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Background Understanding care patterns of persons living with HIV prior to diagnosis can inform prevention opportunities, earlier diagnosis, and engagement strategies. We examined healthcare utilization among HIV-positive individuals and compared them to HIV-negative controls. Methods Data were from a retrospective cohort from Manitoba, Canada. Participants included individuals living with HIV presenting to care between 2007 and 2011, and HIV-negative controls, matched (1:5) by age, sex, and region. Data from population-based administrative databases included physician visits, hospitalizations, drug dispensation, and chlamydia and gonorrhea testing. Diagnoses associated with physician visits were classified according to International Classification of Diseases chapters. Conditional logistic regression models were used to compare cases/controls, with adjusted odds ratios (AORs) and their 95% confidence intervals (95% CI) reported. Results A total of 193 cases and 965 controls were included. Physician visits and hospitalizations were higher for cases, compared to controls. In the 2 years prior to case date, cases were more likely to be diagnosed with “blood disorders” (AOR: 4.2, 95% CI: 2.0–9.0), be treated for mood disorders (AOR: 2.4, 95% CI: 1.6–3.4), and to have 1+ visits to a hospital (AOR: 2.2, 95% CI: 1.4–3.6). Conclusion Opportunities exist for prevention, screening, and earlier diagnosis. There is a need for better integration of healthcare services with public health.

CONTEXTE: Le rôle des enfants dans la propagation et la transmission communautaire du coronavirus du syndrome respiratoire aigu sévère 2 (SRAS-CoV-2) est encore mal compris. Nous visons à quantifier l’infectivité du SRAS-CoV-2 d’échantillons nasopharyngés provenant d’enfants comparativement à ceux provenant d’adultes. MÉTHODES: Nous avons obtenu des écouvillons nasopharyngés de cas adultes et pédiatriques de la maladie à coronavirus 2019 (COVID-19) ainsi que de leurs contacts qui ont obtenu un résultat positif à la présence du SRAS-CoV-2 lors d’un test de dépistage au Manitoba entre les mois de mars et décembre 2020. Nous avons comparé la croissance virale en culture cellulaire, les valeurs de cycle seuil de test d’amplification en chaîne par polymérase couplé à une transcription inverse (RT-PCR) de l’enveloppe (E) du gène du SRAS-CoV-2 et de la dose infectieuse pour 50 % de la culture tissulaire (DICT50/mL) entre les adultes et les enfants. RÉSULTATS: Parmi les 305 échantillons positifs à la présence du SRAS-CoV-2 validés par RT-PCR, 97 échantillons provenaient d’enfants de 10 ans et moins, 78 échantillons d’enfants de 11–17 ans et 130 échantillons d’adultes (≥ 18 ans). On a observé une croissance virale en culture dans 31 % des échantillons, dont 18 (19 %) échantillons d’enfants de 10 ans et moins, 18 (23 %) d’enfants de 11–17 ans et 57 (44 %) d’adultes (enfants c. adultes, rapport de cotes 0,45; intervalle de confiance [IC] à 95 % 0,28–0,72). Le cycle seuil était de 25,1 (IC à 95 % 17,7–31,3) chez les enfants de 10 ans et moins, 22,2 (IC à 95 % 18,3–29,0) chez les enfants de 11–17 ans et 18,7 (IC à 95 % 17,9–30,4) chez les adultes (p < 0,001). La DICT50/mL médiane était considérablement plus faible chez les enfants de 11–17 ans (316, écart interquartile [EI] 178–2125) que chez les adultes (5620, EI 1171–17 800, p < 0,001). Le cycle seuil était un indicateur exact d’une culture positive chez les enfants et les adultes (aire sous la courbe de la fonction d’efficacité du récepteur, 0,87, IC à 95 % 0,81–0,93 c. 0,89, IC à 95 % 0,83–0,96, p = 0,6). INTERPRÉTATION: Comparés aux adultes, les enfants qui ont obtenu un résultat positif à un test de dépistage du SRAS-CoV-2 à l’aide d’un écouvillon nasopharyngé étaient moins susceptibles de présenter une croissance du virus en culture et obtenaient un cycle seuil plus élevé et une concentration virale moins élevée, indiquant que les enfants ne sont pas les principaux vecteurs de la transmission du SRAS-CoV-2.

Background and Objective We describe the development of the first HIV care cascade for Manitoba, Canada, detailing steps taken to establish indicator definitions for each cascade step, and derive a full complement of local estimates. Methods Manitoba is a Canadian Prairie Province with disproportionately high annual HIV incidence. In 2013, a clinical cohort of people living with HIV was established within the primary HIV care program in Manitoba. Using cohort data from 2017, we describe the creation of a set of indicator definitions and calculate estimates for each cascade step to create the first Manitoban cascade model. Results Of the 703 cohort participants categorized as alive and diagnosed, 638 (90.8%) were in care, 606 (86.2%) retained in care, 573 (81.5%) on treatment, and 523 (74.4%) virologically suppressed. The greatest point of leakage occurred between the first and second steps; 9.3% of those alive and diagnosed in 2017 were not in care in the same calendar year. Conclusion This is the first comprehensive examination of HIV clinical epidemiology in Manitoba using a cascade framework, with the potential inform programming to improve service coverage within Manitoba and significantly contribute to evidence informing provincial policies to support these efforts.

A retrospective cohort study (n=8) was used to examine the effect of the timing of administration of oseltamivir chemoprophylaxis for the control of influenza B outbreaks among residents in long-term care facilities in Manitoba, Canada during the 2017-2018 influenza season. Delay of oseltamivir chemoprophylaxis was associated with increased odds of influenza-like illness in both univariate and multivariable analyses with an adjusted odds ratio of 1.34 (95% CI: 1.12-1.60) per day for influenza B.

In 2013, the Living with HIV (LHIV) Innovation team established clinical cohorts of people living with HIV in Manitoba and Newfoundland and Labrador, and they linked the data to provincial health administrative databases. Access to these data enabled researchers to conduct studies across provincial borders; contribute to a national dialogue on HIV health system performance; and give recommendations for evidence-based healthcare, health policy and public health. However, research funding is episodic; maintaining cohorts requires stable funding. We support the establishment of a cross-jurisdictional approach to facilitate streamlined data collection and linkage without interruption and to allow for meaningful analysis in order to inform national policies.

BACKGROUND: The role of children in the transmission and community spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unclear. We aimed to quantify the infectivity of SARS-CoV-2 in nasopharyngeal samples from children compared with adults. METHODS: We obtained nasopharyngeal swabs from adult and pediatric cases of coronavirus disease 2019 (COVID-19) and from their contacts who tested positive for SARS-CoV-2 in Manitoba between March and December 2020. We compared viral growth in cell culture, cycle threshold values from the reverse transcription polymerase chain reaction (RT-PCR) of the SARS-CoV-2 envelope (E) gene and the 50% tissue culture infective dose (TCID50/mL) between adults and children. RESULTS: Among 305 samples positive for SARS-CoV-2 by RT-PCR, 97 samples were from children aged 10 years or younger, 78 were from children aged 11–17 years and 130 were from adults (≥ 18 yr). Viral growth in culture was present in 31% of samples, including 18 (19%) samples from children 10 years or younger, 18 (23%) from children aged 11–17 years and 57 (44%) from adults (children v. adults, odds ratio 0.45, 95% confidence interval [CI] 0.28–0.72). The cycle threshold was 25.1 (95% CI 17.7–31.3) in children 10 years or younger, 22.2 (95% CI 18.3–29.0) in children aged 11–17 years and 18.7 (95% CI 17.9–30.4) in adults (p < 0.001). The median TCID50/mL was significantly lower in children aged 11–17 years (316, interquartile range [IQR] 178–2125) than adults (5620, IQR 1171 to 17 800, p < 0.001). Cycle threshold was an accurate predictor of positive culture in both children and adults (area under the receiver-operator curve, 0.87, 95% CI 0.81–0.93 v. 0.89, 95% CI 0.83–0.96, p = 0.6). INTERPRETATION: Compared with adults, children with nasopharyngeal swabs that tested positive for SARS-CoV-2 were less likely to grow virus in culture, and had higher cycle thresholds and lower viral concentrations, suggesting that children are not the main drivers of SARS-CoV-2 transmission.

PurposeThe LHIV-Manitoba cohort was developed as a way to provide a comprehensive source of HIV-related health information in the central Canadian Prairie province of Manitoba. The cohort will provide important information as we aim to better understand local HIV epidemiology and address key knowledge and practice gaps in HIV prevention, treatment and care programming in the province.ParticipantsIn total, 890 individuals, aged 18 or older and living or receiving HIV care in Manitoba are enrolled in the cohort. A complete clinical dataset exists for 725 participants, which includes variables on sociodemographic characteristics, comorbidities and co-infections, self-reported HIV exposure categories and HIV clinical indicators. A limited clinical dataset exists for an additional 165 individuals who were enrolled posthumously. 97.5% of cohort participants’ clinical records are linked to provincial administrative health datasets.Findings to dateThe average age of cohort participants is 49.7 years. Approximately three-quarters of participants are male, 42% self-identified as white and 42% as Indigenous. The majority of participants (64%) reported condomless vaginal sex as a risk exposure for HIV. Nearly one-fifth (18%) of participants have an active hepatitis C virus infection and the cohort’s median CD4 count increased from 316 cells/mm3 to 518 cells/mm3 between time of entry into care and end of the first quarter in 2019.Future plansThe LHIV-Manitoba cohort is an open cohort, and as such, participant enrolment, data collection and analyses will be continually ongoing. Future analyses will focus on the impact of provincial drug plans on clinical outcomes, determinants of mortality among cohort participants and deriving estimates for a local HIV care cascade.

ObjectiveThis study examined the effect of the timing of administration of oseltamivir chemoprophylaxis for the control of influenza A H3N2 outbreaks among residents in long-term care facilities (LTCFs) in Manitoba, Canada, during the 2014–2015 influenza season.MethodsA retrospective cohort study was conducted of all LTCF influenza A H3N2 outbreaks (n=94) using a hierarchical logistic regression analysis. The main independent variable was how many days passed between the start of the outbreak and commencement of oseltamivir chemoprophylaxis. The dependent variable was whether each person in the institution developed influenza-like illness (yes or no).ResultsDelay of oseltamivir chemoprophylaxis was associated with increased odds of infection in both univariate (t=5·41; df=51; Pt=6·04; df=49; PConclusionsThe sooner chemoprophylaxis is initiated, the lower the odds of secondary infection with influenza in LTCFs during outbreaks caused by influenza A H3N2 in Manitoba. For every day that passed from the start of the outbreak to the initiation of oseltamivir, the odds of a resident at risk of infection in the facility developing symptomatic infection increased by 33%.

To support the use of the Diabetes Population Risk Tool (DPoRT) in public health settings, a knowledge brokering (KB) team used and evaluated the Population Health Planning Knowledge-to-Action model. Participants (n = 24) were from four health-related organizations. Data sources included document reviews, surveys, fo-cus groups, interviews, and observational notes. Site-specific data were analyzed and then triangulated across sites using an evaluation matrix. The KB team facilitated DPoRT use through planned and iterative strategies. Outcomes included changes in skill, knowledge, and organizational practices. The Population Health Planning Knowledge-to-Action model and team-based KB strategy supported DPoRT use in public health settings. Resume: Pour appuyer l’utilisation de l’outil Diabetes Population Risk Tool (DPoRT) dans les milieux de sante publique, une equipe de courtage de connaissances (KB) a utilise et evalue le modele Population Health Planning Knowledge-to-Action. Les sources de donnees comprenaient des documents, des sondages, des groupes de dis-cussion, des entrevues et des notes d’observation. L’equipe de KB a facilite l’utilisation de DPoRT. Les resultats comprenaient les changements dans les competences, les connaissances et les pratiques organisationnelles. Le modele Population Health Planning Knowledge-to-Action et la strategie KB basee sur l’equipe ont appuye l’utilisation de DPoRT.

Background Gonorrhea (GC) is the most commonly reported drug resistant sexually transmitted infection (STI) in Canada with 23,708 cases reported in 2016, double the 11,874 cases reported in 2007, corresponding to an 81% increase in rates. Only about 19% of these were cultured, meaning that direct AMR data was only available for one-fifth of GC cases. The Public Health Agency of Canada (PHAC) launched the Enhanced Surveillance of Antimicrobial-Resistance Gonorrhea (ESAG) program in 2013 in three jurisdictions (Alberta, Manitoba, and Nova Scotia) in order to improve the understanding of current trends of AMR-GC. This enhanced laboratory-epidemiological linked surveillance program collects data not available via its existing routine and laboratory surveillance. Methods All cultures and data from participating jurisdictions are included in the surveillance program. The National Microbiology Laboratory performs antimicrobial susceptibility testing for a panel of antimicrobials and sequence typing. Enhanced epidemiological data collected includes treatment information and risk factors. Results From 2014–2017, ESAG captured 2767 cultures from 2566 cases. The majority of the cases were male (81%) and less than 40 years old (83%). There was a 25% decrease from 2014 to 2017 in the number of cases from men who have sex with men. The proportion of isolates demonstrating resistance to at least one antibiotic agent steadily increased from 2014 (54%) to 2016 (66%), dropping to 58% in 2017. Large declines in decreased susceptibility to both cefixime (91%) and ceftriaxone (88%) and increasing rates of resistance to azithromycin were observed. Conclusion ESAG data for 2014–2017 demonstrated decreased susceptibility to the preferred therapy antimicrobials, suggesting that resistance to these key antimicrobials could complicate GC treatment considerably in the future. The expansion of ESAG remains a priority with negotiations currently underway with the remaining jurisdictions with the goal national representation. Disclosure No significant relationships.

Background In the development of administrative data case-definitions for HIV, it is important to understand the contribution of each data source to prevalence estimates, especially as it pertains to generalizability of methods. Methods HIV case-definitions were constructed from four population-based databases available in Manitoba: physician claims, hospital discharge, pharmaceutical dispensations, and provincial laboratory tests. Performance was assessed using sensitivity, specificity, positive/negative predictive value (PPV & NPV), and Youden’s index (YI). Cases identified by HIV case-definitions, and those reported to public health surveillance were compared using annualized incidence. The distribution of those flagged as HIV-positive was compared by database. Results The best performing case-definition (YI 0.71) was two or more HIV diagnoses in two years in physician claims, or in hospital discharge abstracts; or 14 or more HAART dispensations in two years; or one positive HIV laboratory. Sensitivity, specificity, PPV and NPV was 82.3% (95%CI: 79.1%-85.5%), 86.8% (95%CI: 84.9%-88.7%), 74.1% (95%CI: 70.6%-77.6%), 91.4% (95%CI: 89.8%-93.1%), respectively. Annualized incidence (2009–2015) calculated from this case-definition was 7.4/100,000 persons (95%CI: 6.8–8.1)]; annualized incidence calculated from surveillance data was 7.7/100,000 persons (95%CI: 7.1–8.3). Approximately 76% of cases would have been flagged through a positive laboratory; 43% through pharmaceutical claims; 34% through physician claims; and 11% through hospital abstracts. 95% of cases would have been flagged through the combination of laboratory and pharmaceutical databases. Only 4% of cases were flagged in all four data sources. Conclusion Although the combination of four databases produced the most complete prevalence snapshot, laboratory data was the most important contributor. The combination of laboratory and pharmaceutical databases would have identified the predominant majority of cases in our sample. Findings can be used to inform the construction of administrative data cohorts where the availability of population-based data sources may be more limited. Disclosure No significant relationships.

Objectives: The purpose of this study was to describe and explore potential driving factors of trends in reported chlamydia infections over time in Manitoba, Canada. Methods: Surveillance and laboratory testing data from Manitoba Health, Seniors and Active Living were analysed using SAS v9.4. Kaplan-Meier plots of time from the first to second chlamydia infection were constructed, and Cox proportional hazards regression was used to estimate the risk of second repeat chlamydia infections in males and females. Results: Overall, the number of reported infections found mirrored the number of tests conducted. From 2008 to 2014, the number of first infections found among females decreased as the number of first tests conducted among females also decreased. Between 2008 and 2012, the number of repeat tests among females increased and was accompanied by an increase in the number of repeat positive results from 2009 to 2013. From 2008 to 2016, the number of repeat tests and repeat positive results increased steadily among males. Conclusions: Chlamydia infection rates consistently included a subset composed of repeat infections. The number of cases identified appears to mirror testing volumes, drawing into question incidence calculations that do not include testing volumes. Summary Box: 1) What is the current understanding of this subject? Chlamydia incidence is high in Manitoba, particularly among young women and in northern Manitoba. 2) What does this report add to the literature? This report suggests that incidence calculated using case-based surveillance data alone does not provide an accurate estimate of chlamydia incidence in Manitoba and is heavily influenced by testing patterns. 3) What are the implications for public health practice? In general, improving testing rates in clinical practices as well as through the provision of rapid services in non-clinical venues could result in higher screening and treatment rates. In turn, this could lead to a better understanding of true disease occurrence.

Understanding patterns of serological testing for hepatitis B & C, and syphilis among HIV-positive individuals, prior to HIV diagnosis, can inform HIV diagnosis, engagement and prevention strategies. This was a population-based, retrospective analysis of prior serological testing among HIV-positive individuals in Manitoba, Canada. HIV cases were age-, sex- and region-matched to HIV-negative controls at a 1:5 ratio. Conditional logistic regression was used to examine previous serological tests and HIV status. Odds ratios (ORs) and their 95% confidence intervals (95% CI) were reported. A total of 193 cases and 965 controls were included. In the 5 years prior to diagnosis, 50% of cases had at least one test, compared to 26% of controls. Compared to those who did not have serological testing in the 5 years prior to HIV infection, those who had one serological test were at twice the odds of being HIV positive (OR: 1.9, 95% CI: 1.2-2.9), while those with 2 or more tests were at even higher odds (OR: 5.5, 95%CI: 3.7-8.4). HIV cases had higher serological testing rates. Interactions between public health and other healthcare providers should be strengthened.