New study shows B.C. successfully engages people into HIV care, yet more needed to maximize benefits of treatment

B.C.’s cascade of HIV care demonstrates increase in viral suppression

A new study shows British Columbia has been increasingly successful at identifying and engaging HIV-positive individuals into treatment following the introduction of Highly Active Antiretroviral Therapy (HAART) in 1996, however more remains to be done to maximize and sustain the individual and public health benefits of treatment.

The study, published online today in the peer-reviewed journal The Lancet Infectious Diseases, analyzed engagement with the cascade of HIV care in British Columbia from 1996 to 2011. Researchers found substantial and steady improvements at each stage of the cascade of care.

“The cascade of care demonstrates the health outcomes of HIV-positive British Columbians have steadily improved, and study findings show meaningful progress has been made in controlling the epidemic,” said Dr. Julio Montaner, director of the BC Centre for Excellence in HIV/AIDS (BC-CfE) and study co-author. “We are unaware of any other jurisdiction in the world that can claim better outcomes than we’re observing here in B.C. However, this tool also demonstrates further efforts are needed to maximize the beneficial effects of available interventions to fully contain the spread of HIV/AIDS.”

From 1996 to 2011, 13,140 people were classified as diagnosed with HIV/AIDS in British Columbia. Over that period:

  • the proportion of unidentified HIV-positive individuals decreased from 49% to 29%
  • the proportion of HIV-positive people with undetectable viral load increased from 0.7% to 34.6%
  • the proportion of HIV-positive people adherent to treatment and not virologically suppressed decreased from 95.2% to 21.6%

Overall, out of every 100 people infected with HIV in 2011, 71 were diagnosed; of these people, 51 were consistently receiving treatment and 35 had an undetectable viral load for a sustained period.

The cascade of HIV care represents a focused approach for implementing Treatment as Prevention, which involves widespread HIV testing and immediate provision of HAART to medically eligible people with HIV. The cascade illustrates the steps in care and support for those living with HIV/AIDS, categorizing eight stages in the cascade of care: HIV infected, diagnosed, linked to HIV care, retained in HIV care, in need of treatment, receiving treatment, adherent to treatment, and virologically suppressed.

“The cascade of HIV care is an invaluable tool and will help us understand where we need to target our funding and focus our efforts in the fight against HIV/AIDS in this province,” said study co-author Dr. Bohdan Nosyk, health economist at the BC-CfE and associate professor of Health Sciences at Simon Fraser University. “We are working with each of B.C.’s health authorities to apply this tool to better serve HIV-positive populations across the province, such as men who have sex with men and injection drug users. The cascade really represents a broader and more comprehensive way to tackle this epidemic.”

The study authors pointed to engagement of individuals linked to or retained in HIV care and not accessing HAART, as well as further expansion of HIV testing, as areas where provincial efforts should be focused.

“Overall, we’re witnessing the positive impacts of British Columbia’s efforts to fight HIV/AIDS,” said Dr. Patricia Daly, Chief Medical Health Officer, Vancouver Coastal Health. “My hope is other provinces will follow our lead to identify opportunities to improve HIV treatment and care in their jurisdictions.”

Every year, 3,300 men and women in Canada are diagnosed with HIV and an estimated 71,300 Canadians are now living with HIV, a number that could double within the next 15 years if the current rate of new infections continues and treatment is not expanded across Canada.

B.C is the only province to implement Treatment as Prevention and the only province where the government provides HAART to all HIV infected individuals. In 2009, the B.C. government invested in the BC-CfE-led Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) pilot project in Prince George and Vancouver to expand HIV testing and treatment. The Treatment as Prevention initiative was expanded province-wide April 1, 2013.

A copy of the paper, titled “The cascade of HIV care in British Columbia, Canada, 1996-2011: a population-based retrospective cohort study,” is available here.

[The above is a news release from the BC Centre for Excellence in HIV/AIDS]