Towards targeted screening for acute HIV infections in British Columbia

<p>Abstract</p> <p>Background</p> <p>Our objective was to describe the characteristics of acute and established HIV infections diagnosed in the Canadian province of British Columbia. Province-wide HIV testing and surveillance data were analyzed to inform recommendations for targeted use of screening algorithms to detect acute HIV infections.</p> <p>Methods</p> <p>Acute HIV infection was defined as a confirmed reactive HIV p24 antigen test (or HIV nucleic acid test), a non-reactive or reactive HIV EIA screening test and a non-reactive or indeterminate Western Blot. Characteristics of unique individuals were identified from the British Columbia HIV/AIDS Surveillance System. Primary drug resistance and HIV subtypes were identified by analyzing HIV <it>pol </it>sequences from residual sera from newly infected individuals.</p> <p>Results</p> <p>From February 2006 to October 2008, 61 individuals met the acute HIV infection case definition, representing 6.2% of the 987 newly diagnosed HIV infections during the analysis period. Acute HIV infection cases were more likely to be men who have sex with men (crude OR 1.71; 95% CI 1.01-2.89], to have had a documented previous negative HIV test result (crude OR 2.89; 95% CI 1.52-5.51), and to have reported a reason for testing due to suspected seroconversion symptoms (crude OR 5.16; 95% CI 2.88-9.23). HIV subtypes and rates of transmitted drug resistance across all classes of drugs were similar in persons with both acute and established HIV infections.</p> <p>Conclusions</p> <p>Targeted screening to detect acute HIV infection is a logical public health response to the HIV epidemic. Our findings suggest that acute HIV infection screening strategies, in our setting, are helpful for early diagnosis in men who have sex with men, in persons with seroconversion symptoms and in previously negative repeat testers.</p

Effects of riparian buffer width on songbirds and forest structure in the southern interior of British Columbia

In harvested landscapes, the retention of riparian buffers along streams may mitigate the effects of habitat loss and fragmentation by providing usable habitat for songbirds. To explore this hypothesis, I studied the influence of riparian buffer width on breeding songbirds and forest structure in a high elevation forest of south-central British Columbia. I studied four different buffer widths, consisting of very narrow (2-3 m), narrow (11-15 m), medium (30-34 m) and wide buffers (57-69 m). Buffer and control (unharvested forest) sites were each replicated twice for a total of ten study sites. I conducted spot map surveys and habitat sampling to measure width effects on songbird density and vegetation, and to assess the influence of forest structure on songbird density. To examine habitat use by forest birds, I observed the foraging behaviours and movements of four songbird species: winter wren, yellow-rumped warbler, golden-crowned kinglet and Townsend's warbler. Riparian buffer width had several effects on the songbirds breeding within the study area. First, buffer width influenced songbird community structure and composition. The juxtaposition of clearcut and forest in the study grids containing medium and wide buffers maximized species richness and diversity. As buffer width decreased, generalist and open-habitat species replaced forest species within the study grids; very narrow and narrow buffers provided little habitat for forest songbirds. Second, although changes in forest structure occurred across buffers, width was the most important factor determining the richness and density of forest songbird species. Third, buffer width influenced the movement patterns of foraging songbirds. Individuals in buffers moved greater distances upstream and downstream than they did towards and away from the stream; individuals in unharvested stands moved almost equally in all directions. Overall, there did not appear to be a threshold buffer width beyond which there was a disproportionate loss of species and individuals. Although several common forest species were present to a certain extent in all riparian buffers, forest songbirds would benefit most from buffers ≥ 30 m in width.Forestry, Faculty ofGraduat

Defining the role of digital public health in the evolving digital health landscape: policy and practice implications in Canada

IntroductionIn this article, we argue that current digital health strategies across Canada do not appropriately consider the implications of digital technologies (DTs) for public health functions because they adopt a primarily clinical focus. We highlight differences between clinical medicine and public health, suggesting that conceptualizing digital public health (DPH) as a field distinct from, but related to, digital health is essential for the development of DTs in public health. Focussing on DPH may allow for DTs that deeply consider fundamental public health principles of health equity, social justice and action on the social and ecological determinants of health. Moreover, the digital transformation of health services catalyzed by the COVID-19 pandemic and changing public expectations about the speed and convenience of public health services necessitate a specific DPH focus. This imperative is reinforced by the need to address the growing role of DTs as determinants of health that influence health behaviours and outcomes. Making the distinction between DPH and digital health will require more specific DPH strategies that are aligned with emergent digital strategies across Canada, development of intersectoral transdisciplinary partnerships and updated competencies of the public health workforce to ensure that DTs in public health can improve health outcomes for all Canadians

Définition du rôle de la santé publique numérique dans le paysage changeant de la santé numérique : répercussions sur les politiques et les pratiques au Canada

IntroductionDans cet article, nous soutenons que les stratégies actuelles en matière de santé numérique à l’échelle du Canada ne tiennent pas adéquatement compte des répercussions des technologies numériques sur les fonctions de santé publique, car elles ont une orientation principalement clinique. Nous soulignons les différences entre médecine clinique et santé publique et nous suggérons qu’il est essentiel, pour le développement des technologies numériques dans le domaine de la santé publique, de concevoir la santé publique numérique comme un domaine distinct de la santé numérique tout en étant lié à celle-ci. Si l’accent était mis sur la santé publique numérique, les technologies numériques pourraient tenir compte en profondeur des principes fondamentaux de la santé publique que sont l’équité en santé, la justice sociale et l’action sur les déterminants sociaux et environnementaux de la santé. De plus, la transformation numérique des services de santé, catalysée par la pandémie de COVID-19, et l’évolution des attentes du public à l’égard de la rapidité et de la commodité des services de santé publique exigent que l’on mette l’accent sur la santé publique numérique. Cet impératif est renforcé par la nécessité de prendre en compte le rôle croissant des technologies numériques en tant que déterminants de la santé ayant une influence sur les comportements et les résultats en matière de santé

Anticipating the potential for positive uptake and adaptation in the implementation of a publicly funded online STBBI testing service: a qualitative analysis

Background: Online health services are a rapidly growing aspect of public health provision, including testing for sexually transmitted and other blood-borne infections (STBBI). Generally, healthcare providers, policymakers, and clients imbue online approaches with great positive potential (e.g., encouraging clients’ agency; providing cost-effective services to more clients). However, the promise of online health services may vary across contexts and be perceived in negative or ambiguous ways (e.g., risks to ‘gold standard’ care provision; loss of provider control over an intervention; uncertainty related to budget implications). This study examines attitudes and perceptions regarding the development of a novel online STBBI testing service in Vancouver, Canada. We examine the perceptions about the intervention’s potential by interviewing practitioners and planners who were engaged in the development and initial implementation of this testing service. Methods: We conducted in-depth interviews with 37 healthcare providers, administrators, policymakers, and community-based service providers engaged in the design and launch of the new online STBBI testing service. We also conducted observations during planning and implementation meetings for the new service. Thematic analysis techniques were employed to identify codes and broader discursive themes across the interview transcripts and observation notes. Results: Some study participants expressed concern that the potential popularity of the new testing service might increase demand on existing sexual health services or become fiscally unsustainable. However, most participants regarded the new service as having the potential to improve STBBI testing in several ways, including reducing waiting times, enhancing privacy and confidentiality, appealing to more tech-savvy sub-populations, optimizing the redistribution of demands on face-to-face service provision, and providing patient-centred technology to empower clients to seek testing. Conclusions: Participants perceived this online STBBI testing service to have the potential to improve sexual health care provision. But, they also anticipated actions-and-reactions, revealing a need to monitor ongoing implementation dynamics. They also identified the larger, potentially system-transforming dimension of the new technology, which enables new system drivers (consumers) and reduces the amount of control health care providers have over online STBBI testing compared to conventional in-person testing.Applied Science, Faculty ofMedicine, Faculty ofNon UBCNursing, School ofPopulation and Public Health (SPPH), School ofReviewedFacult

A qualitative analysis of the experiences of gay, bisexual and other men who have sex with men who use GetCheckedOnline.com : A comprehensive internet-based diagnostic service for HIV and other sexually transmitted infections

Objectives. To describe the factors that influence gay, bisexual, and other men who have sex with men’s (gbMSM) experiences with GetCheckedOnline.com (GCO) in British Columbia (BC), Canada. GCO clients complete an internet-based risk assessment and print a laboratory test requisition form for HIV and other sexually transmitted infections (STIs) to take to a private laboratory for diagnostic services. Methods. Drawing on a purposive stratified sampling framework we conducted 37 in-depth semistructured interviews with gbMSM who had used GCO at least once between 2015 and 2017. Results. Participants expressed a preference for GCO (instead of clinic-based testing) because of convenience, privacy, and control over specimen collection (specifically with doing one’s own throat or anal swab). Participants preferred receiving their results online via GCO compared to phone or email follow-up by clinic staff. GCO was viewed positively because it offers gbMSM living outside of urban city centres easy access to diagnostic services, including access to pooled nucleic acid amplification testing. Many participants also continued to positively view the clinicbased services available for gbMSM in their community. These services were frequently described as highly competent, tailored and comprehensive in responding to more complex needs. For example, attending a clinic was viewed as preferential to GCO in instances where there was a desire to access services addressing co-occurring health issues (e.g., mental health; substance use disorders). Almost all of the participants anticipated using both GCO and clinicbased services in the future. Conclusions. gbMSM report positive experiences and perceptions of GCO; however, they do not view GCO as a panacea. The results of this study point to the need to ensure that a wide range of integrated service options (e.g., online; clinic-based) are available to address the range of sexual health needs of gbMSM living in BC's diverse settings.Medicine, Faculty ofOther UBCNon UBCMedicine, Department ofPopulation and Public Health (SPPH), School ofReviewedFacultyResearcherPostdoctora

Examining E-Loyalty in a Sexual Health Website: Cross-Sectional Study

Background: Web-based sexual health resources are typically evaluated in terms of their efficacy. Information is lacking about how sexual health promotion websites are perceived and used. It is essential to understand website use to address challenges with adherence and attrition to Web-based health interventions. An existing theoretical framework for examining loyalty to electronic health (eHealth) interventions has been not yet been applied in the context of sexual health promotion nor has the association between e-loyalty and intended intervention efficacy outcomes been investigated. Objective: The objectives of this study were to investigate users’ loyalty toward a sexual health website (ie, e-loyalty), measure user perceptions of the website, and measure the association between e-loyalty and perceived knowledge increase and intent to change behavior. Methods: Over 4 months, website users (clients and health care providers) participated in an open, online, cross-sectional survey about their user experiences that measured e-loyalty, user perceptions, and intended website efficacy outcomes. Relationships between user perceptions and e-loyalty were investigated using structural equation modeling (SEM). Associations between e-loyalty and website efficacy outcomes were tested using Spearman rank correlation. Results: A total of 173 participants completed user perception questions and were included in the analysis. E-loyalty was high for both clients and providers and was significantly correlated with clients’ perceived knowledge increase (ρ(171)=.30, P<.001), their intent to have safer sex (ρ(171)=.24, P=.01), and their intent to get tested for sexually transmitted infections (ρ(171)=.37, P<.001). The SEM showed that trustworthiness, overall experience, active trust, and effectiveness were directly related to e-loyalty. Finding the website “easy to understand” was significantly related to active trust (ie, participants’ willingness to act upon information presented on the website). Conclusions: E-loyalty may be related to the efficacy of the selected website in improving one’s sexual health and was significantly associated with all three intended knowledge and behavioral outcomes. To increase e-loyalty, trustworthiness and active trust are important user perceptions to deliberately engender. Our findings indicate that understanding a website contributes to active trust, thereby highlighting the importance of considering eHealth literacy in designing health promotion websites. Our study confirms the relevance of e-loyalty as an outcome for evaluating the antecedents of the use and efficacy of online public health interventions across disciplines by adapting and validating an existing e-loyalty framework to the field of sexual health promotion. Our findings suggest that e-loyalty is positively associated with measures of website efficacy, including increased knowledge and intent to change behavior. Longitudinal research with larger samples could further investigate the relationships between e-loyalty, website understandability, and outcomes of online health interventions to determine how the manipulation of website characteristics may impact user perceptions and e-loyalty

Cost-effectiveness of internet-based HIV screening of HIV in gay, bisexual and other men who have sex with men (GBMSM) in Metro Vancouver, Canada: Full model and methodologies.

Cost-effectiveness of internet-based HIV screening of HIV in gay, bisexual and other men who have sex with men (GBMSM) in Metro Vancouver, Canada: Full model and methodologies.</p