Grant: Operating Grant - HIV/AIDS CBR Program - General

Canada continues to see unacceptable rates of HIV, particularly among gay, bisexual and other men who have sex with men, trans- and cis-gender women, and African, Caribbean and Black (ACB) communities. A new strategy called PrEP (pre-exposure prophylaxis, the daily use of anti-HIV medication by those at high risk) holds great promise to help address this challenge, and is already being prescribed in Canada. However, PrEP remains controversial due to uncertainty about whether its HIV prevention potential is counterbalanced by increases in risk behaviour and sexually transmitted infections, whether users will be able to adhere and stay engaged in care, and whether user experiences such as PrEP-related stigma impact on use. In addition, there is great concern among communities that PrEP access has been inequitable. To address these issues, we will study 800 PrEP users in Ontario in a cohort study over three years. Our fundamental questions are, "Is PrEP having the intended impacts on the health of at-risk populations in Ontario? What are the 'real world' benefits and challenges of PrEP rollout? How can we optimize PrEP delivery and access?" We will: 1.Gather real world data on key biological, behavioural, experiential, and engagement in care outcomes over time, in a diverse cohort of PrEP users in Ontario 2.Characterize multiple measures of PrEP access within the cohort 3.Compare PrEP outcomes according to key characteristics of PrEP users. Because some of the key populations affected by HIV have been underrepresented in PrEP studies, we have reserved spots within the cohort for transgender women, cisgender women and ACB persons. In conjunction with our recruitment activities, we have developed a detailed plan for outreach with at-risk populations and the providers that serve them to raise awareness about PrEP and provide advice on PrEP access. Our findings will directly inform future efforts to optimize PrEP rollout and improve PrEP access in Canada.