BACKGROUND:Men who have sex with men (MSM) and transgender women experience high sexually transmitted infection (STI) rates. This study evaluated the feasibility of doxycycline pre-exposure prophylaxis (doxyPrEP) for STI prevention in these key populations. METHODS:Sexually-active MSM and transgender women without human immunodeficiency virus (HIV) with prior syphilis were recruited. Participants initiated HIV PrEP with tenofovir disoproxil fumarate/emtricitabine (TDF/FTC) daily for 48 weeks and were randomized 1:1 to daily doxyPrEP for 48 weeks (immediate arm), or doxyPrEP initiated at 24 weeks (deferred arm). Primary outcomes included adherence, measured using questionnaires, along with tolerability; STI incidence (chlamydia, gonorrhea, syphilis) was a secondary outcome. Nasal carriage of Staphylococccus aureus was assessed serially for doxycycline resistance. RESULTS:Fifty-two participants were enrolled into the immediate (n = 26) and deferred (n = 26) arms. At 48 weeks, self-reported adherence (≥95%) was 75.0% versus 66.7% (P = .538) for TDF/FTC, and 70.8% versus 61.9% (P = .526) for doxycycline in the immediate versus deferred arms, respectively. No doxyPrEP-related serious adverse events occurred. Incidence of any STI at 24 weeks was reduced in the immediate versus deferred arms, and over 48 weeks, being on doxycycline (vs being off; ie, first 24 weeks of deferred arm) was associated with STI reduction (adjusted odds ratio [aOR] 0.36; 95% confidence interval [CI]: .15-.89). Emergent doxycycline-resistant S. aureus was identified in six individuals, with five in the immediate arm (P = .077). CONCLUSIONS:Dual HIV/doxyPrEP is feasible and associated with a significant reduction in incident STI. Further evaluation of dosing strategies, efficacy and impact on antimicrobial resistance is warranted.

Structurally marginalized populations living with poverty in the urban core of large cities are disproportionately affected by mental health problems. We undertook an analysis to determine what factors are associated with improvements in mental health symptoms over time among clients of a primary care clinic in the Downtown Eastside of Vancouver, Canada. Beginning in June 2021, we enrolled clients of a low-barrier integrated primary care clinic, and administered surveys every six months until December 2023. Symptoms for depression and anxiety were measured using the Center for Epidemiologic Studies Depression Scale-10 (CESD-10) and Generalized Anxiety Disorder-7 (GAD-7) scales. We used logistic regression with Generalized Estimating Equations to examine associations between sociodemographic and structural factors, substance use and clinical factors and improvements in mental health symptoms. We included 455 participants, with complete GAD-7 and CESD-10 assessments at baseline. Of these, 67.2

OBJECTIVE:We examined whether rural residence would compound existing challenges in continuity of HIV care and post discharge follow-up among people with HIV (PWH), leading to higher odds of 30-day hospital readmission compared to urban residence. METHODS:We used data from the Comparative Outcomes and Service Utilization Trends (COAST) study to identify hospitalizations between April 2001 and March 2020. COAST includes virtually all known PWH in British Columbia. Readmissions were defined as hospitalizations occurring within 30 days of discharge. Rural, small urban, and large urban areas were defined using census-derived statistical area classification groups. We used logistic regression models with generalized estimating equations to examine the association between rurality and readmission. RESULTS:Among 7159 PWH included in our analyses, 82.3% (n = 5893) resided in large urban areas,11.8% (n = 848) in small urban areas and 5.9% (n = 418) in rural areas. Living in a small urban area was associated with lower odds of readmission compared with large urban areas [adjusted odds ratio (aOR) = 0.83; 95% confidence interval (CI): 0.72-0.95]. No significant difference in the odds of readmission was observed between large urban and rural areas (aOR = 1.02; 95% CI: 0.86-1.22). CONCLUSION:Small urban residence was associated with lower odds of 30-day hospital readmission among PWH compared with large urban residence, whereas rural residence was not. Further research is needed to identify the healthcare and social factors underlying these geographic differences.

Introduction The Comparative Outcomes and Service Utilization Trends (COAST) study compares health outcomes among People With HIV (PWH) and People Without HIV (PWoH) in British Columbia (BC), Canada. The cohort was recently updated to include persons diagnosed with HIV after March 31, 2013, and expanded to broaden research applications. Methods COAST includes PWH and a 10% random sample of the general population without HIV, all aged ≥19. Our study links an HIV registry to healthcare practitioner billing, hospital and emergency department attendance data, prescription drug dispensations, and a cancer registry. Our cohort update included new sampling strategies, adding data on emergency department visits not previously captured, and extending our follow-up period to 28 years (from 1992 to 2020). COAST now includes 17,119 PWH and 615,264 PWoH. Findings to date COAST has contributed to our understanding of combination antiretroviral therapy (ART) use, health service utilization, chronic diseases, mental health and substance use disorders, and mortality among PWH in BC. Key findings include earlier age at diagnosis of certain chronic conditions, a higher incidence of mood disorders among PWH, and noteworthy shifts in causes of death among PWH on ART. The updated cohort will provide insights into the changing nature of the population living with HIV in BC and serves as a novel foundation for further research. Future plans To explore and extend knowledge of the evolving trends among people living and aging with HIV in BC, regular data linkage updates and the inclusion of additional datasets are scheduled every two years.

Maintaining a suppressed HIV plasma viral load (pVL) is critical to the optimal management of people living with HIV (PLWH), and to prevent HIV transmission. We examined trends and determinants of unsuppressed pVL among PLWH from April 2005 to March 2020 in British Columbia (BC), Canada by HIV exposure groups. We analyzed data from all PLWH in BC identified in a provincial database linking testing, treatment, laboratory, pharmacy and administrative health data. For each year, individuals were classified as having an unsuppressed pVL if they were newly diagnosed, had any pVL ≥ 200 copies/mL test result, or had no pVL measurement. We used univariate generalized estimating equations (GEE) to examine trends over time and multivariate GEE modelling to examine factors associated with unsuppressed pVL. PLWH in BC increased from 5712 in 2005 to 8012 in 2020, and the proportion of those with pVL ≥ 200 copies/mL decreased from 66.4

BACKGROUND/METHODS:Treatment guidelines recommend genotypic HIV drug resistance testing (DRT) at virologic failure, typically for plasma viral loads (pVL) > 1000 HIV RNA c/mL. In some settings, DRT can be performed on low viral load (LVL) samples (pVL of 50-250 c/mL); however, such testing is resource-intensive and its clinical benefit is unclear. Therefore, we investigated the frequency and factors associated with emergent resistance in LVL samples using a comprehensive, provincial database of HIV Protease-Reverse Transcriptase and Integrase sequences. RESULTS:A total of 43,979 Protease-RT DRTs were performed in British Columbia between 1999 and 2022, of which 2970 (6.8 %) were on LVL samples. Testing was successful for 1575 (53.0 %) LVL samples compared to 81.4 % and 94.4 % of samples with pVL 250-999 and pVL ≥ 1000 c/mL, respectively (p < 0.001). Compared to prior genotypes collected from samples with pVL > 250 c/mL, a total of 104 (7.3 %) cases of new or evolving drug resistance were identified from 1423 LVL DRTs. Of these, 49.5 %, 42.9 % and 22.9 % exhibited new Nucleoside Reverse Transcriptase, Non-Nucleoside Reverse Transcriptase and Protease resistance, respectively. Of 9309 Integrase DRTs performed between 2008 and 2022, only 4 (1.2 %) cases of new or evolving integrase resistance were observed. Multivariable analyses identified clinical/sociodemographic factors significantly associated with emergent resistance, including time elapsed between DRTs, historic cumulative resistance and NNRTI-based antiretroviral therapy. CONCLUSIONS:Emergent or evolving resistance is identified infrequently in low viral load specimens. Given its resource-intensive nature, resistance testing of low viral load specimens may not be generally warranted.

People living with HIV (PLWH) in Canada experience high rates of interpersonal violence which may lead to adverse health outcomes that require hospitalization. Using self-reported data on experiences of violence linked to administrative health data on hospitalizations, we used Poisson regression modelling to examine and compare the associations between experiences of violence (recent [in the past 6 months], non-recent [>6 months ago], or none) and hospitalization rates, among a sample of PLWH in British Columbia, Canada. Of 984 PLWH included in this study, 60.0% reported experiencing non-recent violence, and 14.8% experienced recent violence. Those who experienced non-recent violence had a higher rate of hospitalization than those who never experienced violence (adjusted Rate Ratio [aRR]: 1.41; 95% Confidence Interval [CI]: 1.05-1.87). There was no difference in hospitalization rates between those who experienced recent violence and those who never did (aRR: 1.08; 95% CI: 0.74-1.60). PLWH who experienced recent violence had the highest proportion of hospitalizations attributed to mental, behavioural, or neurodevelopmental disorders. Efforts are needed to provide violence-aware care that recognizes violence and its impacts on PLWH experiencing multiple sociostructural inequities. Further studies should evaluate the impacts of violence on other types of healthcare utilization in generalizable samples of PLWH in Canada.

OBJECTIVE:People living with HIV (PLWH) are disproportionately affected by substance use disorder (SUD) and mood/anxiety disorders, which are barriers to sustained viral suppression and can contribute to increased healthcare utilisations. This study examined the impact of SUD and mood/anxiety disorders on healthcare utilisation of PLWH with sustained and unsustained viral suppression. DESIGN AND PARTICIPANTS:This retrospective population-based cohort study used administrative data from 9757 antiretroviral-treated PLWH (83% men, median age 40 years). Eligible PLWH were≥19 years of age, followed during 2001-2019, and achieved viral suppression at least once during follow-up. SETTING:This study was conducted in British Columbia, Canada. MEASUREMENTS:The exposure variable consisted of eight levels and included (1) sustained suppression, (2) SUD and mood/anxiety disorder diagnoses and the interaction between (1) and (2). Outcome variables included annual counts of primary care and specialist physician visits, laboratory visits, acute care hospitalisation, day surgery episodes and hospital length of stay (LOS). Statistical count models were used to determine the effect of exposure variables on each healthcare utilisation outcome while adjusting for socioeconomic confounders. RESULTS:In the presence of sustained suppression, having both disorders was significantly associated with over four times more acute-care hospitalisations (0.28 vs 0.05), three times longer LOS (9.1 vs 3.0 days) and almost double primary care physician (13.1 vs 6.9) and specialist (7.9 vs 4.0) visits. Overall, SUD alone was associated with increased use of all healthcare services (except day surgery). Regardless of disorder diagnoses, unsustained suppression was associated with higher healthcare utilisation (except day surgery). CONCLUSION:In this study, SUD, mood/anxiety disorders and unsustained suppression, when combined, resulted in the highest healthcare utilisation among PLWH. The results suggest that providing comprehensive mental health and substance use services to PLWH and addressing barriers to sustained suppression could reduce the healthcare burden within this population.

People living with HIV (PLWH) are disproportionately affected by mood, anxiety, and substance use disorders that prevent their sustained engagement with HIV care. Comprehensive research on the impact of these disorders on the HIV continuum of care is lacking. This study aimed to assess the impact of the syndemic between substance use disorder (SUD) and mood/anxiety disorders on the HIV continuum of care for PLWH in British Columbia (BC), Canada, and identify the stage with the highest attrition in the continuum. This retrospective population-based cohort study utilized data from the Comparative Outcomes And Service Utilization Trends (COAST) study that contains data on all diagnosed PLWH in BC. Eligible individuals were ≥ 19 years of age and were followed during 2001–2019. Our exposure variable was SUD or mood/anxiety disorder diagnoses. Our outcomes were the achievement of the following stages of the HIV continuum of care: (1) antiretroviral therapy (ART) initiation, (2) on-ART, (3) ART adherence, (4) viral suppression, and (5) maintained suppression. We estimated attrition by estimating the proportion of PLWH who proceed to each stage. Generalized linear mixed-effect models assessed the association between SUD and mood/anxiety disorders and the achievement of each stage while controlling for sociodemographic and HIV-related confounders. For the 14,398 eligible PLWH, maintained suppression exhibited the highest attrition. Having SUD or both SUD and mood/anxiety disorder were significantly associated with reduced odds of achieving all stages of the HIV continuum of care except on-ART. SUD had the strongest association with reduced odds of ART adherence (adjusted odds ratio (aOR) 0.47; 95

Background: Although sexual activity and function decline in older women living with HIV, positive dimensions of sexual health, such as satisfaction, are relatively unexplored. We evaluated the prevalence of sexual satisfaction for midlife women with HIV and assessed its relation to women's physical, mental, and sociostructural experiences. Setting: We studied women in the Canadian HIV Women's Sexual and Reproductive Health Cohort Study (CHIWOS) over 3 survey waves (2013–2018). Methods: We included women living with HIV aged ≥45 years who reported ever having consensual sex. Sexual satisfaction was assessed using an item from the Sexual Satisfaction Scale for Women and was dichotomized into satisfactory (“completely/very/reasonably satisfactory”) and not satisfactory (“not very/not at all satisfactory”). Probable depression was based on CES-D ≥10. Multivariable logistic regression and fixed effects models determined correlates of sexual satisfaction. Reasons for sexual inactivity and alternate forms of sexual expression were also explored. Results: Among 508 midlife women, 61% were satisfied with their sexual lives at baseline. Women with probable depression had lower odds of sexual satisfaction than those without (aOR: 0.44; 95% CI: 0.27 to 0.71) and worsening depressive symptoms over time were associated with poorer sexual satisfaction ( P = 0.001). Increased sexual activity was associated with higher sexual satisfaction (aOR: 2.75; 95% CI: 1.54 to 4.91); however, 51% of women reporting sexual satisfaction were sexually inactive. Sexually inactive women engaged in alternate forms of sexual expression such as self-pleasure (37%) and intimate relationships without sex (13%). Conclusion: Midlife women with HIV have high rates of sexual satisfaction, even in the absence of sexual activity. Depressive symptoms were closely associated with sexual dissatisfaction, alerting providers to the importance of screening for depression and sexual health together.

OBJECTIVE:There has been interest in a possible negative association between HIV and multiple sclerosis (MS). We aimed to compare the risk of MS in a cohort of individuals living with HIV to that in the general population. METHODS:Population-based health data were accessed for 2 cohorts of HIV-positive persons from Sweden and British Columbia, Canada. Incident MS was identified using MS registries or a validated algorithm applied to administrative data. Individuals with HIV were followed from 1 year after the first clinical evidence of HIV or the first date of complete administrative health data (Canada = April 1, 1992 and Sweden = January 1, 2001) until the earliest of incident MS, emigration, death, or study end (Canada = March 31, 2020 and Sweden = December 31, 2018). The observed MS incidence rate in the HIV-positive cohort was compared to the expected age-, sex-, calendar year-, income-specific, and region of birth-specific rates in a randomly selected sample of >20% of each general population. The standardized incidence ratio (SIR) for MS following the first antiretroviral therapy exposure ("ART-exposed") was also calculated. RESULTS:The combined Sweden-Canada cohort included 29,163 (75% men) HIV-positive persons. During 242,248 person-years of follow-up, 14 incident MS cases were observed in the HIV-positive cohort, whereas 26.19 cases were expected. The SIR for MS in the HIV-positive population was 0.53 (95% confidence interval [CI] = 0.32-0.90). The SIR for MS following the first ART exposure was 0.55 (95% CI = 0.31-0.96). INTERPRETATION:This international population-based study demonstrated a lower risk of MS among HIV-positive individuals, and HIV-positive ART-exposed individuals. These findings provide support for further exploration into the relationship among HIV, ART, and MS. ANN NEUROL 2024;95:487-494.

Objectives: People living with human immunodeficiency virus in Canada can face criminal charges for human immunodeficiency virus non-disclosure before sex, unless a condom is used and their viral load is <1500 copies/mL. We measured the reported impact of human immunodeficiency virus non-disclosure case law on violence from sexual partners among women living with human immunodeficiency virus in Canada. Methods: We used cross-sectional survey data from wave 3 participant visits (2017–2018) within Canadian HIV Women’s Sexual and Reproductive Health Cohort Study; a longitudinal, community-based cohort of women living with human immunodeficiency virus in British Columbia, Ontario and Quebec. Our primary outcome was derived from response to the statement: ‘[HIV non-disclosure case law has] increased my experiences of verbal/physical/sexual violence from sexual partners’. Participants responding ‘strongly agree/agree’ were deemed to have experienced increased violence due to the law. Participants responding ‘not applicable’ (i.e. those without sexual partners) were excluded. Multivariate logistic regression identified factors independently associated with increased violence from sexual partners due to human immunodeficiency virus non-disclosure case law. Results: We included 619/937 wave 3 participants. Median age was 46 (interquartile range: 39–53) and 86% had experienced verbal/physical/sexual violence in adulthood. Due to concerns about human immunodeficiency virus non-disclosure case law, 37% had chosen not to have sex with a new partner, and 20% had disclosed their human immunodeficiency virus status to sexual partners before a witness. A total of 21% self-reported that human immunodeficiency virus non-disclosure case law had increased their experiences of verbal/physical/sexual violence from sexual partners. In adjusted analyses, women reporting non-White ethnicity (Indigenous; African/Caribbean/Black; Other), unstable housing and high human immunodeficiency virus–related stigma had significantly higher odds of reporting increased violence from sexual partners due to human immunodeficiency virus non-disclosure case law. Conclusion: Findings bolster concerns that human immunodeficiency virus criminalization is a structural driver of intimate partner violence, compromising sexual rights of women living with human immunodeficiency virus. Human immunodeficiency virus non-disclosure case law intersects with other oppressions to regulate women’s sexual lives.

Objectives: We assessed the prevalence and correlates of sexual concerns and associated distress among women living with HIV in Canada. Methods: We analyzed cross-sectional survey data from the Canadian HIV Women’s Sexual and Reproductive Health Cohort Study (2017–2018). Self-identified women living with HIV were asked about sexual concerns post-HIV diagnosis and associated distress (none, mild, moderate, severe). Five areas of concern were assessed, including difficulties related to sexual self-esteem, sexual function, relationships, and emotional and behavioral aspects of sex. Logistic regression analyses identified correlates of reporting any sexual concerns and severe distress about these concerns. Results: Of 906 participants (median age 48, Q1–Q3 = 41–55), 596 (65.8%) reported sexual concerns post-HIV diagnosis. We found a high prevalence of concerns related to relationships (43.3%), sexual self-esteem (49.4%), and emotional aspects of sex (45.4%), relative to sexual functioning (38.4%) and behavioral aspects (33.7%). Of those with sexual concerns, 36.7% reported severe distress. Reports of severe distress were the highest for relationship difficulties (32.5%), relative to other areas of concern (21.4%–22.8%). In adjusted analyses, women reporting sexual dissatisfaction and high HIV-related stigma had significantly higher odds of reporting sexual concerns. Conversely, those reporting higher resilience, better mental health, African, Caribbean, and Black identity, and sex as somewhat unimportant, not at all important, or neutral to their lives had lower adjusted odds. Factors associated with severe distress about sexual concerns included older age, body dissatisfaction, sexual dissatisfaction, and high HIV-related stigma, while better mental health and getting support from someone living with HIV were protective. While 84.4% of women had discussed with a provider how viral load impacts transmission risk, only 40.6% had conversations about sexual wellbeing. Conclusion: More attention to women’s sexual wellbeing within social and relational contexts is critical to ensure the sexual rights of women living with HIV are upheld.

Background: In 2016, the British Columbia HIV/AIDS Drug Treatment Program modified its prescriber alert system for antiretroviral therapy (ART) interruptions to include referrals to regional public health nursing teams for direct outreach support for those who remain off treatment for 4 months or longer. We evaluated clinically relevant outcomes of this Re-Engagement and Engagement in Treatment for Antiretroviral Interrupted and Naïve populations (RETAIN) initiative, in comparison to previous time-periods. Methods: We analyzed ART interruptions triggering alerts in pre-RETAIN (July 2013-April 2016) and post-RETAIN periods (May 2016–October 2017) with follow-up continuing until October 2018. We compared the proportions of those who restarted ART and achieved viral suppression in pre-RETAIN and post-RETAIN periods and the time to ART restart using generalized estimating equations. Cox proportional hazards modelling was used to examine associations with time-to-ART-restart. Results: A total of 1805 individuals experienced ART interruptions triggering 3219 alerts; 2050 in pre-RETAIN and 1169 in post-RETAIN periods. Participants were predominantly men (74%) and had a median duration of ART of 5 years. Among persons who remained interrupted >4 months after an ART interruption alert was sent, the median time from interruption to ART re-initiation declined from 8.7 months to 7.4 months (P < 0.001) from pre-to post-RETAIN periods. Interruptions in the post-RETAIN era were associated with an increased hazard of restarting ART (adjusted hazard ratio 1.51; 95% CI: 1.34 to 1.69). Conclusions: Public health referrals shortened the length of ART interruptions after alerts sent to prescribers had not resulted in re-engagement. Similar programs should be considered in other jurisdictions.

Background: Sexual relationship power (SRP) inequities, including having a controlling partner, have not been widely examined among women living with HIV (WLWH). We measured the prevalence and key outcomes of relationship control among WLWH in Canada. Methods: Baseline data from WLWH (≥16 years), reporting consensual sex in the last month enrolled in a Canadian community-collaborative cohort study in British Columbia, Ontario, and Quebec, included the relationship control SRP subscale by Pulerwitz (2000). Scale scores were dichotomized into medium/low (score = 1–2.82) vs. high relationship control (score = 2.82–4), and high scores indicate greater SRP equity. Cronbach's alpha assessed scale reliability. Bivariate analyses compared women with high vs. medium/low relationship control. Crude and adjusted multinomial regression examined associations between relationship control and condom use [consistent (ref), inconsistent, or never]; any sexual, physical, and/or emotional violence; and physical and/or sexual violence [never (ref), recent (≤3 months ago), and previous (>3 months ago)]. Results: Overall, 473 sexually active WLWH (33% of cohort), median age = 39 (IQR = 33–46) years, 81% on antiretroviral therapy, and 78% with viral loads <50 copies/mL were included. The subscale demonstrated good reliability (Cronbach's alpha = 0.92). WLWH with high relationship control (80%) were more likely (P < 0.05) to be in a relationship, have no children, have greater resilience, and report less sociostructural inequities. In adjusted models, high relationship control was associated with lower odds of inconsistent vs. consistent condom use [adjusted odds ratio (aOR): 0.39 (95% confidence interval: 0.18 to 0.85)], any recent violence [aOR: 0.14 (0.04–0.47)] as well as recent physical and/or sexual [aOR : 0.05 (0.02–0.17)] but not previous violence (vs. never). Discussion: Prioritizing relationship equity and support for WLWH is critical for addressing violence and promoting positive health outcomes.

Using baseline data from a community-collaborative cohort of women living with HIV in Canada, we assessed the prevalence and correlates of help-seeking among 1,057 women who reported experiencing violence in adulthood (≥16 years). After violence, 447 (42%) sought help, while 610 (58%) did not. Frequently accessed supports included health care providers (n = 313, 70%), family/friends (n = 244, 55%), and non-HIV community organizations (n = 235, 53%). All accessed supports were perceived as helpful. Independent correlates of help-seeking included reporting a previous mental health diagnosis, a history of injection drug use, experiencing childhood violence, and experiencing sexism. We discuss considerations for better supporting women who experience violence.

Objectives Innovative methods are needed for identification of transgender people in administrative records for health research purposes. This study investigated the feasibility of using transgender-specific healthcare utilisation in a Canadian population-based health records database to develop a computable phenotype (CP) and identify the proportion of transgender people within the HIV-positive population as a public health priority.Design The Comparative Outcomes and Service Utilization Trends (COAST) Study cohort comprises a data linkage between two provincial data sources: The British Columbia (BC) Centre for Excellence in HIV/AIDS Drug Treatment Program, which coordinates HIV treatment dispensation across BC and Population Data BC, a provincial data repository holding individual, longitudinal data for all BC residents (1996–2013).Setting British Columbia, Canada.Participants COAST participants include 13 907 BC residents living with HIV (≥19 years of age) and a 10% random sample comparison group of the HIV-negative general population (514 952 individuals).Primary and secondary outcome measures Healthcare records were used to identify transgender people via a CP algorithm (diagnosis codes+androgen blocker/hormone prescriptions), to examine related diagnoses and prescription concordance and to validate the CP using an independent provider-reported transgender status measure. Demographics and chronic illness burden were also characterised for the transgender sample.Results The best-performing CP identified 137 HIV-negative and 51 HIV-positive transgender people (total 188). In validity analyses, the best-performing CP had low sensitivity (27.5%, 95% CI: 17.8% to 39.8%), high specificity (99.8%, 95% CI: 99.6% to 99.8%), low agreement using Kappa statistics (0.3, 95% CI: 0.2 to 0.5) and moderate positive predictive value (43.2%, 95% CI: 28.7% to 58.9%). There was high concordance between exogenous sex hormone use and transgender-specific diagnoses.Conclusions The development of a validated CP opens up new opportunities for identifying transgender people for inclusion in population-based health research using administrative health data, and offers the potential for much-needed and heretofore unavailable evidence on health status, including HIV status, and the healthcare use and needs of transgender people.

Introduction People living with HIV (PLHIV) are increasingly at risk of age-related comorbidities such as diabetes mellitus (DM). While DM is associated with elevated mortality and morbidity, understanding of DM among PLHIV is limited. We assessed the incidence of DM among people living with and without HIV in British Columbia (BC), Canada, during 2001–2013.Methods We used longitudinal data from a population-based cohort study linking clinical data and administrative health data. We included PLHIV who were antiretroviral therapy (ART) naïve at baseline, and 1:5 age-sex-matched persons without HIV. All participants had ≥5 years of historic data pre-baseline and ≥1 year(s) of follow-up. DM was identified using the BC Ministry of Health’s definitions applied to hospitalisation, physician billing and drug dispensation datasets. Incident DM was identified using a 5-year run-in period. In addition to unadjusted incidence rates (IRs), we estimated adjusted incidence rate ratios (IRR) using Poisson regression and assessed annual trends in DM IRs per 1000 person years (PYs) between 2001 and 2013.Results A total of 129 PLHIV and 636 individuals without HIV developed DM over 17 529 PYs and 88,672 PYs, respectively. The unadjusted IRs of DM per 1000 PYs were 7.4 (95% CI 6.2 to 8.8) among PLHIV and 7.2 (95% CI 6.6 to 7.8) for individuals without HIV. After adjustment for confounding, HIV serostatus was not associated with DM incidence (adjusted IRR: 1.03, 95% CI 0.83 to 1.27). DM incidence did not increase over time among PLHIV (Kendall trend test: p=0.9369), but it increased among persons without HIV between 2001 and 2013 (p=0.0136).Conclusions After adjustment, HIV serostatus was not associated with incidence of DM, between 2001 and 2013. Future studies should investigate the impact of ART on mitigating the potential risk of DM among PLHIV.