A Comparison of Virological Suppression and Rebound between Indigenous and Non-Indigenous Persons Initiating Combination Antiretroviral Therapy in a Multisite Cohort of Individuals Living with HIV in Canada

Bridges, Building; Benoit, Anita C.; Younger, Jaime; Beaver, Kerrigan; Jackson, Randy; Loutfy, Mona; Masching, Renée; Nobis, Tony; Nowgesic, Earl; O'Brien-Teengs, Doe; Whitebird, Wanda; Zoccole, Art; Hull, Mark; Jaworsky, Denise; Rachlis, Anita; Rourke, Sean B.; Burchell, Ann; Cooper, Curtis; Hogg, Robert S.; Klein, Marina B.; Machouf, Nimâ; Montaner, Julio S. G.; Tsoukas, Chris; Raboud, Janet

doi:10.3851/imp3114

Cited by 5 publications

(4 citation statements)

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“…A study comparing African-American with European-American US military personnel found that, despite having free access to medical care and medication and similar durations of infection before diagnosis, the proportion of people obtaining viral load suppression at 6 months and 12 months after ART initiation was still 40% lower in the African-American group. 5 The data for durable viral load suppression are conflicting regarding whether minority groups or disadvantaged populations have the same 5,6 or, as was found by O'Connor and colleagues, higher 9 rates of viral rebound than non-minority populations. Notably, a growing body of data exists that shows good overall rates of viral suppression in sub-Saharan Africa.…”

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confidence: 99%

“…2,3 Of note, the authors also found that black African men and women had higher rates of viral rebound, a finding that was also shown in a study investigating protease inhibitor monotherapy in the UK. 4 Lower initial rates of viral suppression after starting ART have been commonly reported in African Americans 5 and Indigenous communities in Canada, 6 but not in Aboriginal people in Australia. 7 A large study in the USA assessing racial differences in ART response from the AIDS Clinical Trials Group found that black participants had a 40% higher risk of virological This finding is perhaps surprising given the substantial attention to the notion of accelerated atherosclerosis, or even accelerated aging, in people with HIV in the past few years.…”

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confidence: 99%

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Long-term durability of HIV viral load suppression

Dharan

Cooper

2017

The Lancet HIV

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confidence: 99%

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confidence: 99%

Long-term durability of HIV viral load suppression

Dharan

Cooper

2017

The Lancet HIV

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“…Indigenous identity reported at ART initiation was also found to be strong predictors of viral suppression in this cohort. Findings from Benoit et al 32 not only echoed the same findings of poor viral suppression among PLWH in Canada, but also reported how younger adults who identify as Indigenous (54%) were less likely than non-Indigenous people (77%) to experience viral suppression. Indigenous women, who comprise 22% of CHIWOS participants, reported low rates of viral suppression in comparison to ACB and white women regardless of whether they lived in the GTA, in the rest of Ontario or in Quebec and BC.…”

Section: Discussionmentioning

confidence: 62%

HIV care cascade for women living with HIV in the Greater Toronto Area versus the rest of Ontario and Canada

et al. 2022

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Background The Greater Toronto Area (GTA) is home to 39% of Canada’s population living with HIV. To identify gaps in access and engagement in care and treatment, we assessed the care cascade of women living with HIV (WLWH) in the GTA versus the rest of Ontario and Canada (in this case: Quebec and British Columbia). Methods We analyzed 2013–2015 self-reported baseline data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study for six care cascade stages: linked to care, retained in care, initiated antiretroviral therapy (ART), currently on ART, ART adherence (≥90%), and undetectable (<50 copies/mL). Multivariable logistic regression was used to reveal associations with being undetectable. Results Comparing the GTA to the rest of Ontario and Canada, respectively: 96%, 98%, 100% were linked to care; 92%, 94%, 98% retained in care; 72%, 89%, 96% initiated ART; 67%, 81%, 90% were currently using ART; 53%, 66%, 77% were adherent; 59%, 69%, 81% were undetectable. Factors associated with viral suppression in the multivariable model included: living outside of the GTA (Ontario: aOR = 1.72, 95% CI: 1.09–2.72; Canada: aOR = 2.42, 95% CI: 1.62–3.62), non-Canadian citizenship (landed immigrant/permanent resident: aOR = 3.23, 95% CI: 1.66–6.26; refugee/protected person/other status: aOR = 4.77, 95% CI: 1.96–11.64), completed high school (aOR = 1.77, 95% CI: 1.15–2.73), stable housing (aOR = 2.13, 95% CI: 1.33–3.39), income of ≥$20,000 (aOR = 1.52, 95% CI: 1.00–2.31), HIV diagnosis <6 years (6–14 years: aOR = 1.75, 95% CI: 1.16–2.63; >14 years: aOR = 1.87, 95% CI: 1.19–2.96), and higher resilience (aOR = 1.02, 95% CI: 1.00–1.04). Conclusion WLWH living in the GTA had lower rates of viral suppression compared to the rest of Ontario and Canada even after adjustment of age, ethnicity, and HIV diagnosis duration. High-impact programming for WLWH in the GTA to improve HIV outcomes are greatly needed.

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“…Benoit et al 2017 [30] Are there differences in experiencing (1) virologic suppression and (2) virologic rebound between Indigenous and non-Indigenous people living with HIV?…”

Section: Building Bridgesmentioning

confidence: 99%

Indigenizing our Research

Nicholson

Bratu

McClean

et al. 2021

IJPDS

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The use of data intensive health research has allowed for greater understandings of population health. When conducting data intensive health research, engaging and involving the community is essential for conducting meaningful research that is responsive to the public’s needs. Particularly, when engaging Indigenous communities in research, there is a need to understand historical and ongoing impacts of colonialism and recognize the strengths in Indigenous Peoples’ knowledges and experiences while supporting Indigenous leadership and self-determination in research. This article describes the approach our research team/organization used to engage and involve Indigenous people living with HIV in three research projects using large, linked datasets and looking at HIV outcomes of Indigenous populations in Canada. The foundation of these projects was simultaneously: 1) supporting Indigenous people living with HIV to be involved as research team members, 2) developing research questions to answer with available datasets, and 3) integrating Indigenous and Western ways of knowing. We have identified important considerations and suggestions for engaging and involving Indigenous communities and individuals in the generation of research ideas and analysis of linked data using community-based participatory research approaches through our work. These include engaging stakeholders at the start of the project and involving them throughout the research process, honouring Indigenous ways of knowing, the land, and local protocols and traditions, prioritizing Indigenous voices, promoting co-learning and building capacity, and focusing on developing longitudinal relationships. We describe keys to success and learnings that emerged. Importantly, the methodology practiced and presented in this manuscript is not a qualitative study design whereby research subjects are surveyed about their experiences or beliefs. Rather, the study approach described herein is about engaging people with living experience to co-lead as researchers. Our approach supported Indigenous people to share research that addresses their research priorities and responds to issues relevant to Indigenous Peoples and communities.

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A Comparison of Virological Suppression and Rebound between Indigenous and Non-Indigenous Persons Initiating Combination Antiretroviral Therapy in a Multisite Cohort of Individuals Living with HIV in Canada

Abstract: Lower suppression rates among Indigenous persons suggest a need for targeted interventions to improve HIV health outcomes during the first year of treatment when suppression is usually achieved.

Cited by 5 publications

References 32 publications

Long-term durability of HIV viral load suppression

Long-term durability of HIV viral load suppression

HIV care cascade for women living with HIV in the Greater Toronto Area versus the rest of Ontario and Canada

Indigenizing our Research

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