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ObjectivesHIV point-of-care testing (POCT) has been available in Manitoba since 2008. This study evaluated the effectiveness of POCT at identifying individuals with previously unknown HIV status, its effects on clinical outcomes and the characteristics of the populations reached.MethodsA retrospective database review was conducted for individuals who received HIV POCT from 2011 to 2014. Time to linkage to care and viral load suppression were compared between individuals who tested positive for HIV using POCT and controls identified as positive through standard screening. Testing outcomes for labouring women with undocumented HIV status accessing POCT during labour were also assessed.Results3204 individuals received POCT (1055 females (32.9%) and 2149 males (67.1%)), being the first recorded HIV test for 2205 (68.8%). Males were more likely to be targeted with POCT as their first recorded HIV test (adjusted OR (AOR) 1.40). Between the two main test sites (Main Street Project (MSP) and Nine Circles Community Health Centre), MSP tested relatively fewer males (AOR 0.79) but a higher proportion of members of all age groups over 30 years old (AOR 1.83, 2.51 and 3.64 for age groups 30–39, 40–49 and >50, respectively). There was no difference in time to linkage to care (p=0.345) or viral load suppression (p=0.405) between the POCT and standard screening cohorts. Of 215 women presenting in labour with unknown HIV status, one was identified as HIV positive.ConclusionsPOCT in Manitoba has been successful at identifying individuals with previously unknown HIV-positive status. Demographic differences between the two main testing sites support that this intervention is reaching unique populations. Given that we observed no significant difference in time to clinical outcomes, it is reasonable to continue using POCT as a targeted intervention.MeSH termsHIV infection; rapid HIV testing; vertical infectious disease transmission; community outreach; service delivery; marginalised populations.

Objectives Increases in case numbers for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) have been noted on a global level. This study analysed 13 years of testing data to better understand case detection trends over time. Methods Data consisted of all nucleic acid probe and nucleic acid amplification diagnostic testing for CT and NG for the population of Manitoba, Canada (1.2 million); January 2000 to December 2012. Logistic regression models were used to analyse ORs associated with positive CT and NG tests by year. Included in the model as predictor variables were test type, specimen type, patient age and residence location. Results For both male and female CT results, unadjusted OR by year mimicked absolute case counts, reflecting a general increase over time in case counts. Adjustment for laboratory-related variables altered this relationship such that a general decline in the odds of identifying a CT case over time was evident. For both male and female NG results, adjustment for laboratory and demographic variables altered the OR associated with each year, but to a lesser extent than for CT. Conclusions Temporal trends associated with CT case numbers should be interpreted after controlling, at a minimum, for the influence of laboratory-related variables. Interpretation of NG trends is feasible using only the number of reported NG cases.

Diez Roux has used the concept of complex systems to describe approaches for the incorporation of social factors into health research. These systems consist of heterogeneous interdependent units that also exhibit emergent properties. The latter embodies the concept that the interdependent units interact with and affect each other such that the resulting properties are not simple aggregates of the individual-level properties. This paper reviews research from Manitoba with a view towards conceptualising and phrasing the observed patterns within a complex system framework. A review of the temporal and spatial patterns seen within two large sexual network databases from Manitoba was undertaken and framed against the overlying patterns of sexually transmitted infection (STI) transmission within Manitoba. The review includes a summation of STI epidemiological patterns in Manitoba over a 5-year time frame, a comparison of temporal sexual network patterns, and an analysis of network patterns in relation to disparity in STI rates. Hypotheses are generated that focus on how individual-level behaviours and interactions create the observed complex system (network) patterns.

Introduction Research on the HIV vulnerability of men who have sex with men (MSM) in India has tended to focus on aggregates of individual risk behaviours. However, such an approach often overlooks the complexities in the sexual networks that ultimately underpin patterns of spread. This paper analyses a set of sexual contact network (SCN) snapshots in relation to ethnographic findings to reorientate individual-level explanations of risk behaviour in terms of more complex systems. Methods Fifteen community researchers conducted a 2-month ethnographic study in three cities in Karnataka to generate descriptions of the risk environments inhabited by MSM. SCNs were reconstructed by two methods. First, initial participants, defined as nodes of various sexual networks, were purposively sampled. In each site, six nodes brought in three sexual partners separately as participants. In all sites, 72 participants completed 431 surveys for their 7-day sexual partners. Second, each site determined four groups representing various sexual networks, each group containing four individuals. In all sites, 48 participants completed 334 surveys for their regular sexual partner. Results Considerable differences were observed between sites for practically all included behavioural variables. On their own, these characteristics yielded contradictory interpretations with respect to understanding contrasts in HIV prevalence at each site. However, viewing these variables in relation to SCNs and ethnographic data produced non-linear interpretations of HIV vulnerability which suggested importance to local interventions. Conclusion SCN data may be used with existing data on risk behaviour and the structural determinants of vulnerability to re-tailor more tightly focused interventions.

Background Sexually transmitted and bloodborne infection (STBBI) risk is multifaceted and can involve a complex interplay between sexual behaviours, substance abuse and mental health conditions. In Winnipeg, Manitoba Canada we conducted a study to better understand the interconnectedness and overlap of these conditions and behaviours. Methods Data from the Social Network study phase III (SNS III) were collected in the fall and winter of 2009 using semi-structured in-person interviews (n=600). Sampling was by respondent driven sampling and targeted street populations. The average mean age was 37 (SD=14.8) and the gender distribution was relatively equal (males constituted 53%). Latent class analysis was used to identify unobserved or latent subgroups (ie, risk profiles) to explore the extent of overlap between risky sexual behaviours, substance use choice (crack, alcohol, solvents, injection drug use), and mental health conditions. Six individual level items constituting risky behaviours and five network or environmental level risk behaviours were used in the latent class analysis. Individual items included: Ever diagnosed with a mental health condition, ever used crack, daily binge drinking, ever used solvents, ever injected drugs and knowing your sex partner has multiple other sex partners while social network items included: the proportion of your social network members who drink alcohol, use crack, sniff solvents, inject drugs, or are sex partners. Fit indices of G2, AIC, and BIC were used in assessing model fit. Additionally, the model fit was assessed by examining the relationship between items and their conditional latent class by strength of homogeneity (closeness to 0 or 1) and by whether there was evidence of good separation of latent classes. Results The 2-, 3-, 4-, and 5-class LCA models were compared. Goodness of fit indices favoured the 4-class model. For the 4-class model indices were: G2=1115, df=2000, AIC=1209, BIC=1415. Class prevalence of the 4 latent classes were: 31% were at high risk for all individual and network items, 25% constituted another latent class labelled as low-risk, 21% constituted a subgroup who were labelled as “loners” and exhibited high risk for mental health issues as well as individual crack, solvent use, and injection use but no network level correlates while the fourth latent class (23%) was distinguished for engaging in risky sexual behaviours and having these risky behaviours be supported at the social network level. Conclusions Latent class analysis demonstrated that there are indeed subgroups of vulnerable populations who warrant targeted interventions given their different risk profiles. This type of investigation offers a public health population segmentation strategy to plan for future targeted prevention efforts that can more effectively address the special needs of these subgroups of vulnerable populations.

Introduction Globally, substantial heterogeneity in the prevalence of HIV and other sexually transmitted infections (STIs) among most at-risk populations (MARPs) has been demonstrated. Examining factors related to heterogeneity can inform targeted programming. In Winnipeg, Canada, particularly high risk for HIV and hepatitis C (HCV) has been observed in injection drug users (IDUs) with a history of solvent use (S-IDUs). However, comparisons to other MARPs have been limited. Thus this study examined the association between HIV/STIs and S-IDUs in comparison to IDUs and other MARPs. Methods Data were from a 2008 to 2009 cross-sectional study of Winnipeg MARPs (IDUs, sex work- and street-involved individuals); subjects were recruited through respondent-driven sampling (RDS) methods. Adjusted ORs (AORs) from multivariable logistic regression models were estimated, examining the risk of HIV, HCV and HIV/HCV co-infection, and corrected for RDS-chain clustering using generalised estimating equations. Results Total sample was 499, of which 13% recently injected drugs (ie, last 6 months), 5% recently inhaled solvents, 6% were recent S-IDUs, and 76% did not inject drugs or inhale solvents. HIV and HCV prevalence among recent S-IDU was 21% and 79%, respectively; HIV/HCV co-infection was 18%. In multivariable models, S-IDUs were at highest risk of HIV (AOR: 3.6, 95% CI: 1.6% to 7.9%; p Conclusions Solvent use occurs among the most marginalised of MARPs, representing unique and complicated drug use trajectories. As the HIV epidemic in Canada becomes increasingly complex, examination of outlier populations such as S-IDU can inform public health by elucidating important pathways by which structural, environmental and individual factors interact to create the highest risk for HIV/STIs and other bloodborne pathogens.