Skip to main content

Advertisement

SpringerLink
Log in

The Impact of Treatment as Prevention on the HIV Epidemic in British Columbia, Canada

  • Treatment as Prevention (S Vermund, Section Editor)
  • Published:
Current HIV/AIDS Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This study proposes to describe the impact of a publicly funded Treatment as Prevention (TasP) strategy in British Columbia (BC), Canada, in decreasing the individual and public health impact of the HIV/AIDS Epidemic.

Recent Findings

In BC, TasP has been associated with a steady decline in HIV-related morbidity and mortality. At the same time, a demographic transition was observed among people living with HIV (PLWH), with the majority of those on antiretroviral treatment (ART) now ≥ 50 years of age, living with at least one comorbidity, and dying from age-associated comorbidities. We also documented a progressive increase in the proportion of viral load suppression as a result of ART expansion. While the pre-ART CD4 T cell count has increased steadily in recent years, there is still a large proportion of PLWH being diagnosed in later stages of HIV infection. New HIV diagnoses have been rapidly declining, however to a lesser extent among men who have sex with men (MSM), and BC is currently experiencing an increase in infectious syphilis cases in this population. These facts reinforce the effectiveness of TasP in decreasing HIV transmission, but at the same time, it highlights the need for further innovation to enhance the control of HIV and syphilis among MSM.

Summary

This study supports the development of new approaches that address existing gaps in the TasP strategy in BC, and the future health needs of PLWH.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. • Eisinger RW, Dieffenbach CW, Fauci AS. HIV Viral Load and Transmissibility of HIV Infection: Undetectable Equals Untransmittable. JAMA. 2019;321(5):451–2. https://doi.org/10.1001/jama.2018.21167This article provides a summary of key studies that showed unequivocal evidence of the efficacy of TasP in prevention onward HIV transmission.

    Article  PubMed  Google Scholar 

  2. Montaner JS, Hogg R, Wood E, Kerr T, Tyndall M, Levy AR, et al. The case for expanding access to highly active antiretroviral therapy to curb the growth of the HIV epidemic. Lancet. 2006;368(9534):531–6. https://doi.org/10.1016/S0140-6736(06)69162-9.

    Article  PubMed  Google Scholar 

  3. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505. https://doi.org/10.1056/NEJMoa1105243.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Lima VD, Lourenco L, Yip B, Hogg RS, Phillips P, Montaner JS. AIDS incidence and AIDS-related mortality in British Columbia, Canada, between 1981 and 2013: a retrospective study. Lancet HIV. 2015;2(3):e92–7. https://doi.org/10.1016/S2352-3018(15)00017-X.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Granich RM, Gilks CF, Dye C, De Cock KM, Williams BG. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet. 2009;373(9657):48–57. https://doi.org/10.1016/S0140-6736(08)61697-9.

    Article  PubMed  Google Scholar 

  6. Gunthard HF, Saag MS, Benson CA, del Rio C, Eron JJ, Gallant JE, et al. Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2016 Recommendations of the International Antiviral Society-USA Panel. JAMA. 2016;316(2):191–210. https://doi.org/10.1001/jama.2016.8900.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. World Health Organization. Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV 2015 [9 October 2019]. Available from: https://www.who.int/hiv/pub/guidelines/earlyrelease-arv/en/.

  8. The Joint United Nations Programme on HIV and AIDS (UNAIDS). 90–90-90 An ambitious treatment target to help end the AIDS epidemic 2014 [1 December 2018]. Available from: https://www.unaids.org/sites/default/files/media_asset/90-90-90_en.pdf.

  9. Stover J, Bollinger L, Izazola JA, Loures L, DeLay P, Ghys PD, et al. What Is Required to End the AIDS Epidemic as a Public Health Threat by 2030? The Cost and Impact of the Fast-Track Approach. PLoS One. 2016;11(5):e0154893. https://doi.org/10.1371/journal.pone.0154893.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. The Joint United Nations Programme on HIV and AIDS (UNAIDS). UNAIDS Data 2019 2019 [9 October 2019]. Available from: https://www.unaids.org/en/resources/documents/2019/2019-UNAIDS-data.

  11. Zuniga JM. UNAIDS 90–90-90—Opportunity in Every Difficulty. J Int Assoc Providers AIDS Care (JIAPAC). 2018;17. https://doi.org/10.1177/2325958218809075.

    Article  Google Scholar 

  12. • Duncombe C, Ravishankar S, Zuniga JM. Fast-Track Cities: striving to end urban HIV epidemics by 2030. Curr Opin HIV AIDS. 2019;14(6):503–8. https://doi.org/10.1097/COH.0000000000000583This article summarizes the progress of the Fast-Track initiative to control the HIV/AIDS epidemic, in different cities/municipalities around the world, by measuring the progress towards the United Nations 90-90-90 Target.

    Article  PubMed  Google Scholar 

  13. Del Rio C. Editorial: can we end HIV as a public health problem globally? Progress towards achieving the UNAIDS 90-90-90 goals. Curr Opin HIV AIDS. 2019;14(6):439–41. https://doi.org/10.1097/COH.0000000000000592.

    Article  PubMed  Google Scholar 

  14. The Joint United Nations Programme on HIV and AIDS (UNAIDS). 2019 [9 October 2019]. Available from: https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2019/july/20190716_PR_UNAIDS_global_report_2019.

  15. Havlir DV, Balzer LB, Charlebois ED, Clark TD, Kwarisiima D, Ayieko J, et al. HIV Testing and Treatment with the Use of a Community Health Approach in Rural Africa. N Engl J Med. 2019;381(3):219–29. https://doi.org/10.1056/NEJMoa1809866.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Hayes RJ, Donnell D, Floyd S, Mandla N, Bwalya J, Sabapathy K, et al. Effect of Universal Testing and Treatment on HIV Incidence - HPTN 071 (PopART). N Engl J Med. 2019;381(3):207–18. https://doi.org/10.1056/NEJMoa1814556.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Makhema J, Wirth KE, Pretorius Holme M, Gaolathe T, Mmalane M, Kadima E, et al. Universal testing, expanded treatment, and incidence of HIV infection in Botswana. N Engl J Med. 2019;381(3):230–42. https://doi.org/10.1056/NEJMoa1812281.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Abdool Karim SS. HIV-1 epidemic control - insights from test-and-treat trials. N Engl J Med. 2019;381(3):286–8. https://doi.org/10.1056/NEJMe1907279.

    Article  PubMed  Google Scholar 

  19. Montaner JS, Lima VD, Harrigan PR, Lourenco L, Yip B, Nosyk B, et al. Expansion of HAART coverage is associated with sustained decreases in HIV/AIDS morbidity, mortality and HIV transmission: the "HIV Treatment as Prevention" experience in a Canadian setting. PLoS One. 2014;9(2):e87872. https://doi.org/10.1371/journal.pone.0087872.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. British Columbia Centre for Excellence in HIV/AIDS (BCCfE). Drug Treatment Program 2019 [9 October 2019]. Available from: http://cfenet.ubc.ca/drug-treatment-program.

  21. British Columbia Centre for Excellence in HIV/AIDS (BCCfE). Guidelines for Antiretroviral ARV Treatment of Adult HIV Infection 2016 [3 April 2019]. Available from: http://cfenet.ubc.ca/therapeutic-guidelines/guidelines-antiretroviral-arv-treatment-adult-hiv-infection.

  22. Heath K, Samji H, Nosyk B, Colley G, Gilbert M, Hogg RS, et al. Cohort profile: seek and treat for the optimal prevention of HIV/AIDS in British Columbia (STOP HIV/AIDS BC). Int J Epidemiol. 2014;43(4):1073–81. https://doi.org/10.1093/ije/dyu070.

    Article  PubMed  PubMed Central  Google Scholar 

  23. British Columbia Ministry of Health (2016):. Medical services plan (MSP) payment information file; consolidation file (MSP Registration & Premium Billing); Home & Community Care (continuing care); mental health; PharmaNet British Columbia Ministry of Health Data Extract MOH (2016). Available from: http://www2.gov.bc.ca/gov/content/health/conducting-health-research-evaluation/data-access-health-data-central. Accessed 8 April 2019.

  24. Canadian Institute of Health Information (2016):. Discharge abstract database (hospital separations). British Columbia Ministry of Health. Data Extract. MOH (2016). Available from: http://www2.gov.bc.ca/gov/content/health/conducting-health-research-evaluation/data-access-health-data-central. Accessed 8 April 2019.

  25. British Columbia Vital Statistics Agency (2016):. Vital statistics deaths. British Columbia Ministry of Health Data Extract MOH (2016). Available from: http://www2.gov.bc.ca/gov/content/health/conducting-health-research-evaluation/data-access-health-data-central. Accessed 8 April 2019.

  26. British Columbia Centre for Disease Control. Reportable Diseases Data Dashboard [8 April 2019]. Available from: http://www.bccdc.ca/health-professionals/data-reports/reportable-diseases-data-dashboard.

  27. British Columbia Ministry of Health. PharmaNet. Data Stewardship Committee [15 February 2016]. Available from: http://www2.gov.bc.ca/gov/content/health/health-drug-coverage/pharmacare-for-bc-residents/pharmanet.

  28. British Columbia Centre for Disease Control. Communicable Disease Control Manual. Guidelines for Testing, Follow up, and Prevention of HIV. Chapter 5 – Sexually Transmitted Infections 2016 [8 April 2019]. Available from: http://www.bccdc.ca/resource-gallery/Documents/Communicable-Disease-Manual/Chapter%205%20-%20STI/HIV_Guidelines_Testing_FollowUp_Prevention.pdf.

  29. British Columbia Centre for Disease Control. HIV in British Columbia: Annual HIV/AIDS Report [8 April 2019]. Available from: http://www.bccdc.ca/health-professionals/data-reports/hiv-aids-reports.

  30. British Columbia Centre for Excellence in HIV/AIDS (BC-CfE). STOP HIV/AIDS Quarterly Monitoring Report for British Columbia Vancouver, Canada: BC-CfE; 2019 [9 October 2019]. Available from: http://stophivaids.ca/data-monitoring/.

  31. British Columbia Centre for Disease Control. Annual STI reports [8 April 2019]. Available from: http://www.bccdc.ca/health-professionals/data-reports/sti-reports.

  32. Schneider E, Whitmore S, Glynn KM, Dominguez K, Mitsch A, McKenna MT, et al. Revised surveillance case definitions for HIV infection among adults, adolescents, and children aged <18 months and for HIV infection and AIDS among children aged 18 months to <13 years--United States, 2008. MMWR Recomm Rep. 2008;57(RR-10):1–12.

    PubMed  Google Scholar 

  33. British Columbia Centre for Disease Control. Acquired Immune Defiency Syndrome (AIDS) Case Report Form 2013 [8 April 2019]. Available from: http://www.bccdc.ca/resource-gallery/Documents/Communicable-Disease-Manual/Chapter%205%20-%20STI/AIDSsurveillanceCRF_2013_Final.pdf.

  34. Roberts HW, Utuama OA, Klevens M, Teshale E, Hughes E, Jiles R. The contribution of viral hepatitis to the burden of chronic liver disease in the United States. Am J Gastroenterol. 2014;109(3):387–93; quiz 6, 94. https://doi.org/10.1038/ajg.2013.477.

    Article  PubMed  Google Scholar 

  35. British Columbia Ministry of Health. Chronic Disease Information Working Group. BC Chronic Disease and Selected Procedure Case Definitions: British Columbia Centre for Disease Control; 2019 [updated 4 April 20198 October 2019]. V2017:[Available from: http://www.bccdc.ca/health-professionals/data-reports/chronic-disease-dashboard#Case%2D%2DDefinitions.

  36. Lapointe-Shaw L, Georgie F, Carlone D, Cerocchi O, Chung H, Dewit Y, et al. Identifying cirrhosis, decompensated cirrhosis and hepatocellular carcinoma in health administrative data: A validation study. PLoS One. 2018;13(8):e0201120. https://doi.org/10.1371/journal.pone.0201120.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Lima VD, St-Jean M, Rozada I, Shoveller JA, Nosyk B, Hogg RS, Sereda P, Barrios R, Montaner JSG. Progress towards the United Nations 90-90-90 and 95-95-95 targets: the experience in British Columbia, Canada. J Int AIDS Soc. 2017;20(3). https://doi.org/10.1002/jia2.25011.

    Article  Google Scholar 

  38. Nosyk B, Montaner JSG, Colley G, Lima VD, Chan K, Heath K, et al. The cascade of HIV care in British Columbia, Canada, 1996–2011: a population-based retrospective cohort study. Lancet Infect Dis. 2014;14(1):40–9. https://doi.org/10.1002/jia2.25011

    Article  Google Scholar 

  39. Public Health Agency of Canada. Summary: Estimates of HIV incidence, prevalence and Canada’s progress on meeting the 90-90-90 HIV targets, 2016. 2018 [9 October 2019]. Available from: https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/diseases-conditions/summary-estimates-hiv-incidence-prevalence-canadas-progress-90-90-90/pub-eng.pdf.

  40. International Advisory Panel on HIV Care Continuum Optimization. IAPAC Guidelines for Optimizing the HIV Care Continuum for Adults and Adolescents. J Int Assoc Providers AIDS Care (JIAPAC). 2015;S3–S34. https://doi.org/10.1177/2325957415613442.

  41. McDonald JH. Handbook of biological statistics. 3rd ed. Baltimore: Sparky House Publishing; 2014.

    Google Scholar 

  42. Wood S. Generalized additive models: an introduction with R. USA: Chapman and Hall/CRC; 2006.

    Book  Google Scholar 

  43. Nosyk B, Zang X, Min JE, Krebs E, Lima VD, Milloy MJ, et al. Relative effects of antiretroviral therapy and harm reduction initiatives on HIV incidence in British Columbia, Canada, 1996–2013: a modelling study. Lancet HIV. 2017;4(7):e303–e10. https://doi.org/10.1016/S2352-3018(17)30045-0.

    Article  PubMed  PubMed Central  Google Scholar 

  44. British Columbia Ministry of Health. Overdose Prevention and Response in B.C. 2019 [9 October 2019]. Available from: https://www2.gov.bc.ca/gov/content/overdose.

  45. The British Columbia Harm Reduction Strategies and Services (HRSS) Committee. BC Harm Reduction Strategies and Services Policy and Guidelines 2014 [9 October 2019]. Available from: http://www.bccdc.ca/our-services/programs/harm-reduction.

  46. Centers for Disease Control and Prevention. HIV Among People Aged 50 and Over 2015 [15 February 2016]. Available from: http://www.cdc.gov/hiv/group/age/olderamericans/index.html.

  47. The Jointed United Nations Programme on HIV/AIDS. The Gap Report 2014 [16 February 2016]. Available from: http://www.unaids.org/en/resources/campaigns/2014/2014gapreport/gapreport/.

Download references

Funding

The programmatic funding for the Drug Treatment Program, Treatment as Prevention and STOP HIV/AIDS initiatives was provided by the British Columbia government. Additional research funding was provided by the Canadian Institutes of Health Research (VDL, ZLB), the Michael Smith Foundation for Health Research (VDL, ZLB), the public Health Agency of Canada (JSGM), Vancouver Coastal Health Authority (JSGM), and the US National Institutes of Health (National Institute on Drug Abuse and Canadian HIV Trials Network) (JSGM).

Author information

Authors and Affiliations

  1. British Columbia Centre for Excellence in HIV/AIDS, Room 667, 1081 Burrard Street, Vancouver, British Columbia, V6Z 1Y6, Canada

    Viviane D. Lima, Zabrina L. Brumme, Chanson Brumme, Paul Sereda, Silvia A. Guillemi, Robert S. Hogg, Rolando Barrios & Julio S. G. Montaner

  2. Department of Medicine, Division of Infectious Diseases, Faculty of Medicine, University of British Columbia, Vancouver, Canada

    Viviane D. Lima, Chanson Brumme & Julio S. G. Montaner

  3. Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada

    Zabrina L. Brumme & Robert S. Hogg

  4. British Columbia Centre for Disease Control, Vancouver, Canada

    Mel Krajden & Jason Wong

  5. Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada

    Mel Krajden

  6. School of Population and Public Health, University of British Columbia, Vancouver, Canada

    Jason Wong

  7. Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, Canada

    Silvia A. Guillemi

  8. British Columbia Ministry of Health, Victoria, Canada

    Bonnie Henry

  9. Vancouver Coastal Health, Vancouver, Canada

    Rolando Barrios

Authors
  1. Viviane D. Lima
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zabrina L. Brumme
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Chanson Brumme
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Paul Sereda
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mel Krajden
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jason Wong
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Silvia A. Guillemi
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Bonnie Henry
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Robert S. Hogg
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Rolando Barrios
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Julio S. G. Montaner
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

for the STOP HIV/AIDS Study Group

Corresponding author

Correspondence to Julio S. G. Montaner.

Ethics declarations

Disclaimer

The sponsors had no role in the design, data collection, data analysis, data interpretation, or writing of the report. The corresponding author had full access to all data in the study and had final responsibility to submit for publication. All inferences, opinions, and conclusions drawn in this manuscript are those of the authors, and do not reflect the opinions or policies of the Data Steward(s).

Conflict of Interest

MK has research and contracts paid to his institution from Roche and Hologic unrelated to this work. Institutional grants have been provided to JSGM by Gilead, Johnson & Johnson, Merck, ViiV Healthcare. The remaining authors do not have conflicts to declare.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Treatment as Prevention

Electronic supplementary material

ESM 1

(DOCX 41.2 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lima, V.D., Brumme, Z.L., Brumme, C. et al. The Impact of Treatment as Prevention on the HIV Epidemic in British Columbia, Canada. Curr HIV/AIDS Rep 17, 77–87 (2020). https://doi.org/10.1007/s11904-020-00482-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11904-020-00482-6

Keywords

Search

Navigation