We examined correlates of late and delayed initiation of antiretroviral therapy (ART) in British Columbia, Canada. From December 2013 to December 2015 we recruited treatment-naïve people living with HIV who initiated ART within the previous year. 'Late initiation' was defined as CD4 cell count ≤500 cells/µL at ART initiation and 'delayed initiation' as ≥1 year between HIV diagnosis and initiation. Multivariable logistic regression assessed independent correlates of late and delayed initiation. Of 87 participants, 44 (51%) initiated late and 22 (26%) delayed initiation. Delayed initiation was positively associated with older age (adjusted odds ratio [AOR]: 1.06 per year, 95% confidence interval [95% CI]: 1.01-1.12) and inversely associated with wanting to start ART at diagnosis (AOR: 0.06, 95% CI: 0.02-0.21). Variables associated with late initiation were older age (AOR: 1.09 per year, 95% CI: 1.03-1.15) and medical reason(s) for initiation (AOR: 5.00, 95% CI: 1.41-17.86). Late initiation was less likely among those with greater perceived ART efficacy (AOR 0.94, 95% CI: 0.90-0.98) and history of incarceration (AOR: 0.12, 95% CI: 0.03-0.56). Disparities in timing of initiation were observed for age, perceived ART efficacy, and history of incarceration. Enhanced health services that address these factors may facilitate earlier treatment initiation.

The BC Women's Hospital and Health Centre's Newcomer Women's Health Clinic (NWHC) opened in 2014 to fill a gap in services for newcomer women to Canada residing in Metro Vancouver. After 1 year the NWHC was operating at only 50% capacity. An evaluation was conducted to better understand the underutilization of clinic services. Evaluation data was collected via patient intake forms, patient feedback surveys, and one-to-one interviews with both newcomer women and service providers who work with newcomer women. Results highlight the heterogeneity in newcomer women's experiences including different perceptions of health, health needs, and health-seeking behaviours. Despite the population's diversity, some common experiences exist, including difficulties navigating and accessing a new health system and lack of awareness of the NWHC. Findings provide insight for improving the delivery of NWHC services, and contribute to a rich and ongoing dialogue concerning the diversity of experiences of newcomer women in Canada.

PurposeThe Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS) Program Evaluation (SHAPE) study is a longitudinal cohort developed to monitor the progress of an HIV testing and treatment expansion programme across the province of British Columbia (BC). The study considers how sociostructural determinants such as gender, age, sexual identity, geography, income and ethnicity influence engagement in HIV care.ParticipantsBetween January 2016 and September 2018, 644 BC residents who were at least 19 years old and diagnosed with HIV were enrolled in the study and completed a baseline survey. Participants will complete two additional follow-up surveys (18 months apart) about their HIV care experiences, with clinical follow-up ongoing.Findings to dateAnalyses on baseline data have found high levels of HIV care engagement and treatment success among SHAPE participants, with 95% of participants receiving antiretroviral therapy and 90% having achieved viral suppression. However, persistent disparities in HIV treatment outcomes related to age, injection drug use and housing stability have been identified and require further attention when delivering services to marginalised groups.Future plansOur research will examine how engagement in HIV care evolves over time, continuing to identify barriers and facilitators for promoting equitable access to treatment and care among people living with HIV. A qualitative research project, currently in the formative phase, will compliment quantitative analyses by taking a strengths-based approach to exploring experiences of engagement and re-engagement in HIV treatment among individuals who have experienced delayed treatment initiation or treatment interruptions.

FSWs, 24% in MSM and 15.8% in PWID, who also shared syringes extensively (31%). Approximately 5% of TG, 16.9% of FSW and 4.0% of MSM reported having sex with a PWID in past year. Only 24.6% PWID, 15% TGs, 8.3% FSWs and 13.3% MSM utilized HIV prevention programs in the past year, which explains the escalating trends of HIV among these populations. Conclusion The HIV epidemic in Pakistan is growing rapidly and is following a rapidly propagating Asian HIV epidemic pattern. Pakistan needs to quickly scale-up services for key populations to contain the epidemic and to prevent a further spread to other KP members and into general population. Disclosure No significant relationships.

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