Overview of a gay men’s STI/HIV testing clinic in Ottawa: Clinical operations and outcomes

O’Byrne, Patrick; MacPherson, Paul; Ember, Andrew; Grayson, Marie-Odile; Bourgault, Andree

doi:10.17269/cjph.105.4471

Cited by 11 publications

(6 citation statements)

References 20 publications

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“…These clinics have been detailed elsewhere. 24,25 In these clinics, we trained nurses who were experts in STI care, and authorized them, under medical directives, to provide PEP. 11 After ensuring a patient qualified for PEP, had no contraindications to PEP medications, and was ostensibly HIV-negative (based on a lack of seroconversion symptoms and a non-reactive HIV point-of-care test), 26 these nurses provided the patient with a three-day or six-day starter pack for PEP.…”

Section: Participants Setting and Interventionmentioning

confidence: 99%

Community-based, nurse-led post-exposure prophylaxis: results and implications

et al. 2016

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HIV medications can be used as post-exposure prophylaxis to efficaciously prevent an HIV-negative person who has come into contact with HIV from becoming HIV-positive. Traditionally, these medications have been available in emergency departments, which have constituted a barrier for the members of many minority groups who are greatly affected by HIV transmission (i.e. gay, bisexual and other men who have sex with men, and persons who use injection drugs). From 5 September 2013 through 4 September 2015, we sought to increase the use of HIV post-exposure prophylaxis by having registered nurses provide these medications, when indicated, in community clinics in Ottawa, Canada. We undertook a chart review of patients who accessed services for HIV post-exposure prophylaxis in this period. Over the two years of data collection, 112 persons requested HIV post-exposure prophylaxis and 64% (n = 72) initiated these medications. Most (93%, or n = 67, of the 72 initiations) were among men, with 88% (n = 59) of these men reporting same sex sexual partners. Among these 58 men, 31% (n = 18) had sexual contact with other men known to be HIV-positive. Among women (n = 8), five initiated post-exposure prophylaxis: three after needle-sharing contact or sexual contact with a male partner who reportedly shared needles, and two after unprotected vaginal sex with a male partner known to be HIV-positive. Overall, no one was diagnosed with HIV at the four-month HIV testing follow-up, although six persons were diagnosed with HIV from the baseline HIV testing, and an additional four were diagnosed with HIV during routine HIV testing one year after completing post-exposure prophylaxis. In total, nine persons in our sample were thus diagnosed with HIV during the study period, which accounted for 9.4% (n = 10 of 106) of all reported HIV diagnoses in Ottawa during this time. We conclude that nurse-initiated HIV post-exposure prophylaxis can be an effective way to provide HIV prevention services to persons who are at high-risk for HIV.

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Section: Participants Setting and Interventionmentioning

confidence: 99%

Community-based, nurse-led post-exposure prophylaxis: results and implications

et al. 2016

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“…A myriad of factors, including the heightened risk of infection via anal sex compared with vaginal sex [ 12 ]; behavioural factors, such as condomless anal intercourse and substance use [ 13 ]; and social factors, including homophobia, stigma, and social exclusion [ 11 , 12 , 14 ] have been advanced to explain these high rates of new infections. Additionally, structural barriers such as criminalization of HIV exposure [ 15 ], insufficient access to culturally appropriate health services and distrust of available health care providers [ 16 – 18 ], may deter some MSM from seeking HIV testing and treatment, as well as negatively impact retention rates. Continuation of treatment is crucial for long-term clinical success and prevention of viral rebound [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

Predictors of viral suppression and rebound among HIV-positive men who have sex with men in a large multi-site Canadian cohort

et al. 2016

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BackgroundGay, bisexual and other men who have sex with men (MSM) are disproportionately affected by HIV in Canada. Combination antiretroviral therapy has been shown to dramatically decrease progression to AIDS, premature death and HIV transmission. However, there are no comprehensive data regarding combination antiretroviral therapy outcomes among this population. We sought to identify socio-demographic and clinical correlates of viral suppression and rebound.MethodsOur analysis included MSM participants in the Canadian Observational Cohort, a multi-site cohort of HIV-positive adults from Canada’s three most populous provinces, aged ≥18 years who first initiated combination antiretroviral therapy between 2000 and 2011. We used accelerated failure time models to identify factors predicting time to suppression (2 measures <50 copies/mL ≥30 days apart) and subsequent rebound (2 measures >200 copies/mL ≥30 days apart).ResultsOf 2,858 participants, 2,448 (86 %) achieved viral suppression in a median time of 5 months (Q1–Q3: 3–7 months). Viral suppression was significantly associated with later calendar year of antiretroviral therapy initiation, no history of injection drug use, lower baseline viral load, being on an initial regimen consisting of non-nucleoside reverse-transcriptase inhibitors, and older age. Among those who suppressed, 295 (12 %) experienced viral rebound. This was associated with earlier calendar year of antiretroviral therapy initiation, injection drug use history, younger age, higher baseline CD4 cell count, and living in British Columbia.ConclusionsFurther strategies are required to optimize combination antiretroviral therapy outcomes in men who have sex with men in Canada, specifically targeting younger MSM and those with a history of injection drug use.

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“…To address this situation, I used the subcultural understandings I developed through my ethnographic research to make clinical services culturally sensitive. The outcomes of this clinic fit the predictive model that ethnographic studies can help yield effective interventions: GayZone had good uptake, had high rates of patient satisfaction, and had higher than expected rates of STI/HIV diagnosis among patients (O'Byrne, MacPherson, Ember, Grayson, & Bourgault, 2014;O'Byrne & Watts, 2014). In 2014, I similarly used my findings from these ongoing studies to implement a nurse-led clinic for HIV postexposure prophylaxis (PEP) and, more recently, in 2018, a nurse-led PrEP service (O'Byrne, MacPherson, Roy, & Orser, 2017).…”

Section: My Preferred Approachmentioning

confidence: 77%

Population Health and Social Governance: A Review, an Update, Some Clarifications, and a Response

O’Byrne

2018

Qual Health Res

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Critical theory is a paradigm that promotes viewpoints that are alternative and, at times, contrary to mainstream beliefs and dictates. In 2012, I adopted this perspective to review the role of ethnography and surmised that the data which arise from this research approach, which I described as an in-depth study of cultures, can be used to discipline and control these groups. In this edition of Qualitative Health Research, another author has critiqued this position. In this article, I review this critique, reiterate my position, update the data I used for my 2012 article, and highlight how I navigate what I feel is a tension between critical theory and practice.

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Overview of a gay men’s STI/HIV testing clinic in Ottawa: Clinical operations and outcomes

Cited by 11 publications

References 20 publications

Community-based, nurse-led post-exposure prophylaxis: results and implications

Community-based, nurse-led post-exposure prophylaxis: results and implications

Predictors of viral suppression and rebound among HIV-positive men who have sex with men in a large multi-site Canadian cohort

Population Health and Social Governance: A Review, an Update, Some Clarifications, and a Response

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