a national network consisting of HIV/AIDS researchers, people living with HIV, community based organizations, clinicians, and policy-makers. We are structured around seven Regional Core Teams that stretch from coast to coast. Each Core Team is led by a community leader and an academic leader, and decides on its own regional research priorities. A National CBR Leadership Committee identifies opportunities for cross-regional initiatives, encourages Core Teams to collaborate to advance shared goals, and ensures that all Core Teams receive appropriate and targeted support.

The Atlantic Coast Study

Principal Investigators: Dr. Lois Jackson (Dalhousie University) and Diane Bailey (Mainline Needle Exchange)
Status: Ongoing to 2021
The Atlantic COAST (COmmunity AddictionSTreatment) Study is funded through a CIHR HIV/AIDS CBR Operating Grant (2018-21). It is being led by Lois Jackson and Paula Martin (Direction 180), and was formerly named “Preventing the spread of HIV: The critical role of drug addiction treatment programs.”

This study examines barriers and facilitators to addiction treatment across the Atlantic region. As outlined on the project’s website , the study aims to:

Explore and understand key policies and practices of drug addiction treatment programs, focusing specifically on barriers and/or facilitators to access and retention for PWUS in Atlantic Canada;
Explore and understand safer/unsafe drug use and sexual health practices among PWUS in Atlantic Canada during the period of time when they want to access/stay in treatment but do not because of program-level policy and practice barriers;
Discuss with PWUS and other stakeholders in Atlantic Canada the findings from objectives 1 and 2 in order to develop recommendations and strategies to address barriers, build on facilitators, and target HIV prevention for PWUS.

Frailty in People Aging With Human Immunodeficiency Virus (HIV) Infection

Gahagan, J. (PI). Co-Is: Lachowsky, N., Manning, E., Dryden, O., Hatchette, T., Haw, J., O’Brien, S., Awareness and understanding of apheresis plasma donation and effectiveness of alternative donor screening questions for diverse gbMSM and trans populations.
The increasing life spans of people infected with human immunodeficiency virus (HIV) reflect enormous treatment successes and present new challenges related to aging. Even with suppression of viral loads and immune reconstitution, HIV-positive individuals exhibit excess vulnerability to multiple health problems that are not AIDS-defining. With the accumulation of multiple health problems, it is likely that many people aging with treated HIV infection may be identified as frail. Studies of frailty in people with HIV are currently limited but suggest that frailty might be feasible and useful as an integrative marker of multisystem vulnerability, for organizing ca`re and for comprehensively measuring the impact of illness and treatment on overall health status. This review explains how frailty has been conceptualized and measured in the general population, critically reviews emerging data on frailty in people with HIV infection, and explores how the concept of frailty might inform HIV research and care.

Canadian Blood Services

Introduction to the Issue: Canadian blood operators continue to face the challenge of addressing gay, bisexual and other men who have sex with men (gbMSM) and trans-related donor deferral policies that are viewed as discriminatory while at the same time meeting Health Canada’s regulatory requirements. The policy shift to the current 3-month deferral period for all sexually active gbMSM and select trans populations to donor policy is viewed as a more acceptable and equitable by these communities.

Project Objectives: To examine the perspectives of members of gbMSM and trans communities regarding: 1) the feasibility and acceptability of donating apheresis plasma for fractionation and alternative screening questions, such as a “capture” question followed by sub-questions; and 2) the feasibility and acceptability of a two-step system of sex and gender questions in the donor questionnaire.

THE POSITIVE EFFECT

The Positive Effect is the result of the national collaborative efforts of health care researchers, practitioners, and community advocates to provide better insight and understanding of what it is like living with HIV, and told from the perspective of those living with the disease and those on the front lines providing treatment and support.

Eliminating HIV stigma and the harmful effects it has on how individuals view prevention and treatment options is critical to eliminating the HIV epidemic in Canada. That is why eliminating HIV stigma is one of the four key goals in the action plan to end Canada’s HIV epidemic by 2025.

GOALS

1. Within 5 years, dramatically reduce new HIV infections from greater than 2,100 to less than 500 per year. The result would be new HIV cases would be considered rare events. Prevention messages have not kept pace with new scientific evidence (Pre-Exposure Prophylaxis, Post-Exposure Prophylaxis, and Treatment as Prevention).

2. Within 5 years, increase the proportion of people living with HIV who are diagnosed to more than 95 per cent. Over 9,000 people in Canada do not know they are infected with HIV—this is 14 per cent of the people in Canada living with HIV.
The evidence shows that point-of-care testing, as well as widely accessible and affordable self-testing options, can dramatically increase rates of HIV testing and significantly reduce numbers of those undiagnosed with HIV and those not in care. Currently, HIV self-test kits are not licensed for use in Canada, however the growing research that shows how self-testing is effective in reducing the unmitigated transmission of the virus has prompted Canadian regulators to re-evaluate its availability in Canada.

3. Within five years, ensure that over 95 per cent of people who know their status are on treatment—and of those on treatment, 95 per cent have their virus suppressed. There are over 10,000 people living with HIV who are diagnosed and not yet on treatment, and over
3,700 who are on treatment but not virally suppressed.
By ensuring that people living with HIV are linked with the appropriate levels of care, they can actually achieve best possible health outcomes and wellbeing. All that it takes in making sure the available health care and community supports are fully aligned with the needs of the population they serve.

4. HIV continues to be a very stigmatized disease. This affects people’s willingness to be tested, and seek out appropriate care. It affects public policy and general support for HIV prevention initiatives, especially harm reduction services.
The Positive Effect is a new movement to stop HIV stigma and reduce HIV-related health inequities. HIV stigma arises out of fear, lack of knowledge, and prejudices, and remains a significant challenge for people living with HIV in Canada. HIV stigma interferes with HIV prevention and deters people from getting tested regularly and knowing their status—only through awareness and increased testing can Canada end the HIV epidemic in five years.