Grant: Travel Awards - Institute Community Support

Despite universal healthcare, women living with HIV in Canada experience barriers to comprehensive care. Strengthening clinical management beyond antiretroviral treatment requires an understanding of care gaps and care delivery. This study sought to answer the questions: 1) what care gaps occur for women living with HIV; and 2) do care gaps vary depending on where (clinics) and from whom (specialist of family doctors) women access care. We analysed data from the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (n=1422). Women with HIV aged >=16 years, and residing in British Columbia, Ontario or Quebec participated from 2013-2015. Women currently accessing HIV-care (n=1242) were asked about components of women's care (pap test, pap test discussions, mammography, and reproductive discussions) and HIV-care (antiretroviral use, adherence, viral load, and viral load discussions). We defined comprehensive care as pap test, mammography, reproductive discussion, and HIV viral load. Overall, 62.3% women experienced at least one gap in care, the most common being reproductive discussions 65.3%, followed by mammography 38.7%, pap test 29.3%, and detectable viral loads 19.0%. Across the typology of care women accessed care from HIV-clinicians in HIV-clinics (70.9%), specialists in non-HIV clinics (17.6%), and family doctors in non-HIV clinics (11.4%). Women accessing care from family doctors in non-HIV clinics had nearly double the odds of not being currently on ART. Women accessing care from specialist in non-HIV clinics had 1.6 times higher odds of not having discussed the importance of regular Pap Tests, while having lower odds of having a detectable viral load. There were no observed differences in comprehensive care gaps across the typology of care. The majority of women in our study continue to experience gaps in care, irrespective of care type, indicating the need for models of care that address both HIV and women's health in a chronic disease era.