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1.
Vaccine ; 40(26): 3690-3700, 2022 Jun 09.
Article in English | MEDLINE | ID: covidwho-1873318

ABSTRACT

BACKGROUND: Starting in 2015/16, most Canadian provinces introduced publicly-funded human papillomavirus (HPV) vaccination programs for gay, bisexual, and other men who have sex with men (GBM) aged ≤ 26 years. We estimated 12-month changes in HPV vaccine coverage among community-recruited GBM from 2017 to 2021 and identified baseline factors associated with vaccine initiation (≥1 dose) or series completion (3 doses) among participants who were unvaccinated or partially vaccinated at baseline. METHODS: We recruited sexually-active GBM aged ≥ 16 years in Montreal, Toronto, and Vancouver, Canada, from 02/2017 to 08/2019 and followed them over a median of 12 months (interquartile range = 12-13 months). We calculated the proportion who initiated vaccination (≥1 dose) or completed the series (3 doses) by 12-month follow-up. Analyses were stratified by city and age-eligibility for the publicly-funded programs at baseline (≤26 years or > 26 years). We used multivariable logistic regression to identify baseline factors associated with self-reported incident vaccine initiation or series completion. RESULTS: Among 165 unvaccinated participants aged ≤ 26 years at baseline, incident vaccine initiation (≥1 dose) during follow-up was 24.1% in Montreal, 33.3% in Toronto, and 38.9% in Vancouver. Among 1,059 unvaccinated participants aged > 26 years, incident vaccine initiation was 3.4%, 8.9%, and 10.9%, respectively. Higher education and trying to access pre-exposure prophylaxis for HIV were associated with incident vaccination among those aged ≤ 26 years, while younger age, residing in Vancouver (vs. Montreal), being diagnosed with anogenital warts, having both government and private extended medical insurance, and being vaccinated against influenza were associated with incident vaccination among those aged > 26 years. CONCLUSIONS: We observed substantial gains in HPV vaccine coverage among young GBM within 5 + years of targeted program implementation, but gaps remain, particularly among older men who are ineligible for publicly-funded programs. Findings suggest the need for expanded public funding or insurance coverage for HPV vaccines.


Subject(s)
Papillomavirus Infections , Papillomavirus Vaccines , Sexual and Gender Minorities , Aged , Bisexuality , Canada , Homosexuality, Male , Humans , Male , Papillomavirus Infections/prevention & control , Vaccination
2.
AIDS Res Hum Retroviruses ; 38(5): 359-362, 2022 05.
Article in English | MEDLINE | ID: covidwho-1840020

ABSTRACT

We performed retrospective chart reviews and described the clinical characteristics, exposure risks, and disease severity of people living with HIV (PLWH) attending the Chronic Viral Illness Service (CVIS) in Montreal, Canada, who developed coronavirus disease 2019 (COVID-19) during September 2020-August 2021, coinciding with the second and third waves of the pandemic. A total of 61 PLWH with a positive COVID-19 polymerase chain reaction were identified, giving a COVID-19 prevalence of 5%. The most common exposure risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during waves two and three was having a family member/close contact with COVID-19 (36%). Similar to what we observed during the first wave, PLWH who acquired COVID-19 during waves two and three of the pandemic often worked or lived in long-term care residences or health care settings, putting them at risk. Five people (8%) were asymptomatic. Nearly all persons had mild disease on initial presentation and most had a full recovery. Two individuals were admitted to hospital with COVID-19, whereas three individuals acquired COVID-19 nosocomially. No individuals died due to COVID-19. Two individuals developed symptoms associated with long COVID-19 syndrome. Findings highlight the ongoing impact of the social determinants of health during the second and third waves of the pandemic in PLWH.


Subject(s)
COVID-19 , HIV Infections , COVID-19/complications , COVID-19/epidemiology , HIV Infections/complications , HIV Infections/epidemiology , Humans , Pandemics , Retrospective Studies , SARS-CoV-2 , Social Determinants of Health , Tertiary Care Centers
3.
Clin Infect Dis ; 2022 Jan 17.
Article in English | MEDLINE | ID: covidwho-1816030

ABSTRACT

BACKGROUND: People in prison are at increased risk of SARS-CoV-2 infection due to overcrowding and challenges in implementing infection prevention and control measures. We examined the seroprevalence of SARS-CoV-2 and associated carceral risk factors among incarcerated adult men in Quebec, Canada. METHODS: We conducted a cross-sectional seroprevalence study in 2021 in three provincial prisons, representing 45% of Quebec's incarcerated male provincial population. The primary outcome was SARS-CoV-2 antibody seropositivity (Roche Elecsys® serology test). Participants completed self-administered questionnaires on sociodemographic, clinical, and carceral characteristics. The association of carceral variables with SARS-CoV-2 seropositivity was examined using Poisson regression models with robust standard errors. Crude and adjusted prevalence ratios (aPR) with 95% confidence intervals (95%CI) were calculated. RESULTS: Between January 19 and September 15, 2021, 246 of 1,100 (22%) recruited individuals tested positive across three prisons (range 15-27%). Seropositivity increased with time spent in prison since March 2020 (aPR 2.17, 95%CI 1.53-3.07 for "all" vs. "little time"), employment during incarceration (aPR 1.64, 95%CI 1.28-2.11 vs. not), shared meal consumption during incarceration ("with cellmates": aPR 1.46, 95%CI 1.08-1.97 vs. "alone"; "with sector": aPR 1.34, 95%CI 1.03-1.74 vs. "alone"), and incarceration post-prison outbreak (aPR 2.32, 95% CI 1.69-3.18 vs. "pre-outbreak"). CONCLUSIONS: The seroprevalence of SARS-CoV-2 among incarcerated individuals was high and varied between prisons. Several carceral factors were associated with seropositivity, underscoring the importance of decarceration and occupational safety measures, individual meal consumption, and enhanced infection prevention and control measures including vaccination during incarceration.

4.
PLoS One ; 17(3): e0264145, 2022.
Article in English | MEDLINE | ID: covidwho-1736505

ABSTRACT

BACKGROUND: Vaccine uptake rates have been historically low in correctional settings. To better understand vaccine hesitancy in these high-risk settings, we explored reasons for COVID-19 vaccine refusal among people in federal prisons. METHODS: Three maximum security all-male federal prisons in British Columbia, Alberta, and Ontario (Canada) were chosen, representing prisons with the highest proportions of COVID-19 vaccine refusal. Using a qualitative descriptive design and purposive sampling, individual semi-structured interviews were conducted with incarcerated people who had previously refused at least one COVID-19 vaccine until data saturation was achieved. An inductive-deductive thematic analysis of audio-recorded interview transcripts was conducted using the Conceptual Model of Vaccine Hesitancy. RESULTS: Between May 19-July 8, 2021, 14 participants were interviewed (median age: 30 years; n = 7 Indigenous, n = 4 visible minority, n = 3 White). Individual-, interpersonal-, and system-level factors were identified. Three were particularly relevant to the correctional setting: 1) Risk perception: participants perceived that they were at lower risk of COVID-19 due to restricted visits and interactions; 2) Health care services in prison: participants reported feeling "punished" and stigmatized due to strict COVID-19 restrictions, and failed to identify personal benefits of vaccination due to the lack of incentives; 3) Universal distrust: participants expressed distrust in prison employees, including health care providers. INTERPRETATION: Reasons for vaccine refusal among people in prison are multifaceted. Educational interventions could seek to address COVID-19 risk misconceptions in prison settings. However, impact may be limited if trust is not fostered and if incentives are not considered in vaccine promotion.


Subject(s)
COVID-19/prevention & control , Prisoners/psychology , Vaccination Refusal/statistics & numerical data , Adult , Alberta , Attitude , British Columbia , COVID-19/epidemiology , COVID-19/virology , Delivery of Health Care , Humans , Interviews as Topic , Male , Middle Aged , Ontario , Risk , SARS-CoV-2/isolation & purification , Social Norms , Social Responsibility , Young Adult
5.
Vaccine X ; 10: 100150, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1693177

ABSTRACT

INTRODUCTION: Canadian correctional institutions have been prioritized for COVID-19 vaccination given the multiple outbreaks that have occurred since the start of the pandemic. Given historically low vaccine uptake, we aimed to explore barriers and facilitators to COVID-19 vaccination acceptability among people incarcerated in federal prisons. METHODS: Three federal prisons in Quebec, Ontario, and British Columbia (Canada) were chosen based on previously low influenza vaccine uptake among those incarcerated. Using a qualitative design, semi-structured interviews were conducted with a diverse sample (gender, age, and ethnicity) of incarcerated people. An inductive-deductive analysis of audio-recorded interview transcripts was conducted to identify and categorize barriers and facilitators within the Theoretical Domains Framework (TDF). RESULTS: From March 22-29, 2021, a total of 15 participants (n = 5 per site; n = 5 women; median age = 43 years) were interviewed, including five First Nations people and six people from other minority groups. Eleven (73%) expressed a desire to receive a COVID-19 vaccine, including two who previously refused influenza vaccination. We identified five thematic barriers across three TDF domains: social influences (receiving strict recommendations, believing in conspiracies to harm), beliefs about consequences (believing that infection control measures will not be fully lifted, concerns with vaccine-related side effects), and knowledge (lack of vaccine-specific information), and eight thematic facilitators across five TDF domains: environmental context and resources (perceiving correctional employees as sources of outbreaks, perceiving challenges to prevention measures), social influences (receiving recommendations from trusted individuals), beliefs about consequences (seeking individual and collective protection, believing in a collective "return to normal", believing in individual privileges), knowledge (reassurance about vaccine outcomes), and emotions (having experienced COVID-19-related stress). CONCLUSIONS: Lack of information and misinformation were important barriers to COVID-19 vaccine acceptability among people incarcerated in Canadian federal prisons. This suggests that educational interventions, delivered by trusted health care providers, may improve COVID-19 vaccine uptake going forward.

6.
Sex Transm Dis ; 48(12): 939-944, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1605252

ABSTRACT

BACKGROUND: Reported cases of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections are increasing among Canadian men. Estimates of community-based CT/NG prevalence are lacking among gay, bisexual, and other men who have sex with men (GBM). METHODS: Respondent driven sampling was used to recruit GBM in Montréal, Canada between February 2017 and June 2018. Specimens provided from urogenital, rectal, and pharyngeal sites were analyzed using nucleic acid amplification test to detect CT/NG. Prevalence estimates of CT/NG, overall and by anatomical site were calculated. All estimates are respondent-driven sampling-adjusted. RESULTS: Among 1177 GBM, the prevalence of rectal, urogenital, pharyngeal and overall were respectively 2.4%, 0.4%, 0.4%, and 2.8% for CT infections, and 3.1%, 0.4%, 3.5%, and 5.6% for NG infections. If testing had been limited to the urogenital site, 80% and 94% of CT and NG infections, respectively, would have been missed. CONCLUSIONS: This community-based study among GBM shows that the CT prevalence was about half of that observed for NG. A large part of CT/NG infections involves only the extragenital sites, highlighting the need for systematic multisite screening regardless of symptoms. In the mist of the COVID-19 pandemic and the limited CT/NG screening capacity due to test kits shortage, it might be considered to prioritize rectal and pharyngeal CT/NG testing over urogenital testing in asymptomatic GBM.


Subject(s)
COVID-19 , Chlamydia Infections , Gonorrhea , Sexual and Gender Minorities , Canada/epidemiology , Chlamydia Infections/epidemiology , Chlamydia trachomatis/genetics , Gonorrhea/epidemiology , Homosexuality, Male , Humans , Male , Neisseria gonorrhoeae/genetics , Pandemics , Prevalence , SARS-CoV-2
7.
PLoS One ; 16(12): e0261006, 2021.
Article in English | MEDLINE | ID: covidwho-1593120

ABSTRACT

BACKGROUND: Adherence to antiretroviral therapy (ART) remains problematic. Regular monitoring of its barriers is clinically recommended, however, patient-provider communication around adherence is often inadequate. Our team thus decided to develop a new electronically administered patient-reported outcome measure (PROM) of barriers to ART adherence (the I-Score) to systematically capture this data for physician consideration in routine HIV care. To prepare for a controlled definitive trial to test the I-Score intervention, a pilot study was designed. Its primary objectives are to evaluate patient and physician perceptions of the I-Score intervention and its implementation strategy. METHODS: This one-arm, 6-month study will adopt a mixed method type 3 implementation-effectiveness hybrid design and be conducted at the Chronic Viral Illness Service of the McGill University Health Centre (Montreal, Canada). Four HIV physicians and 32 of their HIV patients with known or suspected adherence problems will participate. The intervention will involve having patients complete the I-Score through a smartphone application (Opal), before meeting with their physician. Both patients and physicians will have access to the I-Score results, for consideration during the clinic visits at Times 1, 2 (3 months), and 3 (6 months). The implementation strategy will focus on stakeholder involvement, education, and training; promoting the intervention's adaptability; and hiring an Application Manager to facilitate implementation. Implementation, patient, and service outcomes will be collected (Times 1-2-3). The primary outcome is the intervention's acceptability to patients and physicians. Qualitative data obtained, in part, through physician focus groups (Times 2-3) and patient interviews (Times 2-3) will help evaluate the implementation strategy and inform any methodological adaptations. DISCUSSION: This study will help plan a definitive trial to test the efficacy of the I-Score intervention. It will generate needed data on electronic PROM interventions in routine HIV care that will help improve understanding of conditions for their successful implementation. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04702412; https://clinicaltrials.gov/.


Subject(s)
Anti-Retroviral Agents/therapeutic use , Electronic Health Records , Health Services , Medication Adherence , Patient Portals , Patient Reported Outcome Measures , Canada , Humans , Pilot Projects
8.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-295207

ABSTRACT

Background: People in prison are at increased risk of SARS-CoV-2 infection due to overcrowding and challenges in implementing infection prevention and control measures. We examined the seroprevalence of SARS-CoV-2 and associated risk factors among incarcerated adult men in Quebec, Canada.Methods: We conducted a cross-sectional seroprevalence study in 2021 in three provincial prisons, representing 45% of Quebec’s incarcerated male provincial population. The primary outcome was SARS-CoV-2 antibody seropositivity (Roche Elecsys® serology test). Participants completed self-administered questionnaires on sociodemographic, clinical, and carceral characteristics. The association of carceral variables with SARS-CoV-2 seropositivity was examined using Poisson regression models with robust standard errors. Crude and adjusted prevalence ratios (aPR) with 95% confidence intervals (95%CI) were calculated.Findings: Between January 19 and September 15, 2021, 246 of 1,100 (22%) recruited individuals tested positive across three prisons (range 15–27%). Seropositivity increased with time spent in prison since March 2020 (aPR 2·17, 95%CI 1·53–3·07 for “all” vs. “little time”), employment during incarceration (aPR 1·64, 95%CI 1·28–2·11 vs. not), shared meal consumption during incarceration (“with cellmates”: aPR 1·46, 95%CI 1·08–1.97 vs. “alone”;“with sector”: aPR 1·34, 95%CI 1·03–1·74 vs. “alone”), and incarceration post-prison outbreak (aPR 2·32, 95% CI 1·69–3·18 vs. “pre-outbreak”).Interpretation: The seroprevalence of SARS-CoV-2 among incarcerated individuals was high and varied between prisons. Several carceral factors were associated with seropositivity, underscoring the importance of decarceration and occupational safety measures, individual meal consumption, and enhanced infection prevention and control measures including vaccination during incarceration. Funding Information: The Public Health Agency of Canada funded this study (# 2021-HQ-000103). Declaration of Interests: CD, AH, SC, JS, HP, LDB, and SP declare no competing interests. NK reports research funding from Gilead Sciences, advisory fees from Gilead Sciences, ViiV Healthcare, Merck and Abbvie, and speaker fees from Gilead Sciences and Merck, all outside of the submitted work. MMG reports an investigator-sponsored research grant from Gilead Sciences Inc. MMG reports contractual arrangements with the World Health Organization, the Institut national de santé publique du Québec, and the Institut d’excellence en santé et services sociaux du Québec, all outside of the submitted work. MPC reports grants from the McGill Interdisciplinary Initiative in Infection and Immunity and from the Canadian Institutes of Health Research. MPC reports personal fees from GEn1E Lifesciences and form nplex biosciences, both outside the submitted work. MPC is the co-founder of Kanvas Biosciences, Inc. and owns equity in the company. MPC has a pending patent for Methods for detecting tissue damage, graft versus host disease, and infections using cell-free DNA profiling pending, and a pending patent for Methods for assessing the severity and progression of SARS-CoV-2 infections using cell-free DNA. JC has research funding from ViiV Healthcare and Gilead Sciences, and reports remuneration for advisory work (ViiV Healthcare, Gilead Sciences and Merck Canada), outside the submitted work.Ethics Approval Statement: Participants provided written informed consent and received an honorarium of $10 CAD for their study participation. This study was approved by the McGill University Health Centre Research Ethics Board (MUHC REB #2021–6888) and the Direction régionale des services correctionnels du Québec (#2020–12493).

9.
JMIR Mhealth Uhealth ; 9(4): e24743, 2021 04 20.
Article in English | MEDLINE | ID: covidwho-1194543

ABSTRACT

BACKGROUND: The COVID-19 pandemic has acted as a catalyst for the development and adoption of a broad range of remote monitoring technologies (RMTs) in health care delivery. It is important to demonstrate how these technologies were implemented during the early stages of this pandemic to identify their application and barriers to adoption, particularly among vulnerable populations. OBJECTIVE: The purpose of this knowledge synthesis was to present the range of RMTs used in delivering care to patients with COVID-19 and to identify perceived benefits of and barriers to their use. The review placed a special emphasis on health equity considerations. METHODS: A rapid review of published research was conducted using Embase, MEDLINE, and QxMD for records published from the inception of COVID-19 (December 2019) to July 6, 2020. Synthesis involved content analysis of reported benefits of and barriers to the use of RMTs when delivering health care to patients with COVID-19, in addition to health equity considerations. RESULTS: Of 491 records identified, 48 publications that described 35 distinct RMTs were included in this review. RMTs included use of existing technologies (eg, videoconferencing) and development of new ones that have COVID-19-specific applications. Content analysis of perceived benefits generated 34 distinct codes describing advantages of RMTs, mapped to 10 themes overall. Further, 52 distinct codes describing barriers to use of RMTs were mapped to 18 themes. Prominent themes associated with perceived benefits included a lower burden of care (eg, for hospitals, health care practitioners; 28 records), reduced infection risk (n=33), and support for vulnerable populations (n=14). Prominent themes reflecting barriers to use of RMTs included equity-related barriers (eg, affordability of technology for users, poor internet connectivity, poor health literacy; n=16), the need for quality "best practice" guidelines for use of RMTs in clinical care (n=12), and the need for additional resources to develop and support new technologies (n=11). Overall, 23 of 48 records commented on equity characteristics that stratify health opportunities and outcomes, including general characteristics that vary over time (eg, age, comorbidities; n=17), place of residence (n=11), and socioeconomic status (n=7). CONCLUSIONS: Results of this rapid review highlight the breadth of RMTs being used to monitor and inform treatment of COVID-19, the potential benefits of using these technologies, and existing barriers to their use. Results can be used to prioritize further efforts in the implementation of RMTs (eg, developing "best practice" guidelines for use of RMTs and generating strategies to improve equitable access for marginalized populations).


Subject(s)
COVID-19 , Pandemics , Humans , SARS-CoV-2 , Technology , Videoconferencing
10.
AIDS Care ; : 1-7, 2021 Mar 28.
Article in English | MEDLINE | ID: covidwho-1155731

ABSTRACT

People living with HIV (PLWH) often have worse health outcomes compared to HIV-uninfected individuals. We characterized PLWH followed at a tertiary care clinic in Montreal who acquired COVID-19 and described their outcomes during the first wave of the pandemic. A retrospective chart review was performed for PLWH followed at the Chronic Viral Illness Service with a positive COVID-19 nasopharyngeal PCR or symptoms suggestive of COVID-19 between 1 March and 15 June 2020. Data on demographics, socioeconomic status, co-morbidities and severity of COVID-19 and outcomes were extracted. Of 1702 individuals, 32 (1.9%) had a positive COVID-19 test (n = 24) or symptoms suspicious for COVID-19 (n = 3). Median age was 52 years [IQR 40, 62]. Nearly all (97%) earned $34,999 Canadian dollars or less. Eleven (34%) individuals worked in long-term care (LTC) homes while 5 (6%) lived in LTC homes. Median CD4 count was 566 cells/mm3 [347, 726] and six had detectable plasma HIV viral loads. Median duration of HIV was 17 years [7, 22] and 30 individuals had been prescribed antiretroviral therapy. Five persons were asymptomatic. Of symptomatic persons, 21 (12%), 1 (4%) and 3 (12%) individuals had mild, moderate and severe disease, respectively. Three individuals died with COVID-19. In one case, the cause of death was due to COVID-19, whereas in the other two cases, the individuals died with positive COVID-19 test results but the immediate cause of death is unclear. PLWH who tested positive for COVID-19 had low socioeconomic status and had employment or living conditions that put them at high risk. PLWH may be disproportionately impacted by the social determinants of health which predispose them to COVID-19.

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