Cohort profile: The Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS)

Abstract

Globally, women are at increased vulnerability to HIV due to biological, social, structural, and political reasons. Women living with HIV also experience unique issues related to their medical and social healthcare, which makes a clinical care model specific to their needs worthy of exploration. Furthermore, there is a dearth of research specific to women living with HIV. Research for this population has often been narrowly focused on pregnancy-related issues without considering their complex structural inequalities, social roles, and healthcare and biological needs. For these reasons, we have come together, as researchers, clinicians and community members in Canada, to develop the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS) to investigate the concept of women-centred HIV care (WCHC) and its impact on the overall, HIV, women’s, mental, sexual, and reproductive health outcomes of women living with HIV. Here, we present the CHIWOS cohort profile, which describes the cohort and presents preliminary findings related to perceived WCHC. CHIWOS is a prospective, observational cohort study of women living with HIV in British Columbia (BC), Ontario, and Quebec. Two additional Canadian provinces, Saskatchewan and Manitoba, will join the cohort in 2018. Using community-based research principles, CHIWOS engages women living with HIV throughout the entire research process meeting the requirements of the ‘Greater Involvement of People living with HIV/AIDS’. Study data are collected through an interviewer-administered questionnaire that uses a web-based platform. From August 2013 to May 2015, a total of 1422 women living with HIV in BC, Ontario, and Quebec were enrolled and completed the baseline visit. Follow-up interviews are being conducted at 18-month intervals. Of the 1422 participants at baseline, 356 were from BC (25%), 713 from Ontario (50%), 353 from Quebec (25%). The median age of the participants at baseline was 43 years (range, 16–74). 22% identified as Indigenous, 30% as African, Caribbean or Black, 41% as Caucasian/White, and 7% as other ethnicities. Overall, 83% of women were taking antiretroviral therapy at the time of the baseline interview and of them, 87% reported an undetectable viral load. Of the 1326 women who received HIV medical care in the previous year and responded to corresponding questions, 57% (95% CI: 54%-60%) perceived that the care they received from their primary HIV doctor had been women-centred. There were provincial and age differences among women who indicated that they received WCHC versus not; women from BC or Ontario were more likely to report WCHC compared to participants in Quebec. They were also more likely to be younger. CHIWOS will be an important tool to develop care models specific for women living with HIV. Moreover, CHIWOS is collecting extensive information on socio-demographics, social determinants of health, psychological factors, and sexual and reproductive health and offers an important platform to answer many relevant research questions for an...

Cervical cancer screening among women living with HIV: a cross-sectional study using the baseline questionnaire data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (CHIWOS)

“…The cohort profile was described in more detail in previous publications. 26,27 Briefly, eligible participants self-identified as women with HIV, were 16 years of age or older and resided in British Columbia, Ontario or Quebec. Participants were recruited through clinics (A.d.P., K.P.-B., I.B., N.P., M.L.…”

“…28 Within each province, we aimed to recruit women according to the same geographical distribution as that reported by public health reports. 26 Purposive sampling was also done to recruit trans women, Indigenous women, women who inject drugs and young women (< 30 yr) to allow analysis of health care access and outcomes for these specific vulnerable populations. Throughout this paper, we used the term women with HIV rather than females with HIV to respect community preference on language.…”

Exploring social ecological pathways from resilience to quality of life among women living with HIV in Canada

“…Our findings extend prior work on resilience among WLHW and have actionable implications to improve health and wellbeing among WLWH. We highlight the importance of both community factors, such as social support, and structural factors, such as WCHC (Carter et al, 2013;Loutfy et al, 2017;O'Brien et al, 2017), as dimensions that can be supported and integrated into policy and programme delivery to foster resilience among WLWH. There is a strong evidence base that peer support is good for WLWH in many ways (Cederbaum, Rice, Craddock, Pimentel, & Beaver, 2017;O'Brien et al, 2017;Paudel & Baral, 2015) and our path analyses suggests that it may be beneficial in increasing resilience, which in turn improves physical and mental HR-QoL.…”

“…We utilized baseline survey data from a national cohort of WLWH (n = 1424) enrolled in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS) from 2013 to 2015 across three provinces (Ontario, Quebec, British Columbia). Methods are detailed elsewhere (Loutfy et al, 2017). Trained peer research associates (PRAs) used purposive sampling methods to recruit WLWH, including wordof-mouth, venue-based sampling from AIDS service agencies, and online listservs.…”

Contraceptive Choice and Use of Dual Protection Among Women Living with HIV in Canada: Priorities for Integrated Care

“…Between August 2013 and May 2015, participants completed a structured questionnaire (supported by FluidSurveys online software) administered by peer research associates, women with HIV who were hired and trained as part of the study team . Surveys were administered in English or French, in‐person at collaborating HIV clinics, AIDS service organizations or community organizations, or in women's homes; or via phone or Skype.…”