Public Health Alert – HIV update

Situation

Prior to 2021 the Human Immunodeficiency Virus (HIV) incidence rate for the Northwestern Health Unit (NWHU) catchment area had generally been lower than that of the province of Ontario; 4.1 per 100,000 in NWHU (2013-2021) compared to 5-6 per 100,000 in Ontario (2012-2022).

NWHU incidence rates for 2022 and 2023 were 12.3 per 100,000 and 23.3 per 100,000 respectively. The incident rate in 2022 was a 10-year high for the region, and that rate nearly doubled in 2023. Although the increase in incidence rate mainly affects Kenora there is increased risk for other communities.

The main risk factors are drug use, homeless/under-housed, sharing drug use equipment, and not using condoms.

Actions for health care providers

• Educate clients on prevention
• Encourage testing when indicated
• Gather detailed information on the best way to contact the case and those exposed for all STBBIs
• Consider PrEP and PEP
• Facilitate treatment

Additional information/support for health care providers

Testing

• Point of Care (POC) testing is available at the NWHU
• NWHU can support other health care agencies in setting up point of care testing
• Visit HIV Testing Ontario for the Ontario Guidelines for Providers Offering HIV testing, including getting set up to receive POC test kits free of charge
• Further information and guidance are available in Public Health Agency of Canada’s HIV Screening and Testing Guide

Treatment

• Ontario HIV Treatment Network 
• Ontario Guidelines for Providers offering HIV Testing – HIV Testing Ontario   
• Effectiveness, uptake and delivery of non-occupational HIV post-exposure prophylaxis (PEP) – Ontario HIV Treatment Network
• HIV pre-exposure prophylaxis (PrEP) in Ontario, 2021 – The Ontario HIV Treatment Network

Pre-exposure prophylaxis (PrEP) is indicated for those who are not yet infected but have ongoing risk. Canadian guidelines on PrEP use indications include:

• People who inject drugs if they share injection drug use equipment with a person with non-negligible risk of HIV infection
• Men who have sex with men who report condomless anal sex within the last 6 months and who have:
  • Infectious syphilis
  • Recurrent use of nonoccupational postexposure prophylaxis (more than one use)
  • Ongoing sexual relationship with an HIV positive partner with risk of transmissible HIV
  • Other high risk criteria
• Heterosexual, condomless vaginal or anal sex where HIV positive partner has risk of transmissible HIV

Non-occupational post-exposure prophylaxis (PEP) is indicated for individuals in emergency situations and is not intended for regular use. PEP can be considered when there is greater than a negligible to low risk of HIV acquisition. Further detail can be found at this source.

Additional treatment resources:

• https://www.ohtn.on.ca/rapid-response-awareness-accessibility-and-uptake-of-pre-exposure-prophylaxis-among-cisgender-and-transgender-women-at-risk-of-hiv-infection/
• https://www.ohtn.on.ca/prep-for-cisgender-women-a-guide-for-healthcare-providers/

Prevention

• Harm reduction supplies including single-use needles are key, given the risk factors specific to NWHU area
• Condoms, dental dams, and substance use harm reduction supplies are available free of charge at NWHU

Contact:
Donna Stanley, RN BN CIC
Director, Health Protection
Northwestern Health Unit