HIV Monitoring
Quarterly Report

FOR BRITISH COLUMBIA

SECOND QUARTER 2019

Foreword

As part of the BC Centre for Excellence (BC-CfE) in HIV/AIDS's mandate to evaluate the outcomes of STOP HIV/AIDS programming in BC, we have developed quarterly HIV/AIDS monitoring reports. These reports provide up-to-date data on a variety of key HIV-related surveillance and treatment indicators. Selection of these indicators was achieved through a collaborative process with various Health Authority (HA) representatives. There are six reports in total, one for each HA and one for the province of BC as a whole. In addition, there is a technical report which explains how each HIV indicator is calculated. Data used in these reports come from the British Columbia Centre for Disease Control (BCCDC), MSP billings, hospitalization data from the Discharge Abstract Database, the Sunquest Laboratory database at the Provincial Public Health Microbiology and Reference Laboratory, Providence Health Care laboratory, BC Vital Statistics, and the BC-CfE Drug Treatment Program (DTP) Database. The STOP HIV/AIDS program is funded by the Province of British Columbia's Ministry of Health.

The objectives of the quarterly HIV/AIDS monitoring reports are to:

Provide timely HA-specific information on key HIV indicators which will guide and inform HIV leaders and innovators in the development of future HIV interventions and programs which will ultimately lead to decreasing the burden of HIV in BC. The indicators will reflect ongoing or past successful public health interventions and highlight areas in the HIV care spectrum which require further attention and support.
Highlight limitations in our current data due to incomplete or time lagged data and to develop future strategies to improve complete and timely data capture.

These reports are produced for the benefit of individual HA’s. As such, we are enthusiastic about your involvement and cooperation regarding the development of these monitoring reports. Please forward your comments and queries to Dr. Rolando Barrios, Senior Medical Director at the BC-CFE, at rbarrios@cfenet.ubc.ca.

List of Indicators

Indicator 1. HIV Testing Episodes Indicator 2. HIV Testing Rate Indicator 3. New HIV Diagnoses Indicator 4. Stage of HIV Infection at Diagnosis Indicator 5. HIV Cascade of Care Indicator 6. Programmatic Compliance Score (PCS) Indicator 7. New Antiretroviral Therapy Starts Indicator 8. CD4 Cell Count at ART Initiation Indicator 9. Active and Inactive Drug Treatment Program (DTP) Participants Indicator 10. Antiretroviral Adherence Indicator 11. Resistance Testing and Results Indicator 12. AIDS-Defining Illness Indicator 13. HIV-Related Mortality Appendices

Acknowledgements and Contributions BC Provincial STOP Program A Note on Monitoring and Interpreting HIV Indicators

Indicator 1 HIV Testing Episodes All HIV Testing Episodes reflect non-prenatal tests. All prenatal tests have been removed. Figure 1.1 HIV Test Episodes for BC, 2014 Q3-2019 Q2 Figure 1.2 HIV Test Episodes for BC by Gender, 2014 Q3-2019 Q2 Figure 1.3 HIV Test Episodes for BC by Age Category, 2014 Q3-2019 Q2 Figure 1.4 Point-of-Care HIV Tests for BC, 2014 Q3-2019 Q2 Figure 1.5 HIV Test Episodes by Health Authority for BC, 2014 Q3-2019 Q2 Figure 1.6 HIV Test Episodes for Non-Prenatal Females in BC by Health Authority, 2014 Q3-2019 Q2 Figure 1.7 HIV Test Episodes for Males in BC by Health Authority, 2014 Q3-2019 Q2 Indicator 2 HIV Testing Rates All HIV Testing Rates reflect non-prenatal tests. All prenatal tests have been removed Figure 2.1 Rate of HIV Testing for BC and Health Authorities, 2009–2018 Figure 2.2 Rate of HIV Testing for BC by Gender, 2009–2018 Figure 2.3 Rate of HIV Testing for BC by Age Category, 2009–2018 Indicator 3 New HIV Diagnoses Figure 3.1 New HIV Diagnoses for BC, 2014 Q3-2019 Q2 Figure 3.2 New HIV Diagnoses for BC by Gender, 2014 Q3-2019 Q2 Figure 3.3 New HIV Diagnoses for BC by Age Category, 2014 Q3-2019 Q2 Figure 3.4 New HIV Diagnoses for BC by Exposure Category, 2014 Q1-2018 Q4 Figure 3.5 New HIV Diagnoses for BC by Health Authority, 2014 Q3-2019 Q2 Indicator 4 Stage of HIV Infection at Diagnosis Stage definitions have been altered to remove AIDS diagnosis data. Individuals previously classified as Stage 3 have been re-classified based on CD4 cell count. Table 1 Staging Classifications of Infection at Time of HIV Diagnosis Based on CDC HIV Surveillance Case Definitions Figure 4.1 Stage of HIV Infection at Diagnosis for BC, 2014–2018 Figure 4.2 Stage of HIV Infection at Diagnosis for BC by Gender, 2014–2018 Figure 4.3 Stage of HIV Infection at Diagnosis for BC by Age Category, 2014–2018 Figure 4.4 Stage of HIV Infection at Diagnosis for BC by Exposure Category, 2014–2018 Indicator 5 HIV Cascade of Care Figure 5.1 Estimated Cascade of Care for BC, Year Ending 2019 Q2 Figure 5.2 Estimated Cascade of Care for BC by Gender, Year Ending 2019 Q2 Figure 5.3 Estimated Cascade of Care for BC by Age Category, Year Ending 2019 Q2 Figure 5.4 Estimated Cascade of Care for BC by MSM Status, Year Ending 2019 Q2 Figure 5.5 Estimated Cascade of Care for BC by Age Category and MSM Status, Year Ending 2019 Q2 Figure 5.6 Estimated Cascade of Care for BC by PWID Status, Year Ending 2019 Q2 Figure 5.7 Estimated Cascade of Care for BC by Health Authority, Year Ending 2019 Q2 Indicator 6 Programmatic Compliance Score (PCS) Table 2 Probability of Mortality, Immunologic Failure and Virologic Failure Based on the Programmatic Compliance Score Figure 6.1

PCS Components for BC, 2017 Q3–2019 Q2

Less than 3 CD4 Tests in First Year

Less than 3 Viral Load Tests in First Year

Not Having Drug Resistance Testing at Baseline

Baseline CD4 < 200 cells/µL

Not Achieving Viral Suppression at 9 Months

Figure 6.2 Historical Trends for PCS Score for BC, 2017 Q3–2019 Q2 Indicator 7 New Antiretroviral Therapy Starts in BC Figure 7 BC-CfE Drug Treatment Program Enrollment:
New Antiretroviral Participants for BC, 2017 Q3–2019 Q2 Indicator 8 CD4 Cell Count at ART Initiation Figure 8 CD4 Cell Count at ART Initiation for BC, 2017 Q3–2019 Q2 Indicator 9 Active and Inactive Drug Treatment Program (DTP) Participants Table 3 Distribution of People on ART in BC, 2019 Q2 Figure 9 Active and Inactive DTP Participants for BC, 2017 Q3–2019 Q2 Indicator 10 Antiretroviral Adherence Figure 10 Distribution of Individuals by Adherence Level in 1st Year of Therapy,
Based on Pharmacy Refill Compliance for BC, 2017 Q3–2019 Q2 Indicator 11 Resistance Testing and Results Figure 11 Cumulative Resistance Testing Results by Resistance Category for BC, 2017 Q3–2019 Q2 Indicator 12 AIDS-Defining Illness Figure 12 AIDS Case Rate and Reports for BC, 2010–2017 Indicator 13 HIV-Related Mortality Figure 13 HIV-Related Deaths by Year for all BC Appendices

Acknowledgements and Contributions

British Columbia Centre for Excellence in HIV/AIDS (BC-CfE): The BC-CfE is responsible for the conception, preparation and ongoing review of this quarterly report. The BC-CfE provides the data and outputs for Indicators 5 (HIV Cascade of Care), 6 (Programmatic Compliance Score), 7 (New Antiretroviral Starts), 8 (CD4 Cell Count at ART Initiation), 9 (Active and Inactive Drug Treatment Program Participants), 10 (Antiretroviral Adherence Level), 11 (Resistance Testing Results by Resistance Category), 12 (AIDS-Defining Illness), and 13 (HIV-Related Mortality). The BC-CfE database provides pVL and CD4 cell count testing data, as well as ART use. All pVL measurements in BC are performed at the St Paul’s Hospital virology laboratory, thus pVL data capture is 100%. An estimated 80% of all CD4 count measurements performed in the province are captured in the BC-CfE data holdings. The STOP HIV/AIDS Technical Monitoring Committee– BC-CFE is responsible for oversight of the monitoring report. Lilith Swetland is the editor of this report. Paul Sereda, Dr. Viviane Lima and Nada Gataric perform analysis of Indicators 5–13. Rafael Trevisan developed programming for this website. This report was conceived and guided by Dr. Julio Montaner.

British Columbia Centre for Disease Control (BCCDC): The BCCDC provides the data and outputs for Indicator 1 (HIV Testing Episodes), Indicator 2 (HIV Testing Rate), Indicator 3 (New HIV Diagnoses), Indicator 4 (Stage of HIV at Diagnosis) and Indicator 12 (AIDS-Defining Illness). The BCCDC is the single provincial agency that centralizes all HIV surveillance through the Public Health Microbiology and Reference Laboratory, which does more than 90% of all HIV screening tests in BC and all confirmatory testing. Olga Mazo, Theodora Consolacion and Dr. Jason Wong are responsible for outputs for Indicators 1–4

Other Data Sources:

The above databases were supplemented with:

(I) The BC Vital Statistics database which was used to calculate Indicator 5. The HIV Cascade of Care and Indicator 13. HIV-Related Mortality.

(II) Linkage and preparation of the de-identified individual-level database used for calculating Indicator 5. The HIV Cascade of Care was facilitated by the British Columbia Ministry of Health.

(III) The Statistics Canada database: BC and HIV-positive population counts were acquired through the Statistics Canada website to calculate HIV-specific mortality rates for Indicator 13. HIV-Related Mortality.

Membership of the STOP HIV/AIDS Technical
Monitoring Committee – BC-CfE

Dr. Rolando Barrios, Chair, BC-CfE

Dr. Kate Heath, BC-CfE

Dr. Bohdan Nosyk, BC-CfE

Dr. Viviane Dias Lima, BC-CfE

Ms. Irene Day, BC-CfE

Mr. Paul Sereda, BC-CfE

Dr. Jason Wong, BCCDC

Dr. Mel Krajden, BCCDC

FNHA (TBC)

Ms. Lily Zhou, FNHA

Dr. Aamir Bharmal, FHA

Ms. Brooke Kinniburgh, FHA

Ms. Barbara Gauthier, IHA

Ms. Robin Yates, MOH

Ms. Kari Harder, NHA

Dr. Neora Pick, PHSA

Dr. Althea Hayden, VCHA

Ms. Laurence Campeau, VIHA

The Seek and Treat for Optimal Prevention (STOP) HIV/AIDS BC Provincial Program: A Note on Monitoring and Interpreting HIV Indicators

The Seek and Treat for Optimal Prevention (STOP) of HIV/AIDS programme is a provincial initiative to improve HIV diagnosis and care delivery in BC through increased HIV-specific funding to all Health Service Delivery Areas (HSDA’s) across BC. The STOP provincial programme is an expansion of a four-year STOP pilot project which was implemented in two Health Service Delivery Areas in March 2010; the Vancouver HSDA which bears the largest burden of the HIV epidemic in the province and the Northern Interior HSDA which bears a high burden of HIV-related mortality. The STOP pilot project demonstrated the urgent need for improved efforts in early diagnosis of HIV and timely initiation of antiretroviral therapy (ART) initiation.

The expansion to a province-wide programme was announced on November 30th, 2013 by the BC Ministry of Health with roll out of funding beginning on April 1st, 2013. This funding is intended to be used in the implementation and evaluation of HIV-related diagnosis and care initiatives within individual HA’s. Goals of the project include: 1. A reduction in the number of new HIV infections in BC; 2. Improvements in the quality, effectiveness, and reach of HIV prevention services; 3. An increase in early diagnosis of HIV; 4. A reduction in AIDS cases and HIV-related mortality.

The goals of HA-led STOP-funded initiatives are to work toward achieving these goals. To these ends some outcome measures or indicators of progress have been drafted that should be considered in the design and implementation phases of these initiatives.

HIV Testing Episodes and Rates

In this section, the number of HIV test episodes and point of care (POC) HIV tests conducted each quarter in BC is shown. In general terms the goal is to increase the number of tests performed and to maximize testing efficiency. Test episodes are allocated by region according to where the test is performed.

N.B. All HIV Testing Episodes reflect non-prenatal tests. All prenatal tests have been removed.

Indicator 1. HIV Testing Episodes

Figure 1.1 HIV Test Episodes for BC

Figure 1.2 HIV Test Episodes by Gender for BC ^{1, 2}

Female

Male

Other

1	Data Source: The BC Public Health Microbiology and Reference Laboratory (BCPHMRL) courtesy of the BC Centre for Disease Control (BCCDC). HIV screening tests conducted by the VIHA Laboratory are not included. Limitation: Repeat tests in individuals who test using various identifiers may not be identified and these individuals may be counted more than once.
2	Testing does not include point of care tests.

Figure 1.3 HIV Test Episodes by Age Category for BC ^{1, 2}

< 30

30–39

40–49

≥ 50

1	Data Source: The BC Public Health Microbiology and Reference Laboratory (BCPHMRL) courtesy of the BC Centre for Disease Control (BCCDC). HIV screening tests conducted by the VIHA Laboratory are not included. Limitation: Repeat tests in individuals who test using various identifiers may not be identified and these individuals may be counted more than once.
2	Testing does not include point of care tests.

Figure 1.4 Point-of-Care HIV Tests for BC

Figure 1.5 HIV Test Episodes for BC by Health Authority ¹

Fraser Health

Interior Health

Northern Health

Vancouver Coastal Health

Vancouver Island Health

Data Source: The BC Public Health Microbiology and Reference Laboratory (BCPHMRL) courtesy of the BC Centre for Disease Control (BCCDC). HIV screening tests conducted by the VIHA Laboratory are not included.

Limitation: Repeat tests in individuals who test using various identifiers may not be identified and these individuals may be counted more than once.

Figure 1.6 HIV Test Episodes for Non-prenatal Females in BC by Health Authority ¹

Fraser Health

Interior Health

Northern Health

Vancouver Coastal Health

Vancouver Island Health

Figure 1.7 HIV Test Episodes for Males in BC by Health Authority ¹

Fraser Health

Interior Health

Northern Health

Vancouver Coastal Health

Vancouver Island Health

Indicator 2. HIV Testing Rates

N.B. All HIV Testing Episodes reflect non-prenatal tests. All prenatal tests have been removed.

Figure 2.1 Rate of HIV Testing for BC and Health Authority ²

All British Columbia

Fraser Health

Interior Health

Northern Health

Vancouver Coastal Health

Vancouver Island Health

2	Testing does not include point of care tests.

Figure 2.2 Rate of HIV Testing by Gender for BC ²

Female

Male

2	Testing does not include point of care tests.

Figure 2.3 Rate of HIV Testing by Age Category for BC ²

< 30

30–39

40–49

≥ 50

2	Testing does not include point of care tests.

New HIV Diagnoses

Trends in HIV diagnoses by gender and exposure category are described. Interpreting HIV diagnoses must be done with consideration that trends are influenced by both changes in testing rate as well as changes in transmission rates. It is important to note that new HIV diagnoses cases and rates are not synonymous with HIV incidence as a person may have become infected with HIV long before they tested positive for HIV. However, as there is no reliable method for measuring HIV incidence, we follow trends in HIV diagnoses.

Indicator 3. New HIV Diagnoses

Figure 3.1 New HIV Diagnoses for BC ³

3	Data Source: BCCDC. When present, “By Provider Address” is graphed as dashed line in same colour.

Figure 3.2 New HIV Diagnoses for BC by Gender ³

Female

Male

3	Data Source: BCCDC. When present, “By Provider Address” is graphed as dashed line in same colour.

Figure 3.3 New HIV Diagnoses for BC by Age Category ³

< 30

30–39

40–49

≥ 50

3	Data Source: BCCDC. When present, “By Provider Address” is graphed as dashed line in same colour.

Figure 3.4 New HIV Diagnoses for BC by Exposure Category ^{3, 4}

MSM

PWID

HET

Other

NIR/Unknown

3	Data Source: BCCDC. When present, “By Provider Address” is graphed as dashed line in same colour.
4	MSM=men who have sex with men; PWID=people who inject drugs; HET=heterosexual. NIR=No identified risk/exposure.

Figure 3.5 New HIV Diagnoses for BC by Health Authority ³

Fraser Health

Interior Health

Northern Health

Vancouver Coastal Health

Vancouver Island Health

3	Data Source: BCCDC. When present, “By Provider Address” is graphed as dashed line in same colour.

Stage of HIV Infection at Diagnosis

Classification of stage of HIV infection, in the absence of information regarding recent testing history, is reliant on clinical information available at the time of diagnosis, including first CD4+ cell count and laboratory results suggestive of acute HIV infection (Table 1). The benefits of Treatment as Prevention (TasP) are maximized when antiretroviral therapy (ART) is initiated at high CD4 cell counts. Accordingly, it is preferable that individuals newly diagnosed with HIV be in the early stages of HIV infection (stage 0 or 1) to allow for early ART initiation.

N.B. Interpretation of Stage of HIV Infection at Diagnosis should proceed with caution. Early increases in diagnosis at late stage (i.e., low CD4 counts) may represent a "catching up" of previously missed long term infected individuals rather than a trend toward diagnosis at later stage of infection. Additionally, there has been an increase in the proportion of new diagnosis in 2016 for whom these data are missing (37%), leading to a slight overestimation of the overall proportion within each stage.

Indicator 4. Stage of HIV Infection at Diagnosis

Table 1: Staging Classifications of Infection at Time of HIV Diagnosis Based on CDC HIV Surveillance Case Definitions

Stage	Criteria
0	Laboratory criteria met for acute HIV infection, or previous negative or indeterminate HIV test within 180 days of first confirmed positive HIV test.
1	Stage 0 not met and	CD4 ≥500
2a		CD4 350–499
2b		CD4 200–349
3		CD4 <200
Unknown		No available CD4

Figure 4.1 Stage of HIV Infection at Diagnosis for BC ⁵

Stage 0

Figure 4.2 Stage of HIV Infection at Diagnosis by Gender for BC ⁵

Stage 0

	British Columbia					Female					Male
	2014	'15	'16	'17	'18	'14	'15	'16	'17	'18	'14	'15	'16	'17	'18
Stage 0	64	52	63	53	25	5	9	8	5	4	59	43	55	47	21
Stage 1	55	50	46	38	52	13	8	10	4	12	42	42	36	34	40
Stage 2a	33	21	28	13	28	4	2	0	2	8	29	19	28	11	18
Stage 2b	30	36	25	18	16	5	7	1	1	2	23	28	24	17	14
Stage 3	44	51	40	29	27	10	7	9	1	5	34	44	30	28	22
Unknown	35	31	39	31	51	8	5	9	2	7	27	25	30	28	43
Total (n=)	261	241	241	182	199	45	38	37	15	38	214	201	203	165	158

5	Data Source: BCCDC

Figure 4.3 Stage of HIV Infection at Diagnosis by Age for BC ⁵

Stage 0

Figure 4.4 Stage of HIV Infection at Diagnosis by Exposure Category for BC ^{5, 6}

Stage 0

	< 30					30–39					40–49					≥ 50					MSM					PWID					HET					Other					Unknown
	2014	'15	'16	'17	'18	'14	'15	'16	'17	'18	'14	'15	'16	'17	'18	'14	'15	'16	'17	'18	'14	'15	'16	'17	'18	'14	'15	'16	'17	'18	'14	'15	'16	'17	'18	'14	'15	'16	'17	'18	'14	'15	'16	'17	'18
Stage 0	28	14	25	27	9	17	16	20	14	9	8	6	8	6	5	11	16	10	6	2	54	35	49	39	15	4	4	8	7	4	4	13	3	5	3	1	0	2	1	0	1	0	1	1	3
Stage 1	12	22	11	10	19	18	10	17	14	11	10	7	8	11	14	15	11	10	3	8	31	36	31	26	32	10	1	5	4	7	13	10	7	6	8	1	1	2	0	2	0	2	1	2	3
Stage 2a	5	7	10	5	7	7	3	10	4	10	8	5	3	2	7	13	6	5	2	4	19	14	18	8	14	1	1	0	1	3	10	4	6	3	8	0	1	2	0	2	3	1	2	1	1
Stage 2b	3	6	4	8	1	10	11	8	3	4	7	9	7	4	6	10	10	6	3	5	14	21	17	13	7	4	4	0	3	1	10	9	7	2	6	1	1	0	0	0	1	1	1	0	2
Stage 3	4	5	3	3	4	11	8	9	8	6	13	13	9	6	5	16	25	19	12	12	16	17	14	19	17	4	5	2	1	2	18	24	20	7	6	3	1	1	0	0	3	4	3	2	2
Unknown	7	4	11	9	13	14	12	11	9	17	7	10	5	8	14	7	5	12	5	5	19	15	17	22	19	3	2	1	2	6	10	9	16	5	14	1	1	0	1	1	2	4	5	1	11
Total (n=)	59	58	64	62	53	77	60	75	52	57	53	50	40	37	51	72	73	62	31	36	153	138	146	127	104	26	17	16	18	23	65	69	59	28	45	7	5	7	2	5	10	12	13	7	22

5	Data Source: BCCDC
6	MSM=men who have sex with men; PWID=people who inject drugs; HET=heterosexual. NIR=No identified risk/exposure.

Indicator 5. HIV Cascade of Care

The success of seek, test, treat and retain (STTR) strategies like STOP is reliant on early diagnosis of HIV, linking newly diagnosed HIV-positive persons with ongoing care, retaining persons in HIV-care; initiating ART based on best evidenced practices and maintaining optimal ART adherence to ensure a suppressed viral load. These stages of HIV-care can be summarized as: 1. HIV diagnosis, 2. Linked to HIV care, 3. Retained in HIV care, 4. On ART, 5. Adherent to ART and 6. Achieving a suppressed VL; collectively, they are referred to as the cascade of care. Attrition between any of these stages of HIV-care means a reduction in the potential of ART as a benefit to the HIV-positive individual and as an HIV transmission prevention method on a population level. Thus, when interpreting trends in the cascade of care, we strive to see increases along each step of the cascade of care (i.e. reduced attrition) with the ultimate goal being 100% within each stage of the cascade. Monitoring the Cascade of Care provides a picture as to where deficiencies lie in the delivery and uptake of HIV-care. In this section, we present the cascade of care for the period stated in BC overall and stratified by sex and age for each Health Authority.

Figure 5.1 Estimated Cascade of Care for BC, Year Ending 2019 Q2 ⁷

9598

8040

7596

7016

5878

Figure 5.2 Estimated Cascade of Care for BC by Gender, Year Ending 2019 Q2 ⁷

7947

6664

6311

5901

5025

1651

1376

1285

1115

853

Data is for the period 2018 Q3–2019 Q2.
Data Sources:
i British Columbia Centre for Excellence Drug Treatment Program (DTP) Database (ARV use, VL and CD4 count).
ii Administrative data (ex. MSP billings; hospitalization data from the Discharge Abstract Database (DAD)).

Limitations: HA assignment is based on the most recent HA of residence of the patient, if not available of the HIV-care provider. If the most recent HA of residence is not updated then the designated HA may be incorrect.

NB: Transgender have been assigned to their biological sex.

Figure 5.3 Estimated Cascade of Care for BC by Age Category, Year Ending 2019 Q2 ⁸

345

298

281

236

188

1197

1019

946

827

688

2091

1752

1654

1485

1208

5965

4970

4715

4468

3794

Figure 5.4 Estimated Cascade of Care for BC by MSM Status, Year Ending 2019 Q2 ⁹

3641

3308

3166

2990

2617

2755

2531

2378

2105

1645

3201

2201

2052

1921

1616

Figure 5.5 Estimated Cascade of Care for BC by Age Category and MSM Status, Year Ending 2019 Q2 ⁹

Figure 5.6 Estimated Cascade of Care for BC by PWID Status, Year Ending 2019 Q2 ⁹

2318

2115

1989

1756

1359

4929

4506

4309

4049

3492

2351

1418

1298

1211

1027

Figure 5.7 Estimated Cascade of Care for BC by Health Authority, Year Ending 2019 Q2 ⁹

2187

1976

1901

1768

1491

647

545

525

485

375

275

237

227

194

121

4710

4166

3991

3711

3204

1078

986

950

856

685

Indicator 6. Programmatic Compliance Score (PCS)

The Programmatic Compliance Score (PCS) is a summary measure of risk of future death, immunologic failure and virologic failure from all causes for people who are starting ART for the first time. It is composed of patient- and physician-driven effects. PCS scores range from 0–6 with higher scores indicative of poorer health outcomes and greater risk of death. Table 2 provides mortality, immunologic failure and virologic failure probabilities for given PCS scores. We interpret an individual with a PCS≥4 as being 22 times more likely to die, almost 10 times more likely to have immunologic failure and nearly 4 times as likely to demonstrate virologic failure compared to those individuals with a PCS score of 0. A detailed description of how the PCS score is calculated and its validation can be found in the technical report. In short, PCS scores are calculated by summing the results (yes=1, no=0) of six un-weighted nonperformance indicators based on IAS–USA treatment guidelines:

having <3 CD4 cell count tests in the first year after starting antiretroviral therapy (ART);
having <3 plasma viral load (VL) tests in the first year after starting ART;
not having drug resistance testing done prior to starting ART;
starting on a non-recommended ART regimen;
starting therapy with CD4<200 cells/µL; and
not achieving viral suppression within 9 months since ART initiation.

In this section we provide PCS scores and their components over time for the province of BC. A decline to 0%, (i.e., all individuals having a score of 0) is the eventual goal.

Table 2. Probability of Mortality, Immunologic Failure and Virologic Failure based on the Programmatic Compliance Score

Programmatic Compliance Score	Mortality Risk Ratio (95% Confidence Interval)	Immunologic Failure Risk Ratio (95% CI)	Virologic Failure Risk Ratio (95% CI)
0 (Best score)	1 (–)	1 (–)	1 (–)
1	3.81 (1.73–8.42)	1.39 (1.04–1.85)	1.32 (1.05–1.67)
2	7.97 (3.70–17.18)	2.17 (1.54–3.04)	1.86 (1.46–2.38)
3	11.51 (5.28–25.08)	2.93 (1.89–4.54)	2.98 (2.16–4.11)
4 or more (Worst score)	22.37 (10.46–47.84)	9.71 (5.72–16.47)	3.80 (2.52–5.73)

Reference: Lima VD, Le A, Nosyk B, Barrios R, Yip B, et al. (2012) Development and Validation of a Composite Programmatic Assessment Tool for HIV Therapy. PLoS ONE 7(11): e47859. doi:10.1371/journal.pone.0047859

Figure 6.1 PCS Components for BC, 2017 Q3–2019 Q2 ¹⁰

<3 CD4 Tests

<3 Viral Load Tests

No Baseline Genotype

Baseline CD4 <200/µL

Non-Recommended ART

Non Viral Suppression at 9 Mo.

10	Data Source: British Columbia Centre for Excellence Drug Treatment Program (DTP) Database. Limitations: CD4 cell count capture is approximately 80%.

Figure 6.2 Historical Trends for PCS Score for BC, 2017 Q3–2019 Q2 ^{10, 11}

≥ 4

10	Data Source: British Columbia Centre for Excellence Drug Treatment Program (DTP) Database. Limitations: CD4 cell count capture is approximately 80%.
11	Each quarter’s data is calculated as the sum of the 4 quarters leading up to it. e.g. 2019 Q2 is calculated from 2018 Q2 – 2019 Q1. NB: A score of 0 is the best score and a score of 4 or more is the worst score.

Indicator 7. New Antiretroviral Therapy Starts in BC

Antiretroviral Uptake

In this section we present trends in ART uptake, the number and proportion of new HIV treatment initiations and the number of active and inactive DTP participants. Trends in ART uptake should be interpreted under the consideration of changing BC HIV treatment guidelines. BC HIV treatment guidelines are updated regularly by the BC-CfE Therapeutic Guidelines Committee and reflect those of the International AIDS Society. Since 2012 HIV treatment has been recommended for all HIV-positive adults regardless of CD4 cell count; as evidence demonstrates that early initiation of HIV treatment maximizes both the individual’s health outcomes as well as the potential of ART as a form of HIV transmission prevention at a population level. As such, trends in the number and proportion of persons on ART and new ART starts (in both naïve and experienced persons) are expected to increase over time at higher CD4 cell counts.

Figure 7 BC-CfE Drug Treatment Program Enrollment New ART Participants in BC, 2017 Q3–2019 Q2 ¹²

First Starts

Experienced Starts

12	Data Source: Drug Treatment Program Database Limitation: DTP participants are designated to an HA based on most current residence provided by the participant.

Indicator 8. CD4 Cell Count at ART Initiation

Figure 8 CD4 Cell Count at ART Initiation of ART-Naïve DTP Participants in BC, 2017 Q3–2019 Q2 ¹³

≥ 500 cells/µL

350–499

200–349

50–199

< 50 cells/µL

Median

13	Data Source: Drug Treatment Program Database Limitations: CD4 cell count data is approximately 80% complete.

Indicator 9. Active and Inactive DTP Participants

Table 3. Distribution of People on ART for 2019 Q2 ¹⁴

		Fraser	Interior	Island	Northern	Vancouver Coastal	Total BC
Age	< 30	89	25	46	8	148	316
	30–39	273	55	99	42	558	1029
	40–49	503	104	196	63	845	1711
	≥ 50	1070	346	621	114	2451	4602
Gender	Male	1486	430	795	137	3525	6375
	Female	449	100	167	90	477	1283
Exposure	MSM	656	199	328	30	1988	3202
	PWID	411	152	257	108	1044	1972
Total		1935	530	962	227	4002	7658

14	Data Source: Drug Treatment Program Database Limitation: DTP participants are designated to an HA based on most current residence provided by the participant. Definition: ‘On antiretroviral therapy’ defined as being on treatment in the current quarter

Figure 9 Active and Inactive DTP Participants in BC, 2017 Q3–2019 Q2 ¹⁵

Active

Inactive

15	Active DTP participants: An individual who has had medication prescribed at least once in the preceding quarter. Inactive DTP participants: Persons no longer prescribed drugs through the HIV/AIDS Drug Treatment Program in the last quarter.

Indicator 10. Antiretroviral Adherence Level

In this section we present trends in prescription refill adherence levels for individuals in their first year of treatment. Given that the benefits of ART are compromised in the presence of imperfect ART adherence, we expect to see the proportion of persons on ART achieving near perfect adherence (ie. ≥95%) to increase with time. Furthermore, it is important that trends in the proportion of ART users achieving prescription refill adherence of ≥95% keep pace with new ART starts and increase among those continuing on ART.

Figure 10 Distribution of Individuals by Adherence Level in 1st Year of Therapy, Based on Pharmacy Refill Compliance for BC, 2017 Q3–2019 Q2 ¹⁶

≥ 95%

80% to
< 95%

40% to
< 80%

< 40%

16	Data Source: Drug Treatment Program Database Limitation: Prescription refill adherence is used as a proxy for patient adherence.

Resistance Testing and Results

Indicator 11. Resistance Testing and Results

In this section, we present trends in cumulative resistance testing by resistance category: Suppressed (where a DTP participant’s viral load is too low to be genotyped); Wild Type (where no HIV treatment resistances were discovered), Never Genotyped, and Resistances to one, two, three, or four HIV treatment classes. Resistance testing prior to ART initiation is recommended in the BC HIV treatment primary care guidelines. Thus, it is expected that trends over time should find all persons enrolled in the DTP to have been genotyped. Trends over time should also show an increase in the proportion of DTP participants achieving a suppressed status and an increase in resistance testing should not lead to an increase in the number of ART resistances occurring.

Figure 11 Cumulative Resistance Testing Results by Resistance Category for BC, 2017 Q3–2019 Q2 ¹⁷

Suppressed

Wild Type

Never Genotyped

1-Class

2-Class

3-Class

4-Class

17	Data Source: Drug Treatment Program Database Limitation: DTP participants are designated to a HA based on most current residence provided by the participant.

AIDS-Defining Illness

Indicator 12. AIDS-Defining Illness

Improvements in ART and the expansion of ART province-wide has led to very low numbers of recorded AIDS cases across BC. However, interpreting trends in AIDS cases is challenging as AIDS reporting is passive in BC and it is likely that they are under-reported across all Health Authorities. In addition to under-reporting, methods of reporting AIDS cases are inconsistent across HA’s and do not truly reflect the current reality of new AIDS diagnoses. Efforts will need to be made to improve under- and inconsistent reporting of AIDS cases across all HA’s. The table below shows AIDS cases using three definitions. First, AIDS cases were defined as the number of physician reported AIDS defining illness (ADI) in a given year. AIDS case reporting is a passive process and physicians can voluntarily report AIDS cases to the BCCDC or DTP. As such, we have plotted both BCCDC reports and DTP reported AIDS cases. We also show the proportion of persons initiating ART with a CD4<200 cells/µL.

Figure 12 AIDS Case Rate and Reports for BC ¹⁸

CD4<200 at ART Initiation

AIDS: DTP Reports

AIDS: BCCDC Reports

Data Source: DTP AIDS cases are obtained from the Drug Treatment Program Database; BCCDC AIDS cases are obtained from the BCCDC; CD4<200 at ART initiation data came from the DTP database. Indicator 12 also reflects information from BC Vital Statistics. As this information is made available to BC-CfE, we use it to inform the development and refinement of this indicator

Limitation: AIDS case reporting was investigated using 3 definitions: First, using AIDS cases reported in AIDS case report forms from the DTP; Second, using AIDS cases reported via the BCCDC and third, using a CD4 cell count of <200 cells/µL at time of ART initiation using DTP data. AIDS case reporting is passive in BC, thus; AIDS case reporting is not well captured. The DTP sends out AIDS reporting forms to physicians annually. The BCCDC uses DTP AIDS case reports as well as physician AIDS case reports made directly to the BCCDC. Interpreting AIDS case reports should be done with these limitations in mind. AIDS data is updated annually as very few AIDS cases reports are reported in general and trends would be difficult to notice if reported quarterly.

HIV-Related Mortality

Indicator 13. HIV-Related Mortality for all BC

Evidence indicates that individuals who initiate treatment with recommended ART in a timely fashion may live near normal lifespans. Excess mortality among HIV positive persons is, therefore, an important measure of HIV care with a goal of minimizing HIV-related mortality in British Columbia.

Figure 13 HIV-Related Deaths by Year for all BC, 2004-2015 ¹⁹

HIV-Related Deaths

19	Data Source: BC Vital Statistics Limitation: 1. DTP participants are designated to an HA based on most current residence provided by the participant. 2. Mortality data is updated annually 3. The most recent available data was used.

APPENDICES

Indicator 1: Test Episodes (thousands)		2014		2015				2016				2017				2018				2019
Indicator 1: Test Episodes (thousands)		Q3	Q4	Q1	Q2	Q3	Q4	Q1	Q2	Q3	Q4	Q1	Q2	Q3	Q4	Q1	Q2	Q3	Q4	Q1	Q2
British Columbia		71.2	70.4	77.9	76.9	79.9	80.7	88.8	87.8	83.2	80.6	87.2	85.1	83.9	81.9	89.1	89.4	86.0	88.2	103.2	103.2
Gender	Female	33.8	33.7	37.4	37.4	38.7	38.7	42.4	42.6	40.1	38.2	41.4	40.6	40.4	39.2	41.8	42.2	40.6	41.4	48.9	49.7
	Male	33.8	33.7	37.2	36.7	38.3	39.1	43.3	42.5	40.4	39.6	42.9	42.0	41.0	40.2	44.9	44.8	42.9	44.7	52.1	51.6
	Other	0.3	0.2	0.3	0.3	0.3	0.3	0.3	0.3	0.3	0.4	0.5	0.5	0.5	0.5	0.6	0.7	0.9	0.8	1.0	0.9
Age	< 30	19.2	18.9	19.7	19.9	21.8	21.8	22.2	22.6	22.8	21.9	22.6	22.7	24.4	23.4	24.1	24.9	25.5	25.9	28.2	27.8
	30–39	14.6	14.0	16.1	16.0	16.6	16.1	18.6	18.3	17.3	16.6	18.6	18.2	18.0	17.6	19.7	19.8	19.0	19.0	22.2	22.3
	40–49	10.5	10.5	11.6	11.4	11.7	11.8	13.3	12.9	11.8	11.6	12.4	12.2	11.7	11.5	12.9	12.5	11.7	12.2	14.1	13.9
	≥ 50	23.5	24.0	27.4	26.9	27.0	28.3	31.7	31.6	28.8	27.8	30.8	29.6	27.5	27.2	30.2	30.1	27.9	29.6	37.2	37.9
POC Tests		3.3	2.9	2.9	2.6	2.6	2.6	2.8	2.3	2.4	2.5	2.5	2.0	2.1	2.0	1.8	1.7	1.5	1.3	1.1	1.0
Fraser Health		14.9	15.1	16.1	15.8	16.8	17.1	18.5	19.2	17.9	17.1	18.3	18.3	18.0	17.6	19.3	20.1	19.2	18.4	19.1	19.7
Female		7.2	7.4	7.6	7.6	8.1	8.1	8.8	9.3	8.6	8.2	8.8	8.7	8.7	8.5	9.4	9.7	9.2	8.7	9.1	9.5
Male		7.3	7.5	8.1	7.8	8.4	8.7	9.4	9.6	9.1	8.7	9.2	9.4	9.0	8.9	9.8	10.2	9.8	9.5	9.9	10.0
Interior Health		5.6	5.9	6.6	7.0	7.9	9.1	10.5	9.9	9.0	8.8	9.9	9.7	9.4	9.7	10.0	10.2	9.6	13.5	23.9	23.6
Female		2.7	2.8	3.2	3.5	3.9	4.5	5.1	4.9	4.4	4.3	4.7	4.8	4.7	4.8	4.8	4.9	4.7	6.7	12.2	12.2
Male		2.7	2.9	3.2	3.4	3.8	4.4	5.1	4.8	4.4	4.3	4.9	4.7	4.5	4.7	5.0	5.0	4.6	6.6	11.4	11.2
Northern Health		2.9	3.0	3.7	3.2	3.2	3.2	3.7	3.4	3.1	3.1	3.7	3.7	3.5	3.4	3.9	4.1	3.6	3.6	4.0	3.9
Female		1.5	1.5	1.9	1.6	1.6	1.6	1.9	1.7	1.5	1.5	1.9	1.8	1.7	1.7	1.9	2.1	1.8	1.8	2.0	2.0
Male		1.3	1.4	1.6	1.4	1.5	1.4	1.6	1.5	1.4	1.4	1.8	1.7	1.6	1.6	1.9	1.9	1.6	1.7	1.9	1.8
Vancouver Coastal Health		43.0	41.6	45.5	44.8	45.5	44.6	49.0	48.0	46.7	45.2	48.5	47.1	46.5	44.6	48.6	47.8	46.6	45.1	48.4	48.5
Female		20.1	19.6	21.8	21.6	21.8	21.2	23.0	23.1	22.2	21.0	22.6	22.1	21.9	20.8	22.1	21.9	21.1	20.5	21.7	22.2
Male		20.4	19.8	21.7	21.4	21.9	21.7	24.1	23.3	22.7	22.3	23.9	23.4	22.9	22.1	24.9	24.4	23.8	23.3	25.3	25.1
Vancouver Island Health		4.8	4.9	5.9	6.0	6.4	6.6	7.1	7.3	6.5	6.4	6.8	6.3	6.6	6.7	7.3	7.2	7.1	7.6	7.7	7.5
Female		2.4	2.4	2.9	3.0	3.2	3.3	3.5	3.7	3.4	3.2	3.5	3.2	3.3	3.4	3.7	3.6	3.7	3.8	3.8	3.8
Male		2.1	2.1	2.6	2.6	2.8	2.9	3.1	3.2	2.8	2.9	3.1	2.8	3.0	3.0	3.3	3.3	3.2	3.5	3.6	3.5

Indicator 2: Rate of HIV Testing per 100,000		2009	2010	2011	2012	2013	2014	2015	2016	2017	2018
All British Columbia		2625.0	2645.7	2714.0	3315.6	4186.8	4951.6	5725.5	6081.2	5952.0	6111.0
Fraser Health		2251.0	2267.2	2330.6	2786.7	3313.1	3592.0	4012.1	4339.2	4154.0	4256.3
Interior Health		2026.8	2072.2	2093.6	2207.6	2657.4	3077.4	4138.0	4995.5	4951.7	5432.4
Northern Health		2291.8	2350.0	2434.3	2930.2	3349.5	3856.1	4505.1	4539.0	4806.8	4988.4
Vancouver Coastal Health		4125.6	4140.2	4342.5	5795.2	8013.8	10170.5	11479.5	11692.1	11522.3	11556.8
Vancouver Island Health		1927.3	1920.1	1850.8	1989.8	2168.5	2342.6	2945.9	3226.7	3091.5	3274.7
Gender	Female	2446.2	2454.2	2522.8	3193.9	4162.8	4926.4	5755.7	6064.8	5889.1	5990.2
Gender	Male	2695.1	2735.0	2809.1	3380.8	4173.4	4936.8	5650.9	6062.7	5963.6	6119.3
Age	< 30	2794.8	2802.0	2854.0	3229.6	3680.6	4031.2	4517.4	4781.2	4876.5	5184.3
	30–39	5089.6	5225.5	5251.7	6050.4	7152.8	8011.9	8965.7	9518.0	9524.7	9813.0
	40–49	3028.0	3025.4	3124.2	3828.0	4920.8	5684.6	6506.6	6877.2	6591.8	6679.2
	≥ 50	1261.7	1304.3	1422.5	2212.7	3373.1	4511.7	5484.9	5851.4	5492.7	5493.2

Indicator 3: New HIV Diagnoses		2014		2015				2016				2017				2018				2019
Indicator 3: New HIV Diagnoses		Q3	Q4	Q1	Q2	Q3	Q4	Q1	Q2	Q3	Q4	Q1	Q2	Q3	Q4	Q1	Q2	Q3	Q4	Q1	Q2
British Columbia	By Client Residence	63	60	65	61	65	50	55	66	66	54	50	44	45	43	57	51	41	50	44	45
British Columbia	By Provider Address	63	60	65	61	65	50	55	66	66	54	50	44	45	43	57	50	41	50	44	45
Gender	Female	13	9	10	4	12	11	9	11	11	6	2	6	2	5	7	11	12	8	3	9
Gender	Male	50	51	55	57	53	39	46	55	55	48	48	38	43	36	50	40	29	41	41	35
Age	< 30	13	18	14	14	21	13	19	14	19	17	20	15	17	13	19	11	10	19	15	16
	30–39	25	15	15	17	17	9	18	13	21	20	18	10	14	12	16	10	15	14	10	12
	40–49	7	13	11	19	10	11	11	12	8	8	5	11	9	8	16	17	8	9	11	10
	≥ 50	18	14	25	11	17	17	7	27	18	9	7	8	5	10	6	12	8	8	8	6
Exposure	MSM	34	37	38	38	36	26	34	39	41	32	38	26	32	31	38	23	18	25
	PWID	3	8	4	4	6	3	3	2	3	8	3	5	4	6	6	5	8	4
	HET	20	10	18	15	19	17	15	18	16	10	6	10	7	5	13	13	9	10
	Other	4	2	3	0	2	0	1	2	3	1	1	0	1	0	0	3	0	2
	NIR/Unknown	2	3	2	4	2	4	2	5	3	3	2	3	1	1	0	7	6	9
Fraser Health	By Client Residence	16	17	18	17	15	13	19	18	17	13	12	9	9	11	12	16	13	18	11	9
Fraser Health	By Provider Address	12	13	11	11	15	15	17	15	12	12	8	9	8	11	5	10	10	9	9	6
Interior Health	By Client Residence	4	6	5	1	7	6	6	2	4	2	2	2	0	3	2	6	1	3	5	4
Interior Health	By Provider Address	4	5	5	1	7	6	6	2	3	2	2	2	0	2	3	5	1	3	6	2
Northern Health	By Client Residence	4	2	1	2	2	1	2	4	4	2	1	0	0	1	3	1	2	1	2	4
Northern Health	By Provider Address	3	2	1	2	2	1	3	4	4	2	1	1	0	1	2	2	2	1	2	4
Vancouver Coastal Health	By Client Residence	32	27	38	34	33	24	21	32	36	29	27	24	26	18	30	16	19	22	14	22
Vancouver Coastal Health	By Provider Address	36	32	45	40	35	23	22	36	44	31	33	24	27	19	37	22	23	30	17	27
Vancouver Island Health	By Client Residence	7	8	3	7	8	6	7	10	4	8	8	9	9	10	10	11	5	6	11	6
Vancouver Island Health	By Provider Address	8	8	3	7	6	5	7	9	3	7	6	8	10	10	10	11	5	7	10	6

Indicator 4: Stage of HIV Infection at Baseline
	British Columbia					Female					Male					< 30 years					30-39 years					40-49 years
	'14	'15	'16	'17	'18	'14	'15	'16	'17	'18	'14	'15	'16	'17	'18	'14	'15	'16	'17	'18	'14	'15	'16	'17	'18	'14	'15	'16	'17	'18
Stage 0	64	52	63	53	25	5	9	8	5	4	59	43	55	47	21	28	14	25	27	9	17	16	20	14	9	8	6	8	6	5
Stage 1	55	50	46	38	52	13	8	10	4	12	42	42	36	34	40	12	22	11	10	19	18	10	17	14	11	10	7	8	11	14
Stage 2a	33	21	28	13	28	4	2	0	2	8	29	19	28	11	18	5	7	10	5	7	7	3	10	4	10	8	5	3	2	7
Stage 2b	30	36	25	18	16	5	7	1	1	2	23	28	24	17	14	3	6	4	8	1	10	11	8	3	4	7	9	7	4	6
Stage 3	44	51	40	29	27	10	7	9	1	5	34	44	30	28	22	4	5	3	3	4	11	8	9	8	6	13	13	9	6	5
Unknown	35	31	39	31	51	8	5	9	2	7	27	25	30	28	43	7	4	11	9	13	14	12	11	9	17	7	10	5	8	14
Total (n=)	261	241	241	182	199	45	38	37	15	38	214	201	203	165	158	59	58	64	62	53	77	60	75	52	57	53	50	40	37	51
	≥ 50 years					MSM					PWID					Heterosexual					Other Exposure					NIR/Unknown
	'14	'15	'16	'17	'18	'14	'15	'16	'17	'18	'14	'15	'16	'17	'18	'14	'15	'16	'17	'18	'14	'15	'16	'17	'18	'14	'15	'16	'17	'18
Stage 0	11	16	10	6	2	54	35	49	39	15	4	4	8	7	4	4	13	3	5	3	1	0	2	1	0	1	0	1	1	3
Stage 1	15	11	10	3	8	31	36	31	26	32	10	1	5	4	7	13	10	7	6	8	1	1	2	0	2	0	2	1	2	3
Stage 2a	13	6	5	2	4	19	14	18	8	14	1	1	0	1	3	10	4	6	3	8	0	1	2	0	2	3	1	2	1	1
Stage 2b	10	10	6	3	5	14	21	17	13	7	4	4	0	3	1	10	9	7	2	6	1	1	0	0	0	1	1	1	0	2
Stage 3	16	25	19	12	12	16	17	14	19	17	4	5	2	1	2	18	24	20	7	6	3	1	1	0	0	3	4	3	2	2
Unknown	7	5	12	5	5	19	15	17	22	19	3	2	1	2	6	10	9	16	5	14	1	1	0	1	1	2	4	5	1	11
Total (n=)	72	73	62	31	36	153	138	146	127	104	26	17	16	18	23	65	69	59	28	45	7	5	7	2	5	10	12	13	7	22

Indicator 5: HIV Cascade of Care			Diagnosed	Linked	Retained	On ARVs	Adherent	Suppressed
British Columbia			10511	9598	8040	7596	7016	5878
Gender	Men		8641	7947	6664	6311	5901	5025
Gender	Women		1870	1651	1376	1285	1115	853
Age Category	< 30		508	345	298	281	236	188
	30–39		1303	1197	1019	946	827	688
	40–49		2269	2091	1752	1654	1485	1208
	≥ 50		6421	5965	4970	4715	4468	3794
MSM Status	MSM		3746	3641	3308	3166	2990	2617
	Non-MSM		2846	2755	2531	2378	2105	1645
	Unknown		3919	3201	2201	2052	1921	1616
Age Category and MSM Status	MSM	< 30	164	152	140	134	115	98
		30-39	535	509	434	412	370	329
		40-49	635	613	559	531	491	423
		≥ 50	2411	2368	2174	2089	2014	1767
	Non-MSM	< 30	62	59	55	50	38	25
		30-39	316	302	290	259	211	157
		40-49	753	725	653	618	531	394
		≥ 50	1715	1669	1534	1451	1325	1069
	Unknown	< 30	282	134	103	97	83	65
		30-39	452	387	295	275	246	202
		40-49	881	753	540	505	463	391
		≥ 50	2295	1928	1262	1175	1129	958
PWID Status	PWID		2392	2318	2115	1989	1756	1359
	Non-PWID		5064	4929	4506	4309	4049	3492
	Unknown		3054	2351	1418	1298	1211	1027
Health Authority	Fraser Health		2299	2187	1976	1901	1768	1491
	Interior Health		672	647	545	525	485	375
	Northern Health		303	275	237	227	194	121
	Vancouver Coastal Health		4877	4710	4166	3991	3711	3204
	Vancouver Island Health		1129	1078	986	950	856	685

Indicator 6: Programmatic Compliance Score (PCS)	2017		2018				2019
Indicator 6: Programmatic Compliance Score (PCS)	Q3	Q4	Q1	Q2	Q3	Q4	Q1	Q2
< 3 CD4 Tests	17.5%	16.7%	15.8%	16.1%	20.7%	20.6%	22.7%	21.9%
< 3 Viral Load Tests	8.4%	7.8%	7.2%	6.6%	9.5%	9.3%	9.7%	10.4%
No Baseline Genotype	6.8%	6.7%	6.8%	6.6%	6.2%	8.4%	8.7%	11.5%
Baseline CD4 < 200 cells/µL	27.0%	26.8%	27.0%	24.5%	23.2%	22.9%	18.8%	20.8%
Non-Recommended ART	17.5%	15.6%	16.2%	15.8%	15.8%	19.6%	19.8%	21.9%
Non Viral Suppression at 9 Mo.	22.4%	21.9%	21.2%	22.3%	25.7%	26.2%	26.1%	24.6%
PCS Score: 0	101	107	108	107	86	68	66	55
PCS Score: 1	98	98	107	106	94	89	88	82
PCS Score: 2	40	43	43	43	41	38	35	28
PCS Score: 3	14	12	11	9	12	12	12	10
PCS Score: 4 or more	10	9	9	8	8	7	6	8
Total (n=)	263	269	278	273	241	214	207	183
Indicator 7: New DTP ARV Participants	2017		2018				2019
Indicator 7: New DTP ARV Participants	Q3	Q4	Q1	Q2	Q3	Q4	Q1	Q2
First Starts	55	43	60	43	56	47	49	49
Experienced Starts	118	131	128	130	149	164	161	126
Indicator 8: CD4 Cell Count Initiation for ARV-Naïve DTP Participants	2017		2018				2019
	Q3	Q4	Q1	Q2	Q3	Q4	Q1	Q2
CD4 ≥ 500	22	16	23	14	19	22	16	16
CD4 350-499	7	8	15	8	11	7	11	13
CD4 200-349	9	9	8	11	11	9	9	8
CD4 50-199	8	5	6	5	9	4	7	5
CD4 < 50	3	4	6	3	4	3	3	4
Total (n=)	49	42	58	41	54	45	46	46
CD4 Median	480	420	440	410	420	485	405	440
Indicator 9: Active and Inactive DTP Participants	2017		2018				2019
Indicator 9: Active and Inactive DTP Participants	Q3	Q4	Q1	Q2	Q3	Q4	Q1	Q2
Active DTP Participants	7484	7466	7497	7515	7538	7592	7651	7658
Inactive DTP Participants	1145	1185	1191	1189	1234	1218	1215	1221
Indicator 10: Antiretroviral Adherence	2017		2018				2019
Indicator 10: Antiretroviral Adherence	Q3	Q4	Q1	Q2	Q3	Q4	Q1	Q2
≥ 95%	99	80	61	67	43	55	55	45
80% to < 95%	16	20	14	11	19	13	15	6
40% to < 80%	6	6	4	6	2	0	7	8
< 40%	3	1	0	0	1	1	0	2
Total (n=)	124	107	79	84	65	69	77	61
Indicator 11: Resistance Testing and Results	2017		2018				2019
Indicator 11: Resistance Testing and Results	Q3	Q4	Q1	Q2	Q3	Q4	Q1	Q2
Suppressed	5198	5111	5445	5409	5307	5182	5406	5370
Wild Type	561	602	545	551	554	579	622	592
Never Genotyped	30	35	32	22	21	27	26	37
1-Class	120	120	104	108	109	100	114	103
2-Class	21	27	22	21	20	15	16	12
3-Class	5	7	4	4	4	2	6	7
4-Class	0	0	0	0	0	0	0	0
Total (n=)	5935	5902	6152	6115	6015	5905	6190	6121

Indicator 12: AIDS-Defining Illness		2010	2011	2012	2013	2014	2015	2016	2017
CD4 < 200 at ART initiation	Cases	138	115	96	90	84	82	78	53
CD4 < 200 at ART initiation	Rate per 100,000	3.1	2.6	2.1	1.9	1.8	1.7	1.6	1.1
AIDS Cases (DTP Reports)	Cases	110	88	83	84	84	84	66	41
AIDS Cases (DTP Reports)	Rate per 100,000	2.5	2.0	1.8	1.8	1.8	1.8	1.4	0.8
AIDS Cases (BCCDC Reports)	Cases	121	104	93	95	97	92	70	45
AIDS Cases (BCCDC Reports)	Rate per 100,000	2.7	2.3	2.0	2.1	2.1	1.9	1.4	0.9

Indicator 13: HIV-Related Mortality	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013	2014	2015
British Columbia	105	146	142	100	79	63	54	59	37	25	22	16
Per 100 HIV+ Population	1.03	1.40	1.34	0.93	0.72	0.56	0.47	0.50	0.32	0.21	0.19	0.14
Per 100,000 Population	2.50	3.43	3.29	2.28	1.80	1.41	1.19	1.29	0.81	0.54	0.47	0.34

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Foreword

List of Indicators

Table of Contents

Acknowledgements and Contributions

Membership of the STOP HIV/AIDS Technical
Monitoring Committee – BC-CfE

The Seek and Treat for Optimal Prevention (STOP) HIV/AIDS BC Provincial Program: A Note on Monitoring and Interpreting HIV Indicators

HIV Testing Episodes and Rates

Indicator 1. HIV Testing Episodes

Indicator 2. HIV Testing Rates

New HIV Diagnoses

Indicator 3. New HIV Diagnoses

Stage of HIV Infection at Diagnosis

Indicator 4. Stage of HIV Infection at Diagnosis

Table 1: Staging Classifications of Infection at Time of HIV Diagnosis Based on CDC HIV Surveillance Case Definitions

Indicator 5. HIV Cascade of Care

Indicator 6. Programmatic Compliance Score (PCS)

Table 2. Probability of Mortality, Immunologic Failure and Virologic Failure based on the Programmatic Compliance Score

Indicator 7. New Antiretroviral Therapy Starts in BC

Antiretroviral Uptake

Indicator 8. CD4 Cell Count at ART Initiation

Indicator 9. Active and Inactive DTP Participants

Table 3. Distribution of People on ART for 2019 Q2 ¹⁴

Indicator 10. Antiretroviral Adherence Level

Resistance Testing and Results

Indicator 11. Resistance Testing and Results

AIDS-Defining Illness

Indicator 12. AIDS-Defining Illness

HIV-Related Mortality

Indicator 13. HIV-Related Mortality for all BC

APPENDICES

Heads Up

It seems that you are using the Safari web browser. However, this website is best viewed using Chrome.

Foreword

List of Indicators

Table of Contents

Acknowledgements and Contributions

Membership of the STOP HIV/AIDS Technical Monitoring Committee – BC-CfE

The Seek and Treat for Optimal Prevention (STOP) HIV/AIDS BC Provincial Program: A Note on Monitoring and Interpreting HIV Indicators

HIV Testing Episodes and Rates

Indicator 1. HIV Testing Episodes

Indicator 2. HIV Testing Rates

New HIV Diagnoses

Indicator 3. New HIV Diagnoses

Stage of HIV Infection at Diagnosis

Indicator 4. Stage of HIV Infection at Diagnosis

Table 1: Staging Classifications of Infection at Time of HIV Diagnosis Based on CDC HIV Surveillance Case Definitions

Indicator 5. HIV Cascade of Care

Indicator 6. Programmatic Compliance Score (PCS)

Table 2. Probability of Mortality, Immunologic Failure and Virologic Failure based on the Programmatic Compliance Score

Indicator 7. New Antiretroviral Therapy Starts in BC

Antiretroviral Uptake

Indicator 8. CD4 Cell Count at ART Initiation

Indicator 9. Active and Inactive DTP Participants

Table 3. Distribution of People on ART for 2019 Q2 14

Indicator 10. Antiretroviral Adherence Level

Resistance Testing and Results

Indicator 11. Resistance Testing and Results

AIDS-Defining Illness

Indicator 12. AIDS-Defining Illness

HIV-Related Mortality

Indicator 13. HIV-Related Mortality for all BC

APPENDICES

Membership of the STOP HIV/AIDS Technical
Monitoring Committee – BC-CfE

Table 3. Distribution of People on ART for 2019 Q2 ¹⁴