Canadian Territories Research Articles

Regional cost effectiveness analyses for increasing radon protection strategies in housing in Canada

The incremental cost effectiveness ratios for implementing a recent recommendation to install a more radon resistant foundation barrier were modelled for new and existing housing in 2016, for each province and territory in Canada. Cost-utility analyses were conducted, in which the health benefit of an intervention was quantified in quality-adjusted life years, to help guide policymakers considering increasing investment in radon reduction in housing to reduce the associated lung cancer burden shouldered by the health care system. Lung cancer morbidity was modelled using a lifetable analysis that incorporated lung cancer incidence and survival time for localized, regional, and distant stages of diagnoses for both non-small cell and small cell lung cancer. The model accounted for surgical or advanced lung cancer treatment costs avoided, and average health care costs incurred for radon-attributable lung cancer cases prevented by the intervention. The incremental implementation of radon interventions in the housing stock was modelled over a lifetime horizon, and a discount rate of 1.5% was adopted. This radon intervention in new housing was cost effective in all but one region, ranging from $18,075/QALY (15,704; 20,178) for the Yukon to $58,454/QALY (52,045; 65,795) for British Columbia. A sequential analysis was conducted to compare intervention in existing housing for mitigation thresholds of 200 and 100 Bq/m3. This intervention in existing housing was cost effective at a mitigation threshold of 200 Bq/m3 in regions with higher radon levels, ranging from $33,247/QALY (27,699; 39,377) for the Yukon to $61,960/QALY (46,932; 113,737) for Newfoundland, and more cost effective at a threshold of 200 than 100 Bq/m3. More lung cancer deaths can be prevented by intervention in new housing than in existing housing; it was estimated that the proposed intervention in new housing would prevent a mean of 446 (416; 477) lung cancer cases annually. The cost effectiveness of increased radon resistance in foundation barriers in housing varied widely, and would support adopting this intervention in new housing across Canada and in existing housing in higher radon regions. This study provides further evidence that the most cost effective way of responding to the geographically variable radon burden is by implementing specific regional radon reduction policies.

431 - Establishing a Canadian National ECHO Educational Program focused on Mental Health of Older Adults

BackgroundProject ECHO is a virtual, case-based capacity-building education program for healthcare providers. It was developed in New Mexico, USA but, due to its effectiveness, the model has now spread to 40 countries around the globe. Baycrest, the Canadian Coalition for Seniors’ Mental Health and the Canadian Academy of Geriatric Psychiatry collaborated to launch a national ECHO for mental health and aging. This partnership, coordinated by a cross-Canadian Steering Group, allows for broad reach, including registration of learning partners from almost all Canadian provinces and territories. The program was funded by the RBC Foundation.MethodsECHO COE: Mental Health pilot consisted of 2 cycles: 6 weekly sessions focused on broader mental health topics (e.g., delirium, mood disorders)10 weeks with more specific topics (e.g., substance use disorders, sleep disorders)Needs assessments of healthcare providers and older adults informed the program curricula. Evaluation included weekly satisfaction surveys, and pre and post evaluations.ResultsParticipants: 154 healthcare providers participated in the 6-week session39% of registrants were nurses or nurse practitioners, 35% allied health professionals, 14% physicians and 12% others9 out of 10 provinces, 1 territory representedPreliminary findings (based on the first 6 sessions): High overall satisfaction (average of 4.5 out of 5).99% would recommend the program to others67% had already shared information with team members and colleagues.ConclusionA national ECHO program is an effective way to bring together clinicians who work with and are interested in the mental health and wellbeing of older adults for education sessions, collaborative and mutual learning as well as for cross-jurisdictional knowledge transfer. Collaborative, cross-professional learning supports the exchange of best practice in mental health for older adults, supports the development of collegial national professional support and can address health system inequities. An international ECHO through IPA would be an exciting and valuable next step.

Review of cannabis reimbursement by workers' compensation insurance in the U.S. and Canada.

Changing public attitudes about cannabis consumption have currently led 36 U.S. states and the District of Columbia to approve laws that make cannabis available to consumers with qualifying medical conditions. This article reviews the 36 states and the District of Columbia with medical cannabis access laws to determine if the state or the District also allows reimbursement of the costs of cannabis for a work-related health condition under that state's or District's workers' compensation insurance (WCI) laws and administrative regulations. The legal basis for a state allowing or not allowing WCI reimbursement is described. The review found that only six of the 36 states expressly allow cannabis WCI reimbursement, six expressly prohibit it, 14 states do not require reimbursement, and 10 states, and the District of Columbia, are silent on the issue. The article describes the role of the insurer, treating physician, and worker in obtaining WCI reimbursement in the six states that expressly allow cannabis WCI reimbursement. Comparisons are made to how selected Canadian provinces and territories administer cannabis reimbursement under Canada's new national cannabis legalization law. The article discusses the future role of cannabis legalization in the United States and the evolving role of cannabis from an international perspective.

Disparities in modifiable cancer risk factors among Canadian provinces, territories, and health regions

Background Data about small area estimates of cancer risk factors are difficult to obtain in Canada. The current study aims to provide an assessment of the prevalence of different behavioral risk factors of cancer at the level of Canadian provinces/territories and sub provincial health regions/units. Methods Canadian Community Health Survey (CCHS) datasets for 2017/2018 were reviewed and adult participants (≥ 18 years old) were included. Baseline demographic data and health behaviors (including ever-smoking, current smoking, alcohol drinking in the past 12 months, below-recommended physical activity, and obesity) were reviewed. Prevalence of each of these behaviors within different provinces/territories as well as within each health region was reviewed. Multivariable logistic regression analysis was then done to examine the association between place of residence and cancer risk factors. Results A total of 104,636 adult participants were included in the current analysis. For ever-smoking, the highest prevalence was noted in Nunavut (79.7%); for current smoking, the highest prevalence was noted in Nunavut (67.2%); for alcohol drinking in the past 12 months, the highest prevalence was noted in Quebec (89.3%); for below-recommended physical activity, the highest prevalence was noted in Nunavut (51.3%); for obesity, the highest prevalence was noted in Northwest territories (31.5%). Compared to individuals living within a territory, individuals living within a province were less likely to ever smoke (OR: 0.62; 95% CI: 0.54–0.71), currently smoke (OR: 0.51; 95% CI: 0.45–0.59), be obese (OR: 0.82; 95% CI: 0.71–0.95), but more likely to drink alcohol in the past 12 months (OR: 1.41; 95% CI: 1.20–1.65). There is no difference between both categories with regards to physical activity (OR: 1.02; 95% CI: 0.89–1.15). Conclusions There is a general province/territory disparity in the prevalence of different modifiable cancer risk factors as well as disparity between individual provinces/health regions in Canada.

News, Events, Publications, and Awards

News, Events, Publications, and Awards

A sub-national real-time epidemiological and vaccination database for the COVID-19 pandemic in Canada

The COVID-19 pandemic has demonstrated the need for real-time, open-access epidemiological information to inform public health decision-making and outbreak control efforts. In Canada, authority for healthcare delivery primarily lies at the provincial and territorial level; however, at the outset of the pandemic no definitive pan-Canadian COVID-19 datasets were available. The COVID-19 Canada Open Data Working Group was created to fill this crucial data gap. As a team of volunteer contributors, we collect daily COVID-19 data from a variety of governmental and non-governmental sources and curate a line-list of cases and mortality for all provinces and territories of Canada, including information on location, age, sex, travel history, and exposure, where available. We also curate time series of COVID-19 recoveries, testing, and vaccine doses administered and distributed. Data are recorded systematically at a fine sub-national scale, which can be used to support robust understanding of COVID-19 hotspots. We continue to maintain this dataset, and an accompanying online dashboard, to provide a reliable pan-Canadian COVID-19 resource to researchers, journalists, and the general public.

Historical foundations and contemporary expressions of a right to health care in Circumpolar Indigenous contexts

Although numerous comparative Indigenous health policy analyses exist in the literature, to date, little attention has been paid to comparative analyses of Circumpolar health policy and the impact these policies may have on Indigenous peoples’ rights to health. In this article, we ground our discussion of Indigenous peoples’ right to access culturally appropriate and responsive health care within the context of the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP). Under UNDRIP, signatory states are obligated to guarantee that Indigenous peoples have access to the same services accessible to all citizens without discrimination. Signatory states must also guarantee access to services that are grounded in Indigenous cultures, medicines, and practices and must address Indigenous peoples’ determinants of health at least to the same extent as their national counterparts. Our analysis finds that the implementation of this declaration varies across the Circumpolar north. The United States recognizes an obligation to provide health care for American Indian and Alaska Native people in exchange for the land that was taken from them. Other countries provide Indigenous citizens access to care in the same health care systems as other citizens. Intercultural models of care exist in Alaska and to some extent across the Canadian territories. However, aside from Sámi Norwegian National Advisory Unit on Mental Health and Substance Use in northern Norway, intercultural models are absent in Nordic countries and in Greenland. While Russia has not ratified UNDRIP, Russian policy guarantees access to health care to all citizens, although access is particularly limited in rural and remote environments, including the Russian Arctic. We conclude that Circumpolar nations should begin and/or expand commitments to culturally appropriate, self-determined, access to health care in Circumpolar contexts to reduce health inequities and adhere to obligations outlined in UNDRIP.

National trends in population rates of opioid-related mortality, hospitalization and emergency department visits in Canada between 2000 and 2017. A population-based study.

Existing assessments of the time-trends of opioid-related mortality, hospitalization and emergency department visits in Canada have relied mainly on provincial databases, while national assessments generally do not provide information before 2016. We aimed to estimate Canadian national time trends in opioid-related mortality from 2000 to 2017 and opioid-related hospitalization and emergency department visits between 2000 and 2012. Retrospective cohort study. Residents of all Canadian provinces and territories for which comparable data were available from 2000 to 2017. We identified opioid-related mortality, hospitalization and emergency department visits using validated algorithms using ICD codes from administrative databases. We calculated crude rates and sex- and age-adjusted rates per million. For hospitalizations, we calculated case-fatality, 90-day and 365-day all-cause mortality and opioid-related re-hospitalization rates. We used Poisson regression to examine the significance of the time trend. From 2000 to 2017, the adjusted opioid mortality rate in Canada (outside Quebec) increased significantly by 592.9% (from 20.0 opioid deaths per million in 2000 to 118.3 in 2017). The highest year-to-year increases were from 2015 to 2016 (31.8%) and from 2016 to 2017 (52.2%). The adjusted hospitalizations doubled significantly during the study period (an increase of 103.7%, from 159.7 opioid hospitalizations per million Canadians in 2000 to 325.3 in 2012). The adjusted rate of emergency department visits increased significantly by 188.7% (from 280.6 per million in 2000 to 810.1 in 2012). Case-fatality was 2.3% overall and was mainly constant during the study period. Both 90- and 365-day all-cause mortality increased significantly between 2000 and 2011 (from 1.7 to 3.1% and 3.9 to 7.4%, respectively), while re-hospitalization for opioid-related diagnoses was reduced (from 7.8 to 6.4% and 14.2 to 12.9%, respectively). Opioid-related mortality, hospitalization and emergency department visits in Canada have been increasing gradually since 2000.

Environmental scan of provincial and territorial planning for COVID-19 vaccination programs in Canada.

Public health departments in Canada are currently facing the challenging task of planning and implementing coronavirus disease 2019 (COVID-19) vaccination programs. To collect and synthesize information regarding COVID-19 vaccination program planning in each province and territory of Canada, including logistic considerations, priority groups, and vaccine safety and effectiveness monitoring. Provincial/territorial public health leaders were interviewed via teleconference during the early planning stage of COVID-19 vaccination programs (August-October 2020) to collect information on the following topics: unique factors for COVID-19 vaccination, intention to adopt National Advisory Committee on Immunization (NACI) recommendations, priority groups for early vaccination, and vaccine safety and effectiveness monitoring. Data were grouped according to common responses and descriptive analysis was performed. Eighteen interviews occurred with 25 participants from 11 of 13 provinces/territories (P/Ts). Factors unique to COVID-19 vaccination included prioritizing groups for early vaccination (n=7), public perception of vaccines (n=6), and differing eligibility criteria (n=5). Almost all P/Ts (n=10) reported reliance on NACI recommendations. Long-term care residents (n=10) and healthcare workers (n=10) were most frequently prioritized for early vaccination, followed by people with chronic medical conditions (n=9) and seniors (n=8). Most P/Ts (n=9) are planning routine adverse event monitoring to assess vaccine safety. Evaluation of effectiveness was anticipated to occur within public health departments (n=3), by researchers (n=3), or based on national guidance (n=4). Plans for COVID-19 vaccination programs in the P/Ts exhibit some similarities and are largely consistent with NACI guidelines, with some discrepancies. Further research is needed to evaluate COVID-19 vaccination programs once implemented.

News, Events, Publications, and Awards

News, Events, Publications, and Awards

Priority Given to Technology in Government-Based Mental Health and Addictions Vision and Strategy Documents: Systematic Policy Review.

BackgroundThe use of information and communication technologies (ICTs) to deliver mental health and addictions (MHA) services is a global priority, especially considering the urgent shift towards virtual delivery of care in response to the COVID-19 pandemic. It is important to monitor the evolving role of technology in MHA services. Given that MHA policy documents represent the highest level of priorities for a government’s vision and strategy for mental health care, one starting point is to measure the frequency with which technology is mentioned and the terms used to describe its use in MHA policy documents (before, during, and after COVID-19). Yet, to our knowledge, no such review of the extent to which ICTs are referred to in Canadian MHA policy documents exists to date.ObjectiveThe objective of this systematic policy review was to examine the extent to which technology is addressed in Canadian government–based MHA policy documents prior to the COVID-19 pandemic to establish a baseline for documenting change.MethodsWe reviewed 22 government-based MHA policy documents, published between 2011 and 2019 by 13 Canadian provinces and territories. We conducted content analysis to synthesize the policy priorities addressed in these documents into key themes, and then systematically searched for and tabulated the use of 39 technology-related keywords (in English and French) to describe and compare jurisdictions.ResultsTechnology was addressed in every document, however, to a varying degree. Of the 39 searched keywords, we identified 22 categories of keywords pertaining to the use of technology to deliver MHA services and information. The 6 most common categories were tele (n=16/22), phone (n=12/22), tech (n=11/22), online (n=10/22), line (n=10/22), and web (n=10/22), with n being the number of policy documents in which the category was mentioned out of 22 documents. The use of terms referring to advanced technologies, such as virtual (n=6/22) and app (n= 4/22), were less frequent. Additionally, policy documents from some provinces and territories (eg, Alberta and Newfoundland and Labrador) mentioned a diverse range of ICTs, whereas others described only 1 form of ICT.ConclusionsThis review indicates that technology has been given limited strategic attention in Canadian MHA policy. Policy makers may have limited knowledge on the evidence and potential of using technology in this field, highlighting the value for knowledge translation and collaborative initiatives among policy makers and researchers. The development of a pan-Canadian framework for action addressing the integration and coordination of technology in mental health services can also guide initiatives in this field. Our findings provide a prepandemic baseline and replicable methods to monitor how the use of technology-supported services and innovations emerge relative to other priorities in MHA policy during and after the COVID-19 pandemic.

A Review of “Optimal Fallow Period” Guidance Across Canadian Jurisdictions

IntroductionUnderstanding how different countries have responded to mitigate the risk of severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) transmission in dental offices is important. This article describes the different approaches taken towards optimal fallow periods in Canadian jurisdictions. MethodsWe searched publicly available information from dentist and dental hygiene regulator websites across the 10 provinces and 3 territories in Canada. We also searched for guidance documents on dental associations’ websites or through personal communication with government officials. We extracted and tabulated information on fallow period recommendations or guidance, when available. ResultsNine jurisdictions (6 provinces and all 3 territories) acknowledge or provide guidance on fallow periods following aerosol-generating procedures. Among those who have provided guidance regarding a fallow period, recommendations follow the Centers for Disease Control and Prevention guidance if the air changes per hour (ACH) in the dental operatory is known. ConclusionThe evidence for deciding on optimal fallow period is limited and still being explored, resulting in substantial variation across Canadian jurisdictions. A focus on developing scientific evidence relevant to dentistry and assimilating existing science is crucial to establishing consistency and uniformity in information to deliver safe oral health care services.

CHLA Standards for Library and Information Services in Canadian Health & Social Services Institutions 2020.

The following standards, with supporting evidence, are intended to serve as a guide to structuring minimum library services within health and social services institutions across all Canadian provinces and territories. The Standards are not intended to be aspirational. The aim of the Task Force was to ensure that the Standards update would not be so removed from the current realities and landscape that they became unattainable to many libraries. For this reason, some Standards outline requirements that are essential to the minimum function of the library, and other Standards provide recommendations only. The intended use of the Standards is to set a baseline for the provision of essential library services and resources and aid in advocating for adequate resources. It is important to note, however, that the Task Force does not intend for the Standards to prevent libraries from reaching a more advanced level of service, and we hope that in their current form they will not be a hindrance to excellence or innovation. Once published, the version of the Standards made freely available on the Canada Health Libraries Association website [1] shall henceforth and always be considered the most recent and active version of the Standards and is the version that should be used to inform practice. The Standards Standing Committee will institute a regular review and updating schedule, ensuring the currency of the Standards.

Identifying gaps in COVID-19 health equity data reporting in Canada using a scorecard approach.

ObjectiveTo assess health equity-oriented COVID-19 reporting across Canadian provinces and territories, using a scorecard approach.MethodsA scan was performed of provincial and territorial reporting of five data elements (cumulative totals of tests, cases, hospitalizations, deaths, and population size) across three units of aggregation (province or territory level, health regions, and local areas) (15 “overall” indicators), and for four vulnerable settings (long-term care and detention facilities, schools, and homeless shelters) and eight social markers (age, sex, immigration status, race/ethnicity, healthcare worker status, occupational sector, income, and education) (180 “equity-related” indicators) as of December 31, 2020. Per indicator, one point was awarded if case-delimited data were released, 0.7 points if only summary statistics were reported, and 0 if neither was provided. Results were presented using a scorecard approach.ResultsOverall, information was more complete for cases and deaths than for tests, hospitalizations, and population size denominators needed for rate estimation. Information provided on jurisdictions and their regions, overall, tended to be more available (average score of 58%, “D”) than that for equity-related indicators (average score of 17%, “F”). Only British Columbia, Alberta, and Ontario provided case-delimited data, with Ontario and Alberta providing case information for local areas. No jurisdiction reported on outcomes according to patients’ immigration status, race/ethnicity, income, or education. Though several provinces reported on cases in long-term care facilities, only Ontario and Quebec provided detailed information for detention facilities and schools, and only Ontario reported on cases within homeless shelters and across occupational sectors.ConclusionOne year into the pandemic, socially stratified reporting for COVID-19 outcomes remains sparse in Canada. However, several “best practices” in health equity-oriented reporting were observed and set a relevant precedent for all jurisdictions to follow for this pandemic and future ones.Supplementary InformationThe online version contains supplementary material available at 10.17269/s41997-021-00496-6.

Physical Restraint, Seclusion, and Time-Out Rooms in Canadian Schools: Analysis of a Policy Patchwork

The intended purpose of physical restraint, seclusion, and time-out rooms in schools is to intervene in a crisis when the behaviour of a student poses an immediate or imminent, and significant threat to physical safety. While the use of physical restraint, seclusion, and time-out rooms is intended to provide protection from immediate physical harm, there is increasing concern that these practices are being used more broadly and that individuals with disabilities are disproportionately subjected to their use. In spite of the importance of this issue, there is a dearth of research analyzing the policy landscape of physical restraint, seclusion, and time-out rooms in Canadian schools. In order to explore this issue, a comparative analysis of publicly available provincial and territorial education documents was conducted. The analysis revealed that in many Canadian provinces and territories, policies and accountability structures on the use of physical restraint, seclusion, and time-out rooms in schools are inconsistent or non-existent. Further, the terminology used to describe seclusion is variable and often conflated with time out, and the conditions under which such practices may be used in some instances are subjective, which may contribute to a broad interpretation of what is deemed acceptable practices in schools. This analysis draws attention to the need for the development of clearly articulated provincial and territorial standards for the use of physical restraint, seclusion, and time out, as well as the need for regulatory and enforcement mechanisms at the school, division, and ministry levels in order to ensure the emotional and physical well-being of all.

Budget practices in Canada's K‐12 education sector: Incremental, performance, or productivity budgeting?

AbstractThis article reports on a first‐ever survey of budgeting practices regarding the public K‐12 education sector in Canada. We interviewed budget officers in 12 of the 13 Canadian provinces and territories. It finds that most jurisdictions construct budgets using incremental approaches and are not allowing for a potential of $5.4 billion in annual productivity gains. We discuss three budgeting approaches for governments to consider: incremental budgeting, performance‐based budgeting, and productivity budgeting. We argue for productivity budgeting because it improves cost‐efficiency, allows productivity gains to be captured at the centre, and is more feasible than performance‐based budgeting.

Evolution of Public Health Human Papillomavirus Immunization Programs in Canada.

Background: Since 2007, all Canadian provinces and territories have had a publicly funded program for vaccination against human papillomavirus (HPV) infection. The objective of this study was to describe the evolution of these vaccination programs. Methods: This was a targeted literature review of public HPV vaccination programs and vaccination coverage rates, based on information provided by jurisdictional public health authorities. Results: HPV vaccination of schoolgirls began in school years 2007/08 to 2010/11 with three doses of the quadrivalent HPV vaccine in all provinces except Quebec, which started with two doses. By 2018/19, all jurisdictions were vaccinating with two doses of the nonavalent vaccine in both girls and boys, except Quebec, which used a mixed vaccination schedule with one dose of the nonavalent and one dose of the bivalent vaccines. Public HPV vaccination programs in most provinces include after-school catch-up vaccination. Immunocompromised or other high-risk individuals are eligible for the HPV public vaccination program in most provinces, but policies vary by jurisdiction. In 2017/18, vaccination coverage rates in provincial HPV school-based programs varied from 62% in Ontario to 86% in Prince Edward Island in girls and from 58% in Ontario to 86% in Prince Edward Island in boys. Conclusions: Since their introduction, Canadian school-based HPV public vaccination programs have evolved from a three-dose to a two-dose schedule, from a quadrivalent to a nonavalent vaccine, and from a girls-only to a gender-neutral policy. Vaccination coverage rates have varied markedly and only Prince Edward Island and Newfoundland/Labrador have maintained rates exceeding 80%.

A comparative analysis of environment and sustainability in policy across subnational education systems

The aim of this study was to better understand how Environmental and Sustainability Education (ESE) policy has been developed and mobilized across subnational contexts in a federated system. We undertook a comparative analysis of sustainability-specific policy and curricula documents from all Canadian provinces and territories. We identified three thematic clusters in the data; two aligned with major global ESE policy initiatives, and a third cluster centered on localized Indigenous education in a northern territory. Conclusions and implications include that the absence of globalized ESE uptake in the northern territory demonstrates localized, relevant, and appropriate policy development, which could inform future global sustainability education initiatives. In addition, with only 6 of 13 provinces and territories having specialized education policy or curricular documents focused on climate and sustainability, there is an urgent need for increased focus in these areas in responding to calls from students and communities for climate action.

The Canadian Alcohol Policy Evaluation project: Findings from a review of provincial and territorial alcohol policies.

Effective alcohol control measures can prevent and reduce alcohol-related harms at the population level. This study aims to evaluate implementation of alcohol policies across 11 evidence-based domains in Canada's 13 jurisdictions. The Canadian Alcohol Policy Evaluation project assessed all provinces and territories on 11 evidence-based domains weighted for scope and effectiveness. A scoring rubric was developed with policy and practice indicators and peer-reviewed by international experts. The 2017 data were collected from publicly-available regulatory documents, validated by government officials, and independently scored by team members. The average score for alcohol policy implementation across Canadian provinces and territories was 43.8%; Ontario had the highest (63.9%) and Northwest Territories the lowest (38.4%) jurisdictional scores. Only six of 11 policy domains had average scores above 50% with Monitoring and Reporting scoring the highest (62.8%) and Health and Safety Messaging the lowest (25.7%). A 2017 provincial/territorial current best practice score of 86.6% was calculated taking account of the highest scores for any individual policy indicators implemented in at least one jurisdiction across the country. Most of the evidence-based alcohol policies assessed by the Canadian Alcohol Policy Evaluation project were not implemented across Canadian provinces and territories as of 2017, and many provinces showed declining scores since 2012. However, the majority of policies assessed have been implemented in at least one jurisdiction. Improved alcohol policies to reduce related harm are therefore achievable and could be implemented consistently across Canada.

HIV in Canada-surveillance report, 2019.

Human immunodeficiency virus (HIV) is a global public health issue. HIV has been nationally notifiable in Canada since 1985. The Public Health Agency of Canada (PHAC) monitors trends in new HIV diagnoses. The objective of this surveillance report is to provide an overview of the epidemiology of reported HIV cases in 2019 in Canada. The report highlights 10-year trends (2010-2019). Data on HIV diagnosed through Immigration Medical Exams (IME) and trends in perinatal transmission of HIV are also presented. PHAC monitors HIV through the HIV/AIDS Surveillance System, a passive, case-based system that collates non-nominal data submitted voluntarily by all Canadian provinces and territories. Descriptive analyses were conducted on national data. IME data were obtained from Immigration, Refugees and Citizenship Canada (IRCC), and data on HIV-exposed pregnancies were obtained through the Canadian Perinatal HIV Surveillance Program. In 2019, a total of 2,122 HIV diagnoses were reported in Canada (5.6 per 100,000 population). Saskatchewan reported the highest provincial diagnosis rate at 16.9 per 100,000 population. The 30 to 39-year age group had the highest HIV diagnosis rate at 12.7 per 100,000 population. While the rates for both males and females fluctuated in the past decade, since 2010 the rates among males decreased overall, while the rate among females increased slightly. As in previous years, the diagnosis rate for males in 2019 was higher than that for females (7.9 versus 3.4 per 100,000 population, respectively). The highest proportion of all reported adult cases with known exposure were gay, bisexual and other men who have sex with men (gbMSM, 39.7%), followed by cases attributed to heterosexual contact (28.3%) and among people who inject drugs (PWID, 21.5%). The number of migrants who tested positive for HIV during an IME conducted in Canada was 626. The one documented perinatal HIV transmission related to a mother who had not received antepartum or intrapartum antiretroviral therapy prophylaxis. The number and rate of reported HIV cases in Canada has remained relatively stable over the last decade, with minor year-to-year variations. As in previous years, the gbMSM and PWID populations represent a high proportion of HIV diagnoses, although a sizable number of cases were attributed to heterosexual contact. It is important to routinely monitor trends in HIV in light of pan-Canadian commitments to reduce the health impact of sexually transmitted and blood-borne infections by 2030.