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For over 30 years, the Government of Canada has developed guidelines on sexually transmitted and blood-borne infections (STBBI) with a group of subject matter experts. This expert group provided advice to the Public Health Agency of Canada (PHAC) from 2004 to 2019; transitioning to the National Advisory Committee on STBBI (NAC-STBBI) in 2019. NAC-STBBI supports PHAC’s mandate to prevent and control infectious diseases by providing advice for the development of STBBI guidelines. The methodology for developing the NAC-STBBI recommendations is evolving to a more rigorous, systematic and transparent process that is consistent with current standards in guideline development. It is also informed by—and aligned with—the methods of several other major guideline developers. The methodology incorporates the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, as appropriate, when conducting evidence reviews and developing recommendations. Recommendations will be published on the canada.ca website with the supporting NAC-STBBI Statement detailing the methodology and evidence used to develop them. This process will ensure that PHAC provides trustworthy evidence-based STBBI recommendations to primary care providers and public health professionals.

Latent tuberculosis infection (LTBI) is characterised by the presence of immune responses to previously acquired Mycobacterium tuberculosis infection without clinical evidence of active tuberculosis (TB). Here we report evidence-based guidelines from the World Health Organization for a public health approach to the management of LTBI in high risk individuals in countries with high or middle upper income and TB incidence of, Guidelines on LTBI for low TB incidence countries – essential element of the @WHO #EndTB strategy and TB elimination http://ow.ly/RW8xn

BACKGROUNDS: Hospitalizations associated with hepatitis C virus (HCV) infection and liver disease increased on average by 6.0% per year from 2004 to 2010 in Canada and were projected (in 2010) to increase by another 4% by 2016. The first generation of direct-acting antivirals (DAAs) became available in 2012. In 2014, a second generation of effective and well-tolerated DAA therapy was authorized in Canada. The impact of DAA therapy on the HCV-associated disease burden in Canada has not been documented. OBJECTIVES: To assess the potential impact of DAA therapy on the disease burden by a) comparing the actual hospitalization rates associated with HCV infection and liver disease following the introduction of DAAs in Canada with the 2010 baseline projection and b) documenting the associated uptake of anti-HCV therapy. METHODS: The hospital records of inpatients diagnosed with chronic HCV and chronic liver disease were extracted from the Canadian Discharge Abstract Database (DAD) by fiscal year for 2004–2016. We compared the actual number of hospitalizations to the baseline projection by year and for selected 5-year birth cohorts (1925–1989). The monthly number of new prescriptions for anti-HCV regimens was extracted from the IQVIA CDH CompuScript database (formerly IMS Health), aggregated to annual levels by age group and compared with hospitalization trends. RESULTS: Compared to the baseline projection, there was a slight reduction in hospitalizations in 2014/15 and 2015/16. This slight reduction was followed by a more significant decline in 2016/17 (32% below expected; 95% confidence interval [CI]: 27%–37%). The largest declines were observed for patients born before 1960 (age 55 or older) at 40% below expected in 2016/17. The number of new anti-HCV prescriptions increased from 5,484 in fiscal year 2012/13 to a peak of 17,775 in 2015/2016. The number of new prescriptions corresponds to approximately 1.3 and five times the number of hospitalizations in 2012/13 and 2015/16, respectively. CONCLUSIONS: In Canada there has been a modest decrease in HCV and liver-related hospitalizations following a significant increase in uptake of second-generation DAAs in 2015. However, the burden is still high. Linked health administrative databases created to monitor the disease burden in the new treatment era should provide additional insight with the linkage of treatment history and disease stage to individual outcomes.

Background Cases of Neisseria gonorrhea are on the rise in Canada, which-if undetected or undertreated-can lead to morbidity and infertility. In addition, the number of antimicrobial resistant strains is also increasing creating the risk that N. gonorrhea may become untreatable. In 2013, the Public Health Agency of Canada (PHAC) released Canadian recommendations for the management and treatment of gonorrhea that identified the need for combination therapy to address and minimize antimicrobial resistance. However, the level of awareness and uptake of these guidelines is not well-known. Objectives To assess primary care physicians' prescribing practices for the management and treatment of gonorrhea. Methods After validity testing, two online cross-sectional surveys were conducted with a convenience sample of Canadian physicians. Physicians answered true/false statements and open-ended questions relating to three clinical scenarios: 1) suspected anogenital infection drawing from a population of men who have sex with men (MSM); 2) suspected anogenital infection drawing from a non-MSM population; and, 3) suspected pharyngeal infection drawing from any population. Frequencies of responses were calculated for the statements. Open-ended responses were recoded into treatment categories and frequencies were calculated for each scenario. Results A total of 625 physicians completed the survey. Most physicians (60%-95%) accurately identified knowledge statements regarding pharmaceutical management, partner notification and public health reporting. For all clinical scenarios, 30%-35% of physicians did not provide any treatment information, approximately 30% indicated treating with cephalosporin monotherapy, 20%-25% indicated they would prescribe a cephalosporin and azithromycin and a minority of physicians identified other treatment options. When physicians were asked about the purpose of the second antibiotic, azithromycin, 49% indicated it was to provide presumptive treatment for gonorrhea and chlamydia. Forty-one percent indicated it was to provide presumptive treatment for chlamydia only. Conclusion This convenience sample suggests that although knowledge of pharmaceutical management, partner notification, and public health reporting is high, the use of combination therapy to deter the development of antimicrobial resistant gonorrhea may not be widespread among primary care physicians. In light of both the growing incidence of N. gonorrhea and the rising rates of antimicrobial resistance in Canada, consideration on how to improve awareness and update of best prescribing practices in primary care may be indicated.

Objective We aimed to assess the potential prevention benefits of HIV treatment as prevention (TasP) in resource-rich countries and examine the potential interactions between TasP and other prevention strategies by reviewing mathematical models of TasP. Method Multiple databases were searched for mathematical models published in the previous 5 years (from July 2007 to July 2012). The nine models located were set in Canada, Australia and the United States. Results These models' predictions suggested that the impact of expanding treatment rates on expected new infections could range widely, from no decrease to a decrease of 76%, depending on the time horizon, assumptions and the form of TasP modeled. Increased testing, reducing sexually transmitted infections and reducing risky practices were also predicted to be important strategies for decreasing expected new infections. Sensitivity analysis suggests that current uncertainties such as the effectiveness of highly active antiretroviral therapy outside of heterosexual transmission, less than ideal adherence, and risk compensation, could impact on the success of TasP at the population level. Conclusion The results from large scale pilots and community randomized controlled trials will be useful in demonstrating how well this prevention approach works in real world settings, and in identifying the factors that are needed to support its effectiveness.

To provide recommendations on the management of gonococcal infection among adults and youth.Treatment recommendations in the Canadian guidelines on sexually transmitted infections are based on review of the literature, as well as the grades of recommendations and the levels of evidence quality determined by a minimum of 2 reviewers. The recommendations are peer-reviewed and require approval by the expert working group.The new key recommendations for managing gonococcal infection among adults and youth include using culture as a diagnostic tool when practical, providing treatment with combination antibiotic therapy (ceftriaxone combined with azithromycin), and promptly reporting all cases with treatment failure to public health.Following these new key recommendations might reduce treatment failure, contribute to better surveillance of antibiotic-resistance trends in Neisseria gonorrhoeae, and contribute to the prevention of transmission of multidrug-resistant gonorrhea.

Background Moving clinical guidelines into practise requires the development of clinical knowledge products to aid family practitioners. A variety of product types and formats may need to be used to suit different needs by career-stage. Methods To evaluate the sexually transmitted and blood-borne infections (STBBI) knowledge product needs of practitioners, information was elicited from a convenience sample (N = 207) of family medicine practitioners at a national Canadian family medicine forum in Toronto between November 15 and 17, 2013. Analysis was stratified by years of practise to identify ways to reach different generations of practitioners concerning STI and HIV clinical recommendations. The Fishers exact and chi-square test was used to determine statistical significance. Data was collected on preferences on clinical aids; methods used to update clinical knowledge; and preferred formats of accessing STI guidelines. Results All practitioners expressed preferences for concise clinical aids such as algorithms (64.2%) and abbreviated pocket guides (35.3%), in addition to prompts on electronic medical records (32.9%). On-line training and education were preferred by early-career practitioners ( Conclusions These findings demonstrate generational differences in preferred formats and methods of accessing STI and HIV clinical information; public health programmes may wish to deliver information using different approaches to reach different practitioners.

Background Clinical guidelines play a critical role in the prevention and control of sexually transmitted and blood-borne infections (STBBIs). Little is known in Canada as to the uptake of clinical recommendations and the comfort-level of family practitioners performing STBBI-related clinical tasks. Methods To evaluate the prevention and control of STBBIs by family practitioners, information was elicited from a convenience sample (N = 207) of family practitioners at a national Canadian family medicine forum in Toronto between November 15 and 17, 2012 using two methods: audience response systems (during a symposium) and a self-administered questionnaire at an exhibition booth. Analysis was stratified by years of practise to identify any differences in STI risk assessments, treatment of gonorrhoea and offering of HIV testing. The Fisher’s exact and chi-square tests were used to determine statistical significance. Results Approximately 26.3% of early-career-practitioners ( Conclusions Results indicate a need to improve uptake of STI and HIV clinical recommendations among all practitioners, but particularly among mid-to-late-career practitioners.