Abstract BackgroundAcute infectious symptoms are a leading cause of pediatric emergency department visits in Canada, many of which are low acuity and could be safely managed at home. Artificial intelligence (AI) chatbots offer a promising avenue for delivering accessible, evidence-based guidance to support families in managing these symptoms. ObjectiveThis study aims to adapt and coconstruct CHAMP (CHatbot to Assist the Management of Pediatric patients), an AI chatbot to support patients and families with acute pediatric infectious symptoms. CHAMP aims to deliver timely, tailored, and validated health information to support safe at-home self-management and informed care-seeking. MethodsThis multiphase, mixed methods participatory study will be conducted at the Montreal Children’s Hospital in Montreal, Quebec, Canada. A coconstruction committee comprised of youth, parents, caregivers, and partners will be engaged as coresearchers. Eligible participants will include (1) youth aged 14‐17 years and (2) parents and caregivers of children aged 0‐17 years. The study comprises 5 phases. Phase 1 involves a qualitative needs assessment using focus groups with 20 participants to explore their informational needs, preferences, and concerns regarding pediatric infections and the use of AI chatbots. Phase 2 focuses on coconstructing and validating CHAMP’s knowledge database through 3‐5 workshops. Coresearchers will review pediatric clinical guidelines, map care questions and decision-making processes, and shape CHAMP’s conversational framework. Phase 3 consists of iterative prototyping and testing through 3‐5 workshops. Coresearchers will engage in prototyping and scenario testing, alongside preliminary usability and acceptability assessments. Phase 4 examines equity and accessibility through focus groups with 20 participants at risk of digital exclusion, as well as multilingual evaluation of an automated large language model–based translation layer. Phase 5 uses collaborative ethnography to explore the process of participatory coconstruction and its impact on CHAMP’s design. ResultsFunding was secured in 2024, and Research Ethics Board approval was obtained in December 2024. As of December 2025, the coconstruction committee is being assembled, and Phase 1 recruitment is underway. ConclusionsThis study will produce a functioning CHAMP prototype grounded in participatory, equitable, and responsible pediatric AI development. Findings will inform usability testing and an implementation-effectiveness evaluation, contributing to best practices for pediatric-centered AI health tools. By providing timely, tailored, and validated health information on acute infections, CHAMP may support safe at-home self-management, reduce preventable emergency department visits, ensure at-risk children are directed to appropriate care, and improve patient and family health care experiences.

Adherence to antiretroviral therapy (ART) is a priority in HIV care. Our goal was to develop and validate a new, short patient-reported outcome measure to screen for barriers to daily oral ART adherence in HIV care in Canada and France. The overarching design was that of a multi-phase, multi-site instrument development project. It involved a previously published qualitative research synthesis (to develop a conceptual framework from which to generate items). Here, we present the results of cognitive interviews (for content validity testing of the preliminary items) and of a longitudinal survey-based study where the revised 7-item instrument (the I-Score) was administered at two timepoints (baseline, 4 weeks), along with five indirect measures of ART adherence, including self-reported HIV viral load and, for a subset of Montreal participants, plasma viral load. The survey data was used to analyze the instrument's measurement properties, namely structural validity (e.g., with Pearson inter-item correlations); construct validity, including cross-cultural validity, for a variety of sociodemographic groups (with receiver operating curve (ROC) analyses and areas under the curve (AUC); reliability (with the intraclass correlation coefficient (ICC)); and measurement error (with the standard error of measurement (SEM)). Study participants were adults living with HIV on antiretroviral therapy recruited from hospital-based infectious disease centers and community-based organizations in Montreal, Toronto, and Paris. The qualitative synthesis of 41 studies led to a framework composed of 6 barrier domains. One item was generated per domain. The 6-item measure was submitted to cognitive testing with 12 adults living with HIV, leading to several changes, including the division of one item into two, creating a 7-item measure. Overall, 305 adults living with HIV participated in the survey. Inter-item correlations were low to moderate, suggesting no redundant items. Among conclusive results, AUC's were all above the predefined threshold (≥ 0.70) for self-reported viral load and plasma viral load for the global sample and across all subgroups examined. The ICC, at 0.81, was also above the predefined threshold (≥ 0.70). The SEM was 0.43. Overall, the evidence generated supports the 7-item I-Score measure's content validity, construct validity/cross-cultural validity, reliability, and acceptable measurement error, in its specified context of use.

OBJECTIVES:Migrants are disproportionately affected by HIV and face inequities in accessing care. This study examined the HIV care cascade among newly registered adults at the Chronic Viral Illness Service (CVIS). METHODS:We conducted a retrospective cohort study of adults (≥18 years) living with HIV and newly registered at the CVIS, in Montréal, Canada, between January 1st, 2022, and December 31st, 2024. Sociodemographic, clinical and care cascade data were extracted from electronic records. Multivariable logistic regression models, adjusted for age, gender, region of birth and diagnosis type, examined associations between seven migration status categories and cascade outcomes. RESULTS:Among 695 patients, 664 (95%) were born outside Canada and 528 (76%) were refugees/asylum seekers. Of these, 281/695 (40%) had a new HIV diagnosis. Among newly diagnosed refugees/asylum seekers, median time from diagnosis to linkage to care was 28 days (interquartile range [IQR]: 18-42). Median time from linkage to antiretroviral therapy (ART) prescription ranged from 0 (IQR: 0-0) to 18 (IQR: 9-27) days across groups. At 6 months, 618/695 (89%) were retained in care and 603/618 (98%) were on ART. At 12 months, 530/603 (88%) were in care and 511/530 (96%) were virally suppressed. In exploratory adjusted analyses, Canadian citizens had lower odds of retention (aOR 0.32, 95% CI 0.14-0.75) and viral suppression (aOR 0.33, 95% CI 0.15-0.75) at 12 months. CONCLUSIONS:Among newly diagnosed refugees/asylum seekers, linkage to care delays appear to have increased since pre-pandemic estimates. Meaningful heterogeneity across migration groups highlights the limitations of treating migrants as a homogeneous population in HIV care.

OBJECTIVES:Material deprivation (MD), the inability to afford essentials, is linked with poorer HIV clinical outcomes. In Canada, migrants living with HIV are a growing group, yet little is known about their experience of MD, especially early in treatment. This study examined the prevalence, nature, sociodemographic and clinical correlates and longitudinal changes in MD among migrants living with HIV initiating antiretroviral therapy (ART). METHODS:Analyses used data from 56 ART-naïve migrants enrolled in the Antiretroviral Speed Access Program (ASAP), a cohort at the McGill University Health Centre, Montreal, Canada receiving access to rapid, no-cost and onsite bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF). MD was assessed at Weeks 4 and 48 using the 17-item Canadian Material Deprivation Index (CMDI), with deprivation defined as checking ≥2 items. Statistical tests included Fisher's exact, Wilcoxon signed-rank, McNemar's exact and correlation coefficients. RESULTS:At Week 4, 48 (85.7%) participants were materially deprived, most commonly reporting inability to cover an unexpected expense (87.5%), afford dental care (73.2%) or buy small gifts (73.2%). Week 4 MD was significantly associated with occupation (p = 0.020) and migration status (p = 0.016). No statistically significant associations were observed between MD and HIV clinical outcomes. Between Weeks 4 and 48, MD scores declined significantly (median: 7.5 to 4.0; p < 0.001), although 67.9% of participants remained deprived. CONCLUSIONS:Associated with occupation and migrant status, MD was highly prevalent and persistent among migrants living with HIV, despite partial improvement over time, underscoring the need for structural supports. Short-term HIV clinical outcomes appeared unaffected, which may reflect access to rapid, no-cost and onsite ART delivery.

Introduction There is international interest in using patient-reported outcome measures in HIV care to improve the well-being of people with HIV, but the prioritisation of specific outcomes and measures remains unclear. This project’s objective is to engage both people with HIV and healthcare, social and community service providers to develop a French and English-language core set of patient-reported outcomes and measures for use in HIV care at the patient level in Montreal (Canada).Methods and analysis This multimethod project will follow guidance from the Core Outcome Measures in Effectiveness Trials Initiative and involve two phases. Phase 1 will see the selection of the core set of outcomes (ie, the health concepts to target) and include a rapid scoping review to inform a Delphi study with a panel of 50 people with HIV and providers in Montreal. It will end with a multidisciplinary consensus meeting to make final decisions on the outcomes. Phase 2 will be devoted to choosing the measures to assess the selected outcomes. It will include a systematic search for instruments, an appraisal of the quality and feasibility of the identified instruments and a consensus meeting for the final selection.Ethics and dissemination Research ethics board (REB) approval was obtained on 9 December 2024, from the institutional REB of the Research Institute of the McGill University Health Centre (reference number: 2024-9695). Findings will primarily be disseminated to (1) healthcare and social service providers through academic rounds and a provincial continuing education programme for HIV clinicians; (2) to people with HIV through partner community organisations and (3) a range of stakeholders at local, national and international conferences and through peer-reviewed publications.

Uses of large language models (LLMs) in health chatbots are expanding into high-stakes clinical contexts, heightening the need for tools that are evidence-based, accountable, accurate, and patient-centred. This conceptual, practice-informed Perspective reflects on engaging patients and non-academic partners for the responsible integration of LLMs, grounded in the co-construction of MARVIN (for people living with HIV) and in an emerging collaboration with MIT Critical Data. Organised by the Software Development Life Cycle, we describe: conception/needs assessment with patient partners to identify use cases, acceptable trade-offs, and privacy expectations; development that prioritises grounding via vetted sources, structured human feedback, and data-validation committees including patient partners; testing and evaluation using patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) chosen in collaboration with patients to capture usability, acceptability, trust, and perceived safety, alongside task performance and harmful-output monitoring; and implementation via diverse governance boards, knowledge-mobilisation materials to set expectations, and risk-management pathways for potentially unsafe outputs. Based on our experience with MARVIN, we recommend early and continuous engagement of patients and non-academic partners, fair compensation, shared decision-making power, transparent decision logging, and inclusive, adaptable governance that can evolve with changing models and standards. These lessons highlight how patient partnership can directly shape chatbot design and oversight, helping teams align LLM-enabled tools with patient-centred goals while building accountable, safe, and equitable systems. Health chatbots powered by large language models (LLMs) can make medical information more accessible, but most are developed without meaningful input from the people who will use them. This risks unsafe answers, hidden bias, and tools that mainly work for privileged groups. Our team built a chatbot called MARVIN to support people living with HIV, and we are now adapting it for cancer care and children’s health. Patients, caregivers, and community partners shaped what MARVIN should do, chose which sources it should trust, and tested early versions. Their feedback led to concrete improvements including clearer language, more relevant features, and safeguards against misinformation. We are also partnering with MIT Critical Data, which brings patients, members of the public, clinicians, engineers, and policymakers together at events to find and fix bias in medical AI. We have learned that technical fixes alone are not enough: trust, fairness, and accountability require active involvement of diverse users at every stage. Based on these lessons, we recommend: (1) including patients and non-academic partners from the start so their insights can shape core design decisions; (2) compensating them fairly so participation is sustainable; (3) giving them real decision-making power so their input is not tokenistic; and (4) being transparent about the limits of AI so expectations are realistic. In our experience, responsible health AI depends on the lived expertise of the people it serves.

Emotional distress is prevalent among cancer patients undergoing systemic therapy, yet it remains significantly underreported and undertreated due to limited clinical time, stigma, and inadequate detection tools. MARVINA is an AI-powered chatbot designed to facilitate symptom management for breast cancer patients. We aim to incorporate psychosocial risk detection features into the chatbot to help identify patients in need of additional psychosocial support or intervention, and to deliver tailored resources accordingly. To explore this functionality, we developed a module to perform emotional tone classification of patient text input. We cleaned an annotated corpus of 3,750 messages drawn from a Mendeley dataset of patient and caregiver posts across five cancer types (brain, colon, liver, leukemia, lung), sourced from Reddit, DailyStrength, and HealthBoards. We categorized posts with a four-item emotional tone scale: very negative (n=1,000), negative (n=1,000), neutral (n=1,000), and positive (n=750). Using a 70/15/15 training/validation/testing split, we fine-tuned a pre-trained DistillBERT classification model—originally trained on a five-item scale (very negative to very positive)—while applying class weights to address label imbalance. To simulate the informal structure of real-world conversations and deepen comprehension, we expanded the model’s vocabulary to include emojis, newlines, emails, URL links, and resized the embedding layer accordingly. Recall, precision, accuracy, and a confidence score—derived from the softmax output of the model’s final layer—were computed for each prediction. Evaluations suggest strong model performance in distinguishing emotional tone, with particularly high precision for very negative content and high recall for neutral content. Metrics for very negative (89%/86%), negative (79%/86%), neutral (91%/84%), and positive (82%/85%) are presented in (precision/recall) format. The model attained an overall accuracy of 85% across all classes. For example, the input “I’m feeling much better today after the treatment 😊. Hope everything will go well in the future!” was classified as positive with 90% confidence. The input, “I'm exhausted. The chemo is unbearable, and every day feels worse than the last. I’ve lost my hair, my strength, and honestly, my hope.” was classified as very negative with 83% confidence. Our module represents an innovative step toward leveraging AI for emotional tone classification in oncology care, laying the groundwork for enhanced mental health monitoring and risk detection within chatbots, while supporting patient self-management in cancer care. Future directions include exploring psychosocial risk evaluation by implementing tailored chatbot responses and automated alerts to care teams in response to very negative or recurrently negative inputs. Conversely, messages that promote resilience and self-efficacy could be used to reinforce a positive tone. Nissim Maxim. Frija-Gruman, Sebastian Villanueva, Yuanchao Ma, Esli Osmanlliu, Sylvie Lambert, Marie-Pascale Pomey, Tarek Hallal, David Lessard, Kim Engler, Jia Lin, Jamil Asselah, Bertrand Lebouché. Emotional tone classification as a tool for psychosocial risk detection in oncology: An AI-powered chatbot [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Artificial Intelligence and Machine Learning; 2025 Jul 10-12; Montreal, QC, Canada. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(13_Suppl):Abstract nr B013.

For people living with HIV (PLHIV), patient portals could facilitate access to personal health records while promoting self-management and retention in care. Given the apparent heterogeneity in the studied factors influencing portal use among PLHIV and the metrics used in research, we conducted a rapid scoping review to inventory them. Two databases were searched (Medline and Embase on the Ovid platform) from conception until 15 September 2023. Two reviewers screened all records and full texts. Studies published in English, employing quantitative methods, including a portal usage metric, and involving PLHIV were included. Influencing factors and metrics were classified based on categorizations generated from previous relevant reviews. From 1421 records, 188 full-text studies were assessed, and 18 were included. Published between 2010 and 2022 and mostly from the USA (94%), these studies identified 35 portal usage metrics in five categories (e.g., patient use/adoption, frequency, duration). Similarly, 35 influencing factors were identified, mainly health-related (e.g., HIV viral load) or demographic (e.g., race/ethnicity). This review confirmed the heterogeneity of metrics and influencing factors concerning patient portal use among PLHIV. Developing a conceptual framework of influencing factors and a taxonomy of use metrics could help orient and harmonize future research in this area.

BACKGROUND:Scholars recommend providing migrants living with HIV (MLWH) with free treatment, rapidly, once linked to care to optimize their HIV-related experiences and health outcomes. Quantitative evaluations of patient-reported measures for MLWH in such models are necessary to explore the viability of these recommendations. METHODS:Within a 96-week prospective cohort study at a multidisciplinary HIV clinic, participants received bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) for free and rapidly following care linkage. Eight patient-reported measures were administered at weeks 4, 24, and 48: (1) mMOS-SS to measure perceived social support; (2) IA-RSS to measure internalized stigma; (3) K6 to measure psychological distress; (4) PROMIS to measure self-efficacy with treatment taking; (5) G-MISS to measure perceived compliance with clinicians' treatment plans; (6) HIVTSQ to measure treatment satisfaction; (7) CARE to measure perceived provider empathy; and (8) PRPCC to measure perceived clinician cultural competence. Linear mixed modelling with bootstrapping was conducted to identify significant differences by sociodemographics and time. RESULTS:Across weeks 4, 24, and 48, results suggest that MLWH enrolled in this study experienced moderate levels of social support; elevated levels of HIV-related stigma; moderate levels of distress; high self-efficacy with daily medication self-management; great compliance with clinicians' treatment plans; high treatment satisfaction; high perceived empathy; and high perceived cultural competence. Experience of social support (i.e., mMOS-SS scores) differed significantly by birth region. Experience of HIV-related stigma (i.e., IA-RSS scores) differed significantly by birth region, age, and language. Experience of distress (i.e., K6 scores) differed significantly by sexual orientation. Experience of treatment satisfaction (i.e., HIVTSQ scores) differed significantly by birth region and age. No significant differences were identified by time for any measure. CONCLUSION:Overall, participants expressed positive experiences around treatment and care, alongside comparably lower perceptions of social support, internalized stigma, and distress, potentially underscoring a need to embed targeted, well-funded, and accessible mental health support within HIV care models.

Background: Pharmacists need up-to-date knowledge and decision-making support in HIV care. We aim to develop MARVIN-Pharma, an adapted artificial intelligence-based chatbot initially for people with HIV, to assist pharmacists in considering evidence-based needs. Methods: From December 2022 to December 2023, an online needs-assessment survey evaluated Québec pharmacists’ knowledge, attitudes, involvement, and barriers relative to HIV care, alongside perceptions relevant to the usability of MARVIN-Pharma. Recruitment involved convenience and snowball sampling, targeting National HIV and Hepatitis Mentoring Program affiliates. Results: Forty-one pharmacists (28 community, 13 hospital-based) across 15 Québec municipalities participated. Participants perceived their HIV knowledge as moderate (M = 3.74/6). They held largely favorable attitudes towards providing HIV care (M = 4.02/6). They reported a “little” involvement in the delivery of HIV care services (M = 2.08/5), most often ART adherence counseling, refilling, and monitoring. The most common barriers reported to HIV care delivery were a lack of time, staff resources, clinical tools, and HIV information/training, with pharmacists at least somewhat agreeing that they experienced each (M ≥ 4.00/6). On average, MARVIN-Pharma’s acceptability and compatibility were in the ‘undecided’ range (M = 4.34, M = 4.13/7, respectively), while pharmacists agreed to their self-efficacy to use online health services (M = 5.6/7). Conclusion: MARVIN-Pharma might help address pharmacists’ knowledge gaps and barriers to HIV treatment and care, but pharmacist engagement in the chatbot’s development seems vital for its future uptake and usability.

Background Chemsex, a type of sexualised drug use, is expanding among gay, bisexual, and other men who have sex with men (GBMSM), with physical and mental health risks. Health-seeking behaviours of GBMSM practising chemsex is not clear.Methods Harm reduction (HR) consultations for GBMSM engaging in chemsex and seeking comprehensive services including HR were offered in a Parisian infectious disease unit. From December 2021 to January 2022, HR consultation patients completed an online survey on their consumption, health, used services, and perspective on consultations. We generated descriptive statistics, and tested (χ2) the relationship between reporting a specialised follow-up and perceived usefulness of intervention.Results Of 172 patients, a total of 96 GBMSM (55.2%) completed the survey. Most ever consumed substance was 3-methylmethcathinone (3MMC; 92/96; 95.8%). Before consultations, about half consumed at least once a week (50/96; 52%), most reported negative impacts of chemsex on their social (60/96, 62.5%), professional (56/96, 58.3%), intimate (53/96; 55.21%), or sexual life (52/96; 54.17%). Also, more than two-thirds (n=57; 69.38%) had received a follow-up in specialised services: one-third had been followed in addictology (28/96, 29.2%) and/or psychotherapy (32/96, 33.3%), and one-fourth (24/96, 25.0%) had used emergency services. After consultations, three-quarters perceived the intervention as useful (n=74; 77.08%); we found no significant relationship with receiving a specialised follow-up; and most were satisfied with professionals' listening (90/96; 93.8%), and reported reduced risks (80/96; 83.3%).Discussion Multidisciplinary HR, preventive, diagnostical, and therapeutic sexological and psychiatric interventions are greatly needed among GBMSM practising chemsex. HR interventions accessible in services already attended by GBMSM are a valuable option.

Le chemsex est une forme d’usage de drogues sexualisé en expansion chez les GBHSH, avec des risques pour la santé physique et mentale. Cet article vise d’abord à mieux comprendre les facteurs de vulnérabilité des GBHSH, de même que les approches sexologiques possibles. Ensuite, des consultations en réduction des risques et des dommages pour les GBHSH pratiquant le chemsex ont été proposées dans une unité de maladies infectieuses parisienne. Nous avons cherché à décrire les comportements des patients. Une enquête a été réalisée auprès des patients des consultations en RdRD. Un total de 96 GBHSH ont rempli un questionnaire en ligne. La plupart rapportaient une pratique du chemsex assez fréquente et des impacts négatifs du chemsex sur leur vie sociale, professionnelle, intime ou sexuelle. La majorité était satisfaite de l’intervention et constatait une réduction du risque. De telles interventions multidisciplinaires préventives, diagnostiques et thérapeutiques en sexologie, psychologie et psychiatrie, dans les services déjà fréquentés par les GBHSH, sont efficaces et grandement nécessaires.

Abstract Purpose Strong primary health care (PHC) systems require well‐established PHC education systems to enhance the skills of general practitioners (GPs). However, the literature on the experiences of international collaboration in primary care education in low‐ and middle‐income countries remains limited. The purpose of this study was to evaluate the implementation and perceived impact of the McGill‐Tongji Blended Education Program for Teacher Leaders in General Practice (referred to as the “Tongji Program”). Methods In 2020–2021, the McGill Department of Family Medicine (Montreal, Canada) and Tongji University School of Medicine (TUSM, Shanghai, China) jointly implemented the Tongji Program in Shanghai, China to improve the teaching capacity of PHC teachers. We conducted an exploratory longitudinal case study with a mixed methods design for the evaluation. Quantitative (QUAN) data was collected through questionnaire surveys and qualitative (QUAL) data was collected through focus group discussions. Results The evaluation showed that learners in Tongji Program were primarily female GPs (21/22，95%) with less than 4 years of experience in teaching (16/22，73%). This program was considered a successful learning experience by most participants (19/22, 86%) with higher order learning tasks such as critical thinking and problem‐solving. They also agreed that this program helped them feel more prepared to teach (21/22，95%), and developed a positive attitude toward primary care (21/22，95%). The QUAL interview revealed that both the Tongji and McGill organizers noted that TUSM showed strong leadership in organization, education, and coordination. Both students and teachers agreed that by adapting training content into contextualized delivery formats and settings, the Tongji Program successfully overcame language and technology barriers. Conclusions Committed partnerships and contextualization were key to the success of the Tongji Program. Future research should focus on how international primary care education programs affect learners' behavior in their practice settings, and explore barriers and facilitators to change.

Background Chatbots, or conversational agents, have emerged as significant tools in health care, driven by advancements in artificial intelligence and digital technology. These programs are designed to simulate human conversations, addressing various health care needs. However, no comprehensive synthesis of health care chatbots’ roles, users, benefits, and limitations is available to inform future research and application in the field. Objective This review aims to describe health care chatbots’ characteristics, focusing on their diverse roles in the health care pathway, user groups, benefits, and limitations. Methods A rapid review of published literature from 2017 to 2023 was performed with a search strategy developed in collaboration with a health sciences librarian and implemented in the MEDLINE and Embase databases. Primary research studies reporting on chatbot roles or benefits in health care were included. Two reviewers dual-screened the search results. Extracted data on chatbot roles, users, benefits, and limitations were subjected to content analysis. Results The review categorized chatbot roles into 2 themes: delivery of remote health services, including patient support, care management, education, skills building, and health behavior promotion, and provision of administrative assistance to health care providers. User groups spanned across patients with chronic conditions as well as patients with cancer; individuals focused on lifestyle improvements; and various demographic groups such as women, families, and older adults. Professionals and students in health care also emerged as significant users, alongside groups seeking mental health support, behavioral change, and educational enhancement. The benefits of health care chatbots were also classified into 2 themes: improvement of health care quality and efficiency and cost-effectiveness in health care delivery. The identified limitations encompassed ethical challenges, medicolegal and safety concerns, technical difficulties, user experience issues, and societal and economic impacts. Conclusions Health care chatbots offer a wide spectrum of applications, potentially impacting various aspects of health care. While they are promising tools for improving health care efficiency and quality, their integration into the health care system must be approached with consideration of their limitations to ensure optimal, safe, and equitable use.

OBJECTIVE:Multidisciplinary care with free, rapid, and on-site bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) dispensation may improve health outcomes among migrants living with HIV. However, models for rapid B/F/TAF initiation are not well studied among migrants living with HIV, and an understanding of how social determinants of health (SDH) may affect HIV-related health outcomes for migrants enrolled in such care models is limited. METHODS:Within a 96-week pilot feasibility prospective cohort study at a multidisciplinary HIV clinic, participants received free B/F/TAF rapidly after care linkage. The effects of SDH (i.e., birth region, sexual orientation, living status, education, employment, French proficiency, health coverage, use of a public health facility outside our clinic for free blood tests, and time in Canada) and other covariates (i.e., age, sex) on median time to antiretroviral therapy (ART) initiation and HIV viral undetectability from care linkage were calculated via survival analyses. RESULTS:Thirty-five migrants were enrolled in this study. Median time to ART initiation and HIV undetectability was 5 days (range 0-50) and 57 days (range 5-365), respectively. Those who took significantly longer to initiate ART were aged <35 years, identified as heterosexual, had less than university-level education, or were unemployed. No factor was found to significantly affect time to undetectability. CONCLUSION:Despite the provision of free B/F/TAF, several SDH were linked to delays in ART initiation. However, once initiated and engaged, migrants living with HIV reached HIV undetectability efficiently. Findings provide preliminary support for adopting this care model with migrants living with HIV and suggest that SDH should be considered when designing clinical interventions for more equitable outcomes.

INTRODUCTION:The Last Gift study at the University of California San Diego (UCSD), United States enrolls terminally ill people with HIV (PWH) in HIV cure research. METHODS:From 2017 to 2022, we conducted surveys with Last Gift participants and their next-of-kin/loved ones to evaluate willingness to participate in different types of HIV cure research at the end of life (EOL). We analyzed willingness data descriptively. RESULTS:We surveyed 17 Last Gift participants and 17 next-of-kin/loved ones. More than half of Last Gift participants ( n  = 10; 58.8%) expressed willingness to participate in studies involving totally new treatments or approaches ('first-in-human' studies), a combination of different approaches, the use of unique antibodies, proteins or molecules, or therapeutic vaccines. Under one-quarter of Last Gift participants ( n  = 4; 23.5%) expressed willingness to participate in research involving interventions that may shorten their life expectancy to benefit medical research. Most Last Gift participants and their next-of-kin/loved ones also expressed high acceptance for various types of donations and biopsies at the EOL (e.g. hair donations and skin, lymph node or gut biopsies). DISCUSSION:Knowing whether people would be willing to participate in different types of EOL HIV cure research can help inform the design of future innovative studies. As a research community, we have a duty to design studies with adequate safeguards to preserve the public trust in research and honor PWH's important gift to humanity.

BackgroundThe COVID-19 pandemic was an unprecedent challenge to public health systems, with 95% of cases in Quebec sent home for self-isolation. To ensure continuous care, we implemented an intervention supported by a patient portal (Opal) to remotely monitor at-home patients with COVID-19 via daily self-reports of symptoms, vital signs, and mental health that were reviewed by health care professionals. ObjectiveWe describe the intervention’s implementation, focusing on the (1) process; (2) outcomes, including feasibility, fidelity, acceptability, usability, and perceived response burden; and (3) barriers and facilitators encountered by stakeholders. MethodsThe implementation followed a co-design approach operationalized through patient and stakeholder engagement. The intervention included a 14-day follow-up for each patient. In the mixed methods study at the McGill University Health Centre in Montreal, Quebec, participants completed questionnaires on implementation outcomes on days 1, 7, and 14. All scores were examined against predefined success thresholds. Linear mixed models and generalized estimating equations were used to assess changes in scores over time and whether they differed by sex, age, and race. Semistructured interviews were conducted with expert patients, health care professionals, and coordinators for the qualitative analysis and submitted to thematic analysis guided by the Consolidated Framework for Implementation Research. ResultsIn total, 51 participants were enrolled between December 2020 and March 2021; 49 (96%) were included in the quantitative analysis. Observed recruitment and retention rates (51/52, 98% and 49/51, 96%) met the 75% feasibility success threshold. Over 80% of the participants found it “quite easy/very easy” to complete the daily self-report, with a completion rate (fidelity) of >75% and a nonsignificant decreasing trend over time (from 100%, 49/49 to 82%, 40/49; P=.21). Mean acceptability and usability scores at all time points exceeded the threshold of 4 out of 5. Acceptability scores increased significantly between at least 2 time points (days 1, 7, and 14: mean 4.06, SD 0.57; mean 4.26, SD 0.59; and mean 4.25, SD 0.57; P=.04). Participants aged >50 years reported significantly lower mean ease of use (usability) scores than younger participants (days 1, 7, and 14: mean 4.29, SD 0.91 vs mean 4.67, SD 0.45; mean 4.13, SD 0.89 vs mean 4.77, SD 0.35; and mean 4.24, SD 0.71 vs mean 4.72, SD 0.71; P=.004). In total, 28 stakeholders were interviewed between June and September 2021. Facilitators included a structured implementation process, a focus on stakeholders’ recommendations, the adjustability of the intervention, and the team’s emphasis on safety. However, Opal’s thorough privacy protection measures and limited acute follow-up capacities were identified as barriers, along with implementation delays due to data security–related institutional barriers. ConclusionsThe intervention attained targets across all studied implementation outcomes. Qualitative findings highlighted the importance of stakeholder engagement. Telehealth tools have potential for the remote follow-up of acute health conditions. International Registered Report Identifier (IRRID)RR2-10.2196/35760