Abstract
BackgroundManitoba is a central Canadian province with annual rates of new HIV infections consistently higher than the Canadian average. National surveillance statistics and data from the provincial HIV care program suggest that epidemiological heterogeneity exists across Manitoba. New HIV cases are disproportionately reported among females, Indigenous-identifying individuals, and those with a history of injection drug use. Given the heterogeneity in acquisition, it is of interest to understand whether this translates into inequalities in HIV care across Manitoba.MethodsA sample of 703 participants from a clinical cohort of people living with HIV in Manitoba, with data current to the end of 2017, was used to conduct cross-sectional, disaggregated analyses of the HIV care cascade to identify heterogeneity in service coverage and clinical outcomes among different groups receiving HIV care in Manitoba. Equiplots are used to identify and visualize inequalities across the cascade. Exploratory multivariable logistic regression models quantify associations between equity variables (age, sex, geography, ethnicity, immigration status, exposure category) and progression along the cascade. Adjusted odds ratios (AOR) and 95% confidence intervals (95%CI) are reported.ResultsEquity analyses highlight inequalities in engagement in and coverage of HIV-related health services among cohort participants. Equiplots illustrate that the proportion of participants in each cascade step is greater for those who are older, white, non-immigrants, and report no history of injection drug use. Compared to those living in Winnipeg, participants in eastern Manitoba have greater odds of achieving virologic suppression (AOR[95%CI] = 3.8[1.3–11.2]). The odds of Indigenous participants being virologically suppressed is half that of white participants (AOR[95%CI] = 0.5[0.3–0.7]), whereas African/Caribbean/Black participants are significantly less likely than white participants to be in care and retained in care (AOR[95%CI] = 0.3[0.2–0.7] and 0.4[0.2–0.9], respectively).ConclusionsInequalities exist across the cascade for different groups of Manitobans living with HIV; equiplots are an innovative method for visualizing these inequalities. Alongside future research aiming to understand why inequalities exist across the cascade in Manitoba, our equity analyses can generate hypotheses and provide evidence to inform patient-centred care plans that meet the needs of diverse client subgroups and advocate for policy changes that facilitate more equitable HIV care across the province.
Highlights
Manitoba is a central Canadian province with annual rates of new HIV infections consistently higher than the Canadian average
Manitoba is a central Canadian province where annual rates of new HIV infections are consistently higher than the national average (7.9 vs. 6.9 per 100,000 population, respectively, in 2018) [1]
Notable heterogeneity in rates of new HIV infection exists across the province by geography, age, and sex [3]—in 2018, 77.6% of new diagnoses occurred in Winnipeg, the provincial capital and main urban centre, and among newly diagnosed females, 11.6% were ≤ 19 years and 14.0% were ≥ 60 years [3]
Summary
Manitoba is a central Canadian province with annual rates of new HIV infections consistently higher than the Canadian average. Manitoba is a central Canadian province where annual rates of new HIV infections are consistently higher than the national average (7.9 vs 6.9 per 100,000 population, respectively, in 2018) [1]. Cascades use aggregate data to illustrate the proportion of individuals in a population of people living with HIV who have been diagnosed, linked to HIV care services, retained in care, initiated and sustained on HIV treatment to, reach virologic suppression. Using aggregate data to illustrate the continuum of HIV care for an entire population is useful insofar as it can provide a general picture of points of “leakage” or “bottlenecks” within a health system or care program. To generate evidence that can help to inform the development and optimization of interventions and programs addressing inequities in HIV care, it is crucial to conduct equity analyses that generate disaggregated cascades to showcase nuances and highlight inequalities across the cascade steps within a population
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
