Findings among Indigenous participants of the Tracks survey of people who inject drugs in Canada, Phase 4, 2017-2019.

BACKGROUND: The Tracks survey of people who inject drugs (PWID) collected data in 14 sentinel sites across Canada (2017-2019). These findings describe the prevalence of human immunodeficiency virus (HIV), hepatitis C and associated risk behaviours among Indigenous participants. METHODS: Information regarding socio-demographics, social determinants of health, use of prevention services and testing, drug use, risk behaviours, and HIV and hepatitis C testing, care and treatment was collected through interviewer-administered questionnaires. Biological samples were tested for HIV, hepatitis C antibodies and hepatitis C ribonucleic acid (RNA). Descriptive statistics were calculated and reviewed by an Indigenous-led advisory group using the Two-Eyed Seeing approach. RESULTS: Of the 2,383 participants, 997 were Indigenous (82.9% First Nations, 14.9% Métis, 2.2% Inuit). Over half (54.5%) were cisgender male and the average age was 38.9 years. A large proportion (84.0%) reported their mental health as "fair to excellent". High proportions experienced stigma and discrimination (90.2%) and physical, sexual and/or emotional abuse in childhood (87.5%) or with a sexual partner (78.6%). Use of a needle/syringe distribution program (90.5%) and testing for HIV (87.9%) and hepatitis C (87.8%) were high. Prevalence of HIV was 15.4% (78.2% were aware of infection status) and 36.4% were hepatitis C RNA-positive (49.4% were aware of infection status). CONCLUSION: High rates of HIV and hepatitis C were identified. Challenges in access to and maintenance of HIV and hepatitis C care and treatment were noted. This information informs harm reduction strategies, including the need to scale-up awareness of prophylaxis in a culturally relevant manner.

The hepatitis C epidemic in Canada: An overview of recent trends in surveillance, injection drug use, harm reduction and treatment.

Hepatitis C continues to be a significant public health concern in Canada, with the hepatitis C virus (HCV) responsible for more life-years lost than all other infectious diseases in Canada. An increase in reported hepatitis C infections was observed between 2014 and 2018. Here, we present changing epidemiological trends and discuss risk factors for hepatitis C acquisition in Canada that may have contributed to this increase in reported hepatitis C infections, focusing on injection drug use. We describe a decrease in the use of borrowed needles or syringes coupled with an increase in using other used injection drug use equipment. Also, an increased prevalence of injection drug use and use of prescription opioid and methamphetamine injection by people who inject drugs (PWID) may be increasing the risk of HCV acquisition. At the same time, while harm reduction coverage appears to have increased in Canada in recent years, gaps in access and coverage remain. We also consider how direct-acting antiviral (DAA) eligibility expansion may have affected hepatitis C rates from 2014 to 2018. Finally, we present new surveillance trends observed in 2019 and discuss how the coronavirus disease 2019 (COVID-19) pandemic may affect hepatitis C case counts from 2020 onwards. Continual efforts to i) enhance hepatitis C surveillance and ii) strengthen the reach, effectiveness, and adoption of hepatitis C prevention and treatment services across Canada are vital to reducing HCV transmission among PWID and achieving Canada's HCV elimination targets by 2030.

National findings from the Tracks survey of people who inject drugs in Canada, Phase 4, 2017-2019.

Background: The Tracks survey of people who inject drugs (PWID) collected data in 14 sentinel sites across Canada (2017-2019). Objective: To describe the prevalence of human immunodeficiency virus (HIV) and hepatitis C and associated risk behaviours and to examine trends over time. Methods: Information regarding socio-demographics, social determinants of health, use of prevention services and testing, drug use, risk behaviours, and HIV and hepatitis C testing, care and treatment was collected through interviewer-administered questionnaires. Biological samples were tested for HIV, hepatitis C antibodies and hepatitis C ribonucleic acid (RNA). Descriptive statistics were calculated and trends over time were assessed. Results: Of the 2,383 participants, 65.6% were cisgender male, 42.2% were Indigenous, 48.0% completed some high school or less, 62.6% lived in unstable housing and 75.7% had ever been incarcerated. Average age was 40.1 years. The majority experienced stigma and discrimination (88.7%) and physical, sexual and/or emotional abuse in childhood (85.0%) or with a sexual partner (75.9%). The majority reported use of a needle/syringe distribution program (90.1%) and tested for HIV (90.5%) and hepatitis C (90.9%).Among participants who had ever had sex, the majority (59.2%) reported inconsistent condom use during vaginal and/or anal sex with a casual sex partner. Prevalence of HIV was 10.3% (82.9% were aware of infection status) and many (36.9%) were hepatitis C RNA-positive (50.1% were aware of infection status).Most surveillance indicators remained relatively stable from Phase 1 to Phase 4. Changes were found in substances used, and improvements were noted related to HIV and hepatitis C prevalence and care cascade indicators. Conclusion: Many PWID in Canada were living in unstable housing and experienced high levels of stigma and discrimination. Prevalence of HIV and hepatitis C was high in some areas. These findings contribute to the evidence base used to inform targeted prevention and control measures.

A systematic review of HIV testing among Canadian populations.

OBJECTIVE: Regular HIV testing and early detection leads to timely treatment. Appropriate treatment and care can prevent disease progression in the individual and prevent onwards transmission within the community. This review describes HIV testing coverage in populations disproportionately affected by HIV and in the general population in Canada. METHODS: A search of published and grey literature on HIV testing uptake in Canada was conducted. Studies reporting quantitative data on testing practices (ever tested, recent testing, and regular testing), published in either English or French from 2008-2012, were included. Studies that involved testing for immigration or prenatal purposes, and post-intervention studies, were excluded. Included studies were assessed using a modified version of the Public Health Agency of Canada's Descriptive Study Critical Appraisal Tool. Pooled prevalence for percent ever tested was calculated for subpopulations and heterogeneity was estimated using the I2 statistic. SYNTHESIS: A total of 26 studies were included in the review. The highest rates of ever having been tested were among people who inject drugs (90.6%) and inmates (90.4%); followed by men who have sex with men (83.0%); Aboriginal peoples (55.5%); and the general population (32.8%). Limited information was available on regular and recent testing. CONCLUSION: HIV testing can reduce the number of undiagnosed cases in Canada. Future research should focus on testing coverage in certain populations, and on the extent to which populations engage in regular testing.

Incidence of hospital admissions and severe outcomes during the first and second waves of pandemic (H1N1) 2009.

BACKGROUND: Canada experienced two distinct waves of pandemic (H1N1) influenza during the 2009 pandemic, one in the spring and the second in early fall 2009. We compared the incidence of hospital admissions and severe outcomes (admission to intensive care unit [ICU] and death) during the two waves. METHODS: We reviewed data on all laboratory-confirmed cases of pandemic (H1N1) influenza that resulted in hospital admission, ICU admission or death reported to the Public Health Agency of Canada by all provinces and territories from Apr. 18, 2009, to Apr. 3, 2010. RESULTS: A total of 8678 hospital admissions (including 1473 ICU admissions) and 428 deaths related to pandemic (H1N1) influenza were reported during the pandemic and post-peak period. There were 4.8 times more hospital admissions, 4.0 times more ICU admissions and 4.6 times more deaths in the second pandemic wave than in the first wave. ICU admissions and deaths as a proportion of hospital admissions declined in the second wave; there was a 16% proportional decline in ICU admissions and a 6% proportional decline in deaths compared with the first wave. Compared with patients admitted to hospital in the first wave, those admitted in the second wave were older (median age 30 v. 23 years) and more had underlying conditions (59.7% v. 47.5%). Pregnant women and Aboriginal people accounted for proportionally fewer patients who were admitted to hospital or who died in the second wave than in the first. INTERPRETATION: The epidemiologic features of the first and second waves of the 2009 pandemic differed. The second wave was substantially larger and, although the patients admitted to hospital were older and more of them had underlying conditions, a smaller proportion had a severe outcome.

Eliciting information on differential sensation of heat in those with and without poststroke aphasia using a visual analogue scale.

BACKGROUND AND PURPOSE: Aphasia can result in an inability to communicate the presence, location, or intensity of pain. Although visual analogue scales (VASs) exist, it is unknown whether they are useful in assessing pain in individuals with aphasia. The objective was to determine whether those with poststroke aphasia could respond differentially to thermal stimuli of varying intensities using a standardized VAS. METHODS: Five groups of participants were assessed: those without stroke, those with stroke but without aphasia, and 3 groups with varying degrees of aphasia. A 10-cm vertical VAS was used to measure responses to varying thermal intensities delivered on the participant's forearm. RESULTS: Across all 5 groups, a similar proportion demonstrated ability to discriminate between 2 temperatures (chi2=1.899; P=0.75). When presented with 4 temperatures, all groups performed more poorly, yet with similar success rates across groups (chi2=0.1267; P=0.88). The repeated-measures ANOVA revealed no effect of group but a significant effect of temperature (P<0.0001). CONCLUSIONS: A VAS may be useful in clinical identification of differing intensities of stimuli in a substantial proportion of those with aphasia.

Reliability of selected measures of nicotine dependence among adolescents.

PURPOSE: To examine the test retest reliability, internal consistency, and convergent construct validity of selected measures of nicotine dependence (ND) among adolescents. METHODS: Self-reports of sociodemographic characteristics and smoking behavior were collected in a convenience sample of 238 high school students aged 13 to 19 years. ND was measured in the Hooked on Nicotine Checklist (HONC), the Stanford Dependence Index (SDI) and in 45 new items identified in consultation with experts and focus group interviews with adolescent smokers. RESULTS: Test retest reliability among past 3-month smokers indicated good to excellent reliability coefficients for HONC items (kappa 0.61 to 0.93), except one item that tapped feelings of depression on withdrawal (kappa = 0.34). Intraclass correlation coefficients for SDI items ranged from 0.71 to 0.77. Test retest reliability coefficients for the 45 new items ranged from 0.20 to 0.90. The HONC and SDI demonstrated good internal consistency (Cronbach's alpha = 0.90 and 0.78, respectively). Convergent construct validity against cigarette exposure was demonstrated for the HONC, SDI, and most of the 45 new items. CONCLUSIONS: The HONC and SDI demonstrated excellent and good psychometric properties, respectively. Most of the 45 new items hold promise as indicators of ND in youth, and should be further investigated.