Grant: Team Gr.: Embracing Diversity Achieve Prec./Health Equity-HIV/AIDS/STBBI-PHP-LOI

Canada's HIV epidemic, as in much of of the world, is entering a new phase. The rate of new HIV infections has declined dramatically thanks to pre-exposure prophylaxis (PrEP) and antiretroviral treatment (ART) for people living with HIV, which suppresses the virus to undetectable, and thus untransmittable, levels. However, important gaps remain: each year, roughly 2000 people become infected with HIV in Canada, including 500 in Ontario. It is estimated that about 50 are diagnosed late, 15% of people diagnosed do not achieve viral suppression, despite advances in service delivery and implementation strategies. While new delivery options are available, such as injectable ART, these have not been spread widely, although many patients are interested in them. Groups disproportionately impacted by HIV and negative HIV related outcomes include members of marginalized groups including sex and gender minorities, as well as racialized, newcomer and socioeconomically disadvantaged groups. Reaching those 'left behind' in the HIV prevention and care cascade will require new transdisciplinary approaches that more precisely identify the specific predictors of poor outcomes such as HIV acquisition, and the specific contexts underlying HIV transmission. Grounded in a health equity framework, our objectives are: 1.To identify the underlying life-course trajectories, patterns of healthcare utilization and gaps in utilization that predict HIV cascade outcomes (PrEP use, PrEP persistence, HIV seroconversion, ART initiation, ART persistence) using epidemiologic and statistical models across linked data sets 2.To identify and characterize the social, health system, and economic contexts in which new HIV transmission events continue to occur in Ontario, using qualitative, social network analyses and phylogenetic methods 3.To co-create novel interventions for better reaching those left behind from existing PrEP and ART programs through an iterative, community-engaged approach.