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ObjectivesIn 2015, a publicly funded human papillomavirus (HPV) vaccination programme was implemented for gay, bisexual and other men who have sex with men (gbMSM) up to age 26 years in British Columbia, Canada. We assessed trends and correlates of HPV vaccine uptake from 2012 to 2019 in a cohort of gbMSM in Vancouver.MethodsWe recruited sexually active gbMSM aged ≥16 years using respondent-driven sampling from February 2012 to February 2015 and followed them until July 2019. We evaluated self-reported HPV vaccine trends using mixed-effects logistic regression and identified factors associated with uptake using multivariable mixed-effects Poisson regression.ResultsA total of 719 participants were recruited and completed the baseline visit, of whom 549 were unvaccinated with at least one follow-up visit. The median age was 33 years and 23% were living with HIV. HPV vaccination increased from 4% in 2012 to 28% in 2019 (p<0.001) among gbMSM >26 years, and from 9% in 2012 to 20% in 2017 (p<0.001) among gbMSM ≤26 years. Vaccination uptake increased after September 2015, following vaccination policy expansion (adjusted rate ratio (aRR)=1.82, 95% CI 1.06 to 3.12). In multivariable models, increased vaccination was associated with age ≤26 years vs ≥45 years (aRR=3.90; 95% CI 1.75 to 8.70), age 27–44 vs ≥45 years (aRR=2.86; 95% CI 1.46 to 5.62), involvement in gay community sports teams (aRR=2.31; 95% CI 1.15 to 4.64) and other groups (aRR=1.71; 95% CI 1.04 to 2.79), awareness of HIV-postexposure prophylaxis (aRR=5.50; 95% CI 1.31 to 23.09), recent sexually transmitted infection testing (aRR=2.72; 95% CI 1.60 to 4.60) and recent sex-work (aRR=2.59; 95% CI 1.08 to 6.19).ConclusionsAlthough we observed increases in HPV vaccination uptake from 2012, by 2019 HPV vaccination still remained below 30% among gbMSM in Vancouver, BC. Additional interventions are needed to increase vaccine uptake.

Objective: The aim of this study was to explore the acceptability of bacterial STI vaccines among young HPV-vaccinated Canadian women to inform future vaccine program implementation. Methods: A 20-item cross-sectional questionnaire was administered from June 2019 to June 2020 to HPV-vaccinated participants of the pan-Canadian QUEST cohort. Multivariable logistic regression models assessed interest in chlamydia, syphilis, and gonorrhea vaccines using a priori variables and factors significant in bivariate analysis. Results: Of the 1092 respondents analyzed, 82% indicated interest in receiving one or more future STI vaccines. Respondents had a median age of 19.6 years (range 16.9–23.4), and 75% of respondents identified as white/European descent. In adjusted analyses, intent to engage in positive health behaviours was associated with vaccine interest for syphilis (OR = 5.76, 95% CI 4.03–8.27), chlamydia (OR = 5.27, 95% CI 3.66–7.63), and gonorrhea (OR = 5.96, 95% CI 4.15–8.60). Willingness to pay for an STI vaccine was also associated with vaccine interest for syphilis (OR = 2.02, 95% CI 1.29–3.19), chlamydia (OR = 2.41, 95% CI 1.50–3.90), and gonorrhea (OR = 2.29, 95% CI 1.44–3.63). Ever having sexual intercourse and identifying as LGBTQ were significantly associated with vaccine interest for all infections, while age and ever being immunosuppressed were not significant in any adjusted models. Conclusion: Findings indicate over 80% of participants in a cohort of young HPV-vaccinated Canadian women are interested in receiving future bacterial STI vaccines. Further exploration of STI vaccine acceptability among diverse populations is required to inform future bacterial STI vaccine program implementation.

ObjectivesWe assessed COVID-19 pandemic impacts on accessing needed sexual health services, and acceptability of alternative service delivery models, among sexual health service clients in British Columbia (BC), Canada.MethodsWe administered an online survey on 21 July–4 August 2020 to clients using a provincial STI clinic or internet-based testing service, GetCheckedOnline, in the year prior to March 2020. We used logistic regression to identify factors associated with having unmet sexual health needs (ie, not accessing needed services) during March–July 2020 and the likelihood of using various alternative service models, if available.ResultsOf 1198 survey respondents, 706 (59%) reported needing any sexual health service since March 2020; of these 706, 365 (52%) did not access needed services and 458 (66%) had avoided or delayed accessing services. GetCheckedOnline users (univariate OR (uOR)=0.62; 95% CI 0.43 to 0.88) or clients with more urgent needs (eg, treatment for new STI, uOR 0.40 (95% CI 0.21 to 0.7)) had lower odds of unmet sexual health needs. The most common factors reported for avoiding or delaying access were public messaging against seeking non-urgent healthcare (234/662, 35%), concern about getting COVID-19 while at (214/662, 32%) or travelling to (147/662, 22%) a clinic or lab and closure of usual place of accessing services (178/662, 27%). All factors were positively associated with having unmet sexual health needs, with public messaging showing the strongest effect (adjusted OR=4.27 (95% CI 2.88 to 6.42)). Likelihood of using alternative sexual health service models was high overall, with the most appealing options being home self-collection kits (634/706, 90%), receiving test kits or antibiotics at home (592/700, 85%) and express testing (565/706, 80%).ConclusionsOf BC sexual health service clients needing services during March–July 2020, many had unmet needs. Offering alternative service delivery methods may help to improve access during and beyond the COVID-19 pandemic.

Objectives: Syphilis rates have increased in BC and disproportionately affect gay, bisexual, and other men who have sex with men (gbMSM). A social marketing campaign (Syphistory) ran from January to September 2017 with the primary goal of increasing syphilis knowledge and a secondary goal of increasing syphilis screening among gbMSM in BC. Methods: We used pre- and post-campaign surveys to assess changes in syphilis knowledge from a convenience sample of clients attending STI clinics using one-sided t-tests. We used online Piwik metrics to examine the campaign reach, and provincial testing data to examine trends in syphilis screening. We used data from the Engage Study to examine factors associated with campaign awareness and associations with syphilis testing. Results: Of the 2155 visitors to the Syphistory website with known geography, 79.4% were from BC. Moreover, STI clinic participants who saw the campaign demonstrated a greater knowledge of syphilis (9.7/12, 80.8%) than those who did not see the campaign (mean 8.9/12, 74%) (p&lt; 0.001). Provincial syphilis testing rates were 8764 and 9749 in the 12 months before and after the campaign; however, we did not find an overall trend in testing before versus after the campaign (p= 0.147). Among Engage participants, 12.7% reported seeing the campaign and we found an association between campaign exposure and recent syphilis testing (aOR = 2.73; 95% CI = 1.51, 4.93). Conclusion: gbMSM who saw the campaign were more likely to report being tested for syphilis in the previous 6 months. STI clinic attendees who reported seeing the campaign also had higher syphilis knowledge compared to those who did not.

Objectives: Initial public health guidance related to sex and COVID-19 infection focused on reducing partner number. We characterized individuals having a higher partner number during the initial phases of the pandemic. Methods: In British Columbia, the initial wave of COVID-19 cases was from March 14 to May 19, 2020, followed by gradual lifting of public health restrictions. We conducted an e-mail survey of existing sexual health service clients during the period of July 23 to August 4, 2020. We used bivariate logistic regression to examine the association between the reported number of sexual partners since the start of the pandemic and key variables (level of significance p&lt; 0.01). Results: Of the 1196 clients in our final sample, 42% reported 2+ partners since the start of the pandemic, with higher odds among participants who were men who have sex with men, and single or in open relationships prior to the pandemic. This group was more likely to perceive stigma associated with having sex during the pandemic, and had the highest use of strategies to reduce risk of COVID-19 infection during sexual encounters (mainly focused on reducing/avoiding partners, such as masturbation, limiting sex to a “bubble”, and not having sex). Conclusion: Sexual health service clients in BC with 2+ partners during the initial phases of BC’s pandemic used strategies to reduce their risk of COVID-19 infection during sex. Our study provides support for a harm reduction approach to guidance on COVID-19 risk during sex, and highlights the need for further research on stigma related to having sex during the COVID-19 pandemic.

Objectives: This study assessed gay, bisexual, and other men who have sex with men’s (GBMSM) awareness of and intention to use GetCheckedOnline, an online sexually transmitted and blood-borne infection (STBBI) testing service. Methods: A cross-sectional study was conducted two years after launch among GBMSM >?18 years of age in British Columbia, Canada. Participants were recruited through community venues, clinics, websites, and apps. Results: Of 1272 participants, 32% were aware of GetCheckedOnline. Gay identity, regularly testing at an STBBI clinic, being out to one’s healthcare provider, attending GBMSM community venues, and frequent social media use were associated with awareness. Among participants who were aware but had not used GetCheckedOnline, knowing GetCheckedOnline users, using social media, not knowing where else to test, and not wanting to see a doctor were associated with intention to use GetCheckedOnline. Conclusion: Early promotion of GetCheckedOnline resulted in greater awareness among those connected to GBMSM.

ObjectiveTo explore sexually transmitted infection (STI) clinic client attitudes and preferences towards STI vaccines and STI vaccine programming in an urban clinic setting.MethodsA 31-item questionnaire was administered during check-in by clinic clerical staff at two STI clinics in Vancouver, Canada. Demographic characteristics and preferences were summarised descriptively. Multivariable logistic regression models to assess factors associated with STI vaccine interest (reported as ORs) were constructed using a priori clinically relevant variables and factors significant at p≤0.05 in bivariate analysis.Results293 surveys were included in analysis. 71.3% of respondents identified as male, 80.5% had college level education or higher and 52.9% identified as white/of European descent. The median age was 33. 86.5% of respondents reported they would be interested in receiving an STI vaccine, with a primary motivator to protect oneself. Bivariate analysis indicated several factors associated with vaccine interest, with differences for each infection. After adjusting for other variables, willingness to pay for an STI vaccine (OR=3.83, 95% CI 1.29 to 11.38, p=0.02) remained a significant factor for syphilis vaccine interest and intent to engage in future positive health behaviours remained a significant factor for chlamydia (OR=5.94, 95% CI 1.56 to 22.60, p=0.01) and gonorrhoea (OR=5.13, 95% CI 1.45 to 18.07, p=0.01) vaccine interest.ConclusionRespondents expressed a strong willingness to receive STI vaccines. These valuable findings will inform for eventual STI vaccine programme planning and implementation.

Background: We examined changes in HIV testing indicators following a recent increase in diagnoses among young gay, bisexual and other men who have sex with men (GBMSM) in BC that accompanied implementation of a provincial HIV strategy. Method: Surveillance and laboratory testing data were used to compare case counts and testing characteristics among GBMSM &lt;?30 and =?30 years diagnosed in 2008–2011 and 2012–2015. We tested differences in the proportion diagnosed on first testing episode, proportion diagnosed at late stage of infection and the median inter-test interval ((ITI) time in months between last negative test and first positive test) using ?2and Wilcoxon rank-sum tests. Results: In 2008–2011, 657 diagnoses were made among GBMSM: 24% among men &lt;?30 years and 76% among men =?30 years. In 2012–2015, 590 diagnoses were made: 28% among &lt;?30 years and 28% among =?30 years. Among men &lt;?30 years, diagnoses made on first testing episode decreased (39.4% vs. 28.7% in 2012–2015; p?=?0.042) and there were few late-stage diagnoses (5.1% in 2008–2011 vs. 9.1% in 2012–2015). The median ITI was 10 months in both periods. No changes were observed over time among men =?30 years. However, in both periods, late-stage diagnosis was more common in men =?30 years (2008–2011, 18.8%; 2012–2015, 18.6%; p?&lt;?0.01 for both). The ITI was also longer for men =?30 years (2008–2011, 24.5 months; 2012–2015, 20 months; p?&lt;?0.001 for both). Conclusion: Testing indicators suggested better testing practices among GBMSM diagnosed at &lt;?30 years compared to those diagnosed at older ages. However, there are clear needs for additional prevention measures in both age groups.

Men who have sex with men (MSM) in British Columbia (BC) are disproportionately affected by infectious syphilis and HIV. In this study, we developed a co-interaction model and evaluated the impact and effectiveness of possible interventions among different MSM subgroups on the syphilis epidemic.

ObjectivesInternet-based sexually transmitted and blood-borne infection (STBBI) testing services reduce testing barriers through bypassing face-to-face clinical encounters, potentially enabling clients at ongoing sexual risk to test more frequently. To our knowledge, this hypothesis has not been previously tested. We compared the frequency of repeat testing between Vancouver-based clients of GetCheckedOnline(GCO)—an internet-based STBBI testing service in British Columbia, Canada—and clients of three sexually transmitted infection (STI) clinics in Vancouver for 29 months after GCO launched.MethodsAn administrative data cohort (n=19 497) was assembled using GCO, clinical and laboratory databases. We included all individuals who tested for HIV, gonorrhoea/chlamydia, syphilis or hepatitis C at three STI clinics or using GCO, between September 2014 and February 2017. The rate of repeat testing (>30 days after first episode) was compared between clients who used GCO at least once and those who tested only in STI clinics. Poisson regression was used to generate relative rate (RR) for repeat testing, with adjustment for age, gender/sexual orientation, risk factors (eg, history of STI diagnosis) and rate of testing before GCO launched.Results1093 GCO clients were identified, of whom 434 (40%) had repeat test episodes; 8200/18 404 (45%) of clinic clients tested more than once. During the 29-month analysis period, GCO clients repeat tested 1.87 times per person-year, whereas clinic clients repeat tested 1.53 times per person-year, resulting in a crude RR of 1.22 (95% CI: 1.14 to 1.31). Adjustment for covariates increased the RR to 1.26 (95% CI: 1.15 to 1.37).ConclusionsIn this cohort, individuals using internet-based STBBI testing had a rate of repeat testing 22% greater than clinic-based clients. This effect was increased after adjusting for characteristics associated with higher test frequency. The online interface of GCO may facilitate more frequent testing and may therefore contribute to earlier STBBI diagnosis.

ObjectiveInternet-based HIV testing offers the potential to address privacy-related barriers to testing and increase frequency of testing but may result in missed opportunities related to sexual health education and prevention that typically occur in face-to-face encounters. In this study, we assessed the HIV test knowledge and sexual risk behaviour of clients testing for HIV through GetCheckedOnline, an internet-based sexually transmitted and bloodborne infection testing platform inclusive of HIV testing, in comparison to clients testing through a large sexual health clinic.MethodsWe concurrently recruited GetCheckedOnlineclients and clinic clients from Vancouver, Canada, over the course of a 10-month period during 2015–2016. Participants completed baseline and 3-month questionnaires, anonymous and online. A six-item score was used to estimate knowledge of HIV test concepts typically conveyed during an HIV pretest encounter in a clinic. We used multiple regression to estimate associations between testing modality (online vs clinic based) and two outcomes—HIV test knowledge and change in condom use pre/post-test—with adjustment for relevant background factors.ResultsAmong 352 participants, online testers demonstrated higher HIV post-test knowledge than clinic-based testers (mean score 4.65/6 vs 4.09/6; p<0.05); this difference was reduced in adjusted analysis (p>0.05). Men who have sex with men, clients with a university degree, those who have lived in Canada >10 years and English speakers had higher HIV post-test knowledge (p<0.05). Eighteen per cent of online testers and 10% of clinic-based testers increased condom use during the 3 months post-test (p>0.05).ConclusionsIn this comparative study between online and clinic-based testers, we found no evidence of decreased HIV test knowledge or decreased condom use following HIV testing through GetCheckedOnline. Our findings suggest that with careful design and attention to educational content, online testing services may not lead to missed opportunities for HIV education and counselling.

ObjectivesInternet-based STI testing programmes may overcome barriers posed by in-clinic testing, though uptake could reflect social gradients. The role these services play in comparison to clinical testing services is unknown. We compared experiences of testing barriers between STI clinic clients to clients of GetCheckedOnline.com (GCO; where clients take a printed lab form to a lab).MethodsOur 10-month cross-sectional study was conducted after GCO was promoted to STI clinic clients and men who have sex with men (MSM). Clinic and GCO clients completed an online survey assessing testing barriers and facilitators; responses were compared using bivariate analysis (level of significance P<0.01; significant results below).ResultsCompared with 321 clinic clients, the 73 GCO clients were more likely to be older (median 35 vs 30 years), MSM (45% vs 16%), be testing routinely (67% vs 39%), have delayed testing for any reason (76% vs 54%) and due to clinic distance (28% vs 9%), report delays due to wait times (50% vs 17%), embarrassment with testing (16% vs 6%), discomfort discussing sexual health where they usually go for testing (39% vs 22%), as well as discomfort discussing sexual history with (19% vs 5%) and fearing judgement from (30% vs 15%) any healthcare provider. GCO clients were less likely to have found clinic hours convenient (59% vs 77%) and clinic appointments easy to make (49% vs 66%), and more likely to report long wait times (50% vs 17%). We found no differences in technology skills/use.ConclusionsIn this urban setting, an internet-based testing service effectively engaged individuals experiencing testing barriers, with few social gradients in uptake. While some testing barriers could be addressed through increasing access to clinical services, others require social and structural changes, highlighting the importance of internet-based STI testing services to increasing test uptake.

IntroductionGay, bisexual, and other men who have sex with men (MSM) in British Columbia (BC) have a high incidence of HIV/STI, with many reporting barriers to accessing testing. An online HIV/STI testing service, Get Checked Online(GCO), was launched in 2014 to reduce these barriers. In this study we examined reach and acceptability of GCO within the MSM community.MethodsWe surveyed MSM living in BC over 6 months in 2016. Participants were recruited at local pride events, bars, on the street, in sexual health clinics, through social media, and on gay hook-up apps and websites. Survey questions were analysed descriptively and included questions about the service itself, sexual health, technology use, and demographic characteristics.ResultsOf 1272 participants completing the survey, 78% identified as gay and 16% as bisexual, 73% identified as White, 52% reported being single, and 55% reported living in the city of Vancouver. 32% were aware of GCO, 13% had visited the website and 3% had tested through the service (10% among the 411 men aware of GCO). Among GCO-aware participants, 50% intended to test through the service in the future (vs. 47% among GCO-unaware), 51% reported talking about GCO with others and 22% knew someone who has used it. 46% reported that at times they would use GCO over their usual place of testing. The most common benefits reported by participants were testing without waiting for an appointment (50%), getting results online (46%), and saving time (38%). The most common drawbacks were not speaking with a doctor or nurse (39%), not being sure how the service works (26%), and worrying about the privacy of one’s online information (20%).ConclusionApproximately 2 years after GCO’s launch, a third of MSM in the region are aware of the service with 1 in 10 GCO-aware men testing through the service. Given high intention to use GCO, these findings highlight the importance of continuing promotion efforts to raise awareness of the service among MSM.

Epidemiologic studies point to multiple health inequities among sexual minority people, but few studies have examined mortality. Some causes of death are more preventable than others, and access to prevention is theorized to follow patterns of access to social and material resources. The objective of this study is to compare estimates of preventable mortality between sexual minority (SM)—i.e., bisexual, lesbian, gay—and heterosexual adults in Canada.

Background The increased risk for cardiovascular disease (CVD) in HIV is well established. Despite high prevalence of viral hepatitis coinfection with HIV, there are few studies on the risk of CVD amongst antiretroviral therapy (ART)-treated coinfected patients.Methods Ontario HIV Treatment Network Cohort Study participants who initiated ART without prior CVD events were analysed. HBV and HCV coinfection were identified by serology and RNA test results. CVD was defined as any of: coronary artery disease including atherosclerosis, chronic ischaemic heart disease and arteriosclerotic vascular disease; myocardial infarction; congestive heart failure; cerebrovascular accident or stroke; coronary bypass; angioplasty; and sudden cardiac death. The impact of HBV and HCV coinfection on time to CVD was assessed using multivariable competing risk models accounting for left truncation between ART initiation and study enrolment.Results A total of 3,416 HIV-monoinfected, 432 HIV-HBV- and 736 HIV–HCV-coinfected individuals were followed for a median (IQR) of 2.32 years (1.36–8.02). Over the study period, 167 CVD events and 613 deaths were documented. After adjustment for age, gender, race, year initiating ART, weight and smoking status, HBV was not associated with time to CVD onset (aHR=1.05, 95% CI [0.63, 1.74]; P=0.86). There was an elevated risk of CVD for HCV-coinfected individuals, which approached statistical significance (aHR=1.44, 95% CI [0.97, 2.13]; P=0.07).Conclusions Our results are consistent with a moderate increase of CVD among individuals with HIV–HCV coinfection relative to those with HIV infection alone, lending support to consideration of initiation of HCV antiviral treatment.

IntroductionThe incidence of infectious syphilis (primary, secondary, or early latent) has increased in British Columbia (BC). Identifying core groups at risk for syphilis can inform public health programming. We assessed the odds of syphilis infection among individuals with repeat Chlamydia trachomatis(CT) and/or Neisseria gonorrhoeae(GC) infections in this population-based analysis.MethodsSurveillance records for all BC residents diagnosed with ≥2 CT (CT reinfection) or ≥2 GC (GC reinfection) or ≥2 infections including CT and GC (CT/GC reinfection) from 1/1/2006 to 12/31/2015 were linked with all infectious syphilis cases from the same time period. Logistic regression models were used to measure the odds of acquiring syphilis with greater number of CT and/or GC reinfections, adjusted for age, ethnicity and population (e.g., men who have sex with men).ResultsOf 1 03 115 people having a CT infection, 11 458 (11.1%) had CT reinfection; of 14 713 people with a GC infection, 1514 (10.3%) had GC reinfection. Overall, 4989 individuals had CT/GC reinfection. Among these three re-infection groups (CT, GC, CT/GC), 80.9%/72.9%/63% had 2 infections, 14.4%/15.9%/19.5% had 3 infections, 3.2%/6.1%/8.9% had 4 infections and 1.6%/5.1%/8.6% had 5+ infections. Of all syphilis cases in BC, 7.4%/9.4%/12.3% were diagnosed among individuals with CT reinfection, GC reinfection and CT/GC reinfection. The odds of syphilis increased with greater number of infections, which persisted after adjustment in all three groups. Among the group with CT/GC reinfection, individuals with 3, 4 and 5+ infections had increased odds of syphilis compared to individuals with 2 infections (OR=2.2 (95%CI 1.6, 3.0), OR=2.5 (95%CI 1.7, 3.6) and OR=4.1 (95%CI 3.0, 5.7) respectively).ConclusionIncreasing number of CT and/or GC reinfections is strongly and independently associated with a syphilis diagnosis. Targeting public health interventions to a core group of individuals with CT/GC reinfections may be an effective syphilis prevention strategy.

IntroductionPositive user experiences are key to trust and repeated use of online services (known as e-Loyalty). GetCheckedOnline (GCO) is an online testing service for HIV/STI where clients complete a risk assessment, print lab forms, submit specimens at a lab, and retrieve results online (if negative) or by phone. We surveyed GCO clients on their perceptions of using the service. MethodsWe invited first-time GCO users (who consented to be contacted for research) to complete an anonymous online survey 2 weeks following reporting of test results. Survey questions were analysed descriptively and included demographics, reason for test, and how participants heard about GCO. Satisfaction, convenience, ease of use, and e-Loyalty (intention to use again, recommend to others) were measured using 5-point Likert scales and collapsed (low to neutral vs high responses). ResultsBetween July 2015-Sept 2016, 23% of 1099 first-time GCO users consented to be contacted for research and 136/208 (65%) of users contacted agreed to participate in the survey. Participants had a median age of 33 years, 80% were white, 67% male, 43% straight, and 43% men who have sex with men. The most common testing reasons were: routine test (64%), risk event/exposure (44%) and new relationship (22%). Participants heard about GCO from clinics/health providers (38%), campaigns (26%), social media (18%), and friends or partners (13%). Almost all participants were satisfied with GCO overall (93%) and with their experience of receiving results (96%), 92% agreed GCO was convenient, 87% found GCO easy to use, and 83% rated the experience of submitting specimens as good or excellent. E-Loyalty was also high: 97% intended to use GCO again and 96% would recommend GCO to others. ConclusionWe found very high satisfaction with and loyalty to GCO among first-time users, indicating a successful service model from a client perspective. In addition to uptake and test outcomes, user experience is a key outcome for evaluation of online HIV/STI testing services.

IntroductionOnline HIV/STI testing is an alternative to in-clinic testing, but may lead to missed opportunities for education due to the lack of provider-delivered pre/post-test counselling. GetCheckedOnline(GCO) is an online testing service offered through an urban STI clinic in Vancouver. It was designed to include concepts typically conveyed during in-clinic HIV counselling sessions (e.g., window period, public health reporting). The aim of this study was to compare knowledge of key HIV test concepts between clients testing through GCO and in-clinic.MethodsGCO and clinic participants were concurrently recruited over 11 months. Participants were invited to complete an anonymous online survey 2 weeks after receipt of test results. Knowledge of key concepts related to HIV testing was measured using a 6-item true/false test previously developed through a modified Delphi process, cognitive testing and psychometric evaluation. Linear regression was used to assess the association between site (GCO vs. clinic) and overall test scores, after adjustment for age, education, immigration history, language, sexual orientation, and testing history.Results404 HIV-negative participants were included in the analysis (73 GCO, 331 in-clinic). HIV test knowledge scores averaged 0.4 points higher among GCO (mean score 4.5) than among clinic (4.1) testers (p=0.01). Following adjustment for relevant covariates, this difference decreased to 0.2 points (p=0.15). Likewise, there was no difference in mean HIV test knowledge scores among first-time testers (n=50; 3.7 GCO, 3.6 in-clinic; p=0.75).ConclusionPost-test knowledge of HIV test concepts addressed in standard pre-test counselling was high in both groups and not significantly different following adjustment. Our study suggests that equivalent education about core HIV testing concepts can be achieved through web-based HIV/STI testing, and illustrates the importance of designing services to intentionally address relevant educational messages covered in provider-delivered HIV test counselling.

IntroductionOnline STI testing programs are thought to overcome barriers posed by in-clinic testing, though uptake could reflect social gradients (e.g., technology access, higher education). To understand types of barriers mitigated by online STI testing we compared clients of a large STI clinic to clients of GetCheckedOnline(GCO).MethodsOur study was conducted in Vancouver after GCO was promoted to provincial STI clinic clients and men who have sex with men (MSM). Clinic and GCO clients were invited to an online survey 2 weeks after receiving test results. Survey questions included barriers/facilitators of testing at individual, provider, clinic and societal levels. We conducted bivariate comparisons between groups (significant results shown at p<0.01).ResultsGCO (n=87) were older than clinic clients (n=424; median 35 vs. 31 years) and a higher proportion were MSM (40.2% vs. 24.4. More GCO clients reported their reason for testing as routine (58.1% vs. 38.9%) and fewer for symptoms or STI contact (10.3% vs 33.5%). More GCO clients considered accessing online health resources important (76.1% vs 56.5%) but otherwise did not differ on technology skills/use. GCO clients were more likely to report delaying testing in the past year due to clinic distance (22.4% vs 9.7%), less likely to agree that clinic hours were convenient (58.2% vs 77.2%) or that making appointments was easy (49.4% vs. 65.4%), and more likely to report long wait times to see a health care provider (HCP) (47.6% vs 20.7%). GCO clients were more likely to be uncomfortable discussing their sexual history with HCP in general (15.5% vs 5.7%) and where they usually presented for health care (34.9% vs 20.6%), as well as reporting more fear of being judged by HCP (28.6% vs 15.4%).ConclusionOur study in Vancouver suggests that online testing services may effectively engage individuals with barriers to testing (i.e., clinic access, discomfort with HCP) with few social gradients in uptake. Further evaluation to verify these findings within different cities/populations is needed.

IntroductionMost research on the sexual health of gay, bisexual, and other men who have sex with men (MSM) relies upon convenience samples, which may not fully represent the MSM population. To investigate this form of selection bias, we concurrently sampled MSM from three distinct venue types, compared sociodemographic, behavioural, and STI testing characteristics across samples, and characterised the degree of overlap between them.MethodsMSM 18+ years of age from British Columbia, Canada completed an anonymous survey during July-December 2016. Participants were recruited from: mobile sex-seeking apps (n=662); a MSM-branded STI clinic (n=303); and in-person at the Vancouver Pride Festival (n=307). Cross-sample comparisons with >10% relative difference and p<0.05 are shown. Sample overlap was measured by self-reported use of other recruitment venue types.ResultsMSM recruited from apps included more bisexual men (24%) than those recruited from the clinic (9%) or from Pride (7%), while MSM recruited from the clinic included more East Asian and Latino men (14% and 13%, respectively, vs. 13% and 6% from Pride, and vs. 5% and 3% recruited from apps). More 18–29 year-olds were recruited from the clinic (47%, vs. 29% Pride, 16% apps). A larger proportion of MSM recruited from apps reported >10 sex partners in the past year (35%, vs. 28% clinic, 21% Pride). Finally, more clinic participants tested for STI/HIV in the past year (82%) as compared with participants recruited from apps (75%) or Pride (73%). When asked which other venues they frequented, 19% of the total sample reported using all 3 recruitment venue types, while 11% of Pride participants, 7% of apps participants, and 4% of clinic participants reported only using the recruitment venue where sampled.ConclusionWe found large differences between MSM sampled from apps, an STI clinic, and Pride, with 22% unlikely to be sampled if relying on a single venue type for recruitment. Our results underscore the importance of multiple sampling strategies in MSM research and provide specific cross-sample differences.

IntroductionHigh-risk oncogenic types of human papillomavirus (HPV) are the major cause of several cancers in men, notably anal cancer. HIV co-infection further elevates risk. We assessed knowledge of and attitudes regarding HPV, HPV vaccination, anal cancer, and anal cancer screening among HIV-positive men.MethodsMale participants of a multi-site cohort of persons in care at 9 specialty HIV clinics in Ontario, Canada, responded to questions about HPV knowledge and attitudes regarding perceived risk and willingness to receive HPV vaccine and anal cancer screening. We analysed data from interviews between 04/2016 and 08/2016.Results678 men were interviewed. Many had either not heard of HPV (20%) or had heard the term but did not know what it was (25%). Among men familiar with the term (n=398), only 51% knew that HPV can cause anal cancer and 56% knew that people with HIV are at higher risk for cancers caused by HPV. Many thought their chance of getting HPV was zero (19%) or low (36%). 63% had heard of the HPV vaccine and 44% knew that it was recommended for males, but only 13% reported that a health professional discussed the vaccine with them and 6% were vaccinated. Men said that they would be likely/very likely to get vaccinated if it were offered free of charge (81%), if they had to co-pay $30/dose (59%), or pay full price (18%). The majority would be likely/very likely to get anal cancer screening via digital rectal exam (87%), Pap cytology (90%), or anoscopy (83%). Men were comfortable/very comfortable discussing anal health with their HIV doctor (87%) and family doctor (84%).ConclusionOur findings suggest that there are many knowledge gaps to address regarding awareness of HPV and HPV-associated disease among HIV-positive men, but that men were comfortable discussing anal health with care providers. Men were generally willing to accept anal cancer screening and HPV vaccination, if offered at no/low cost. Future work will identify correlates of hesitancy to accept vaccination and screening, which can guide promotional messaging and interventions.

IntroductionPersistent infection with high-risk human papillomavirus (hrHPV) is a necessary step in anal cancer’s pathogenesis. With no universally-accepted guidelines on screening, and given the suboptimal performance of cytology, anal HPV testing is increasingly recognised as an important, adjunctive screening tool for anal cancer precursors. mRNA-based HPV assays targeting the E6/7 oncogenes are emerging as more specific tests for persistent HPV than the traditionally-used DNA-based tests. No data exists on serial monitoring of anal hrHPV in MSM using this novel assay. The objectives of this study are to describe HPV prevalence/persistence rates in a sample of high-risk, HIV-negative MSM enrolled in a PrEP demonstration project.MethodsParticipants were drawn from PREPARATORY-5, which recruited HIV-negative MSM with high HIV risk as determined by a score of ≥10 on the HIV Incidence Risk Index for MSM (HIRI-MSM) and a history of condomless receptive anal sex in the prior 6 months. Anal samples were tested for hrHPV via the mRNA-based Aptima HPV Assay at baseline, months 6 and 12. Logistic regression was used to assess characteristics associated with hrHPV infection.Results43 participants were recruited, with median age 33 years (IQR 28–37). 10 (23%) were current smokers, and median HIRI-MSM score was 28 (IQR 19.5–35.5). 24 (56%) participants had hrHPV at any timepoint, and 15 (35%) had persistent hrHPV, defined as hrHPV isolated at two different timepoints. In multivariable logistic regression, current smoking status (OR=9.2, 95%CI=1.16–72.59, p=0.03) and HIRI-MSM score (OR: 1.2 per 1-point increase, 95%CI=1.03–1.33, p=0.01) were associated with hrHPV infection. ConclusionUsing a novel HPV E6/E7 mRNA assay with higher specificity for persistent infection, this study demonstrated a high burden of overall and persistent hrHPV infection in high-risk, HIV-negative MSM. These findings support the inclusion of MSM at high risk of sexual HIV acquisition when considering interventions related to the prevention and screening of anal cancer precursors.

IntroductionIn Sept 2014, the BC Centre for Disease Control (BCCDC) launched GetCheckedOnline (GCO), an online testing service for STI/HIV which is integrated with clinical and public health services and developed to reduce testing barriers. Based on a successful pilot in urban Vancouver (BC’s largest city) and alignment with regional health authority testing priorities, GCO was expanded to five other urban, suburban and rural communities across BC in Feb 2016. Here we examine differences in GCO uptake between Vancouver and expansion sites from the first year of scale-up in British Columbia (BC). MethodsWe used routinely collected GCO program data in combination with BC Public Health Laboratory testing data to describe differences between GCO clients in Vancouver and expansion sites. We compared demographic characteristics and testing history as well as key program measures including service uptake (percent creating a GCO account who submitted specimens) and positivity rates (percent positive of specimens submitted). ResultsBetween Feb-Dec 2016, of 2397 clients creating accounts, 1297 (54%) submitted specimens; uptake was slightly lower in expansion sites (577 specimens, 51%) vs. Vancouver (720, 57%; p=0.001), with comparable positivity rates (6% vs. 5%; p=0.77). Compared to Vancouver, GCO clients in expansion sites were more likely to be younger (20–24 years of age) (20% vs. 13%) and symptomatic (20% vs. 14%), and less likely to be men who have sex with men (22% vs. 42%; p≤0.001 for all). GCO clients in expansion sites were more likely to be testing for the first time for both HIV (22% vs. 9%) and STI (16% vs. 9%; p<0.001).ConclusionScale-up of GCO to five smaller urban, suburban and rural communities across BC demonstrated differences in uptake and populations reached, including greater engagement of individuals not previously tested. Our study highlights the importance of differing regional contexts on the impact of online testing services and the need for their evaluation during scale-up.