news and updates

OHESI shares OHTN report on HIV pre-exposure prophylaxis (PrEP) use in Ontario

OHESI would like to share a newly released report by The Ontario HIV Treatment Network (OHTN) titled “HIV pre-exposure prophylaxis in Ontario”.

View report

HIV pre-exposure prophylaxis (PrEP) is the use of daily antiretroviral medications by HIV-negative individuals to reduce their risk of HIV infection. PrEP is a highly effective HIV-risk reduction strategy and a critical part of a comprehensive approach to HIV prevention. It is important to monitor PrEP uptake to provide information to improve access and identify implementation gaps. However, Ontario does not currently have a provincial-level monitoring system for PrEP. To fill this gap, the OHTN is using pharmacy data on PrEP prescriptions to summarize PrEP uptake in Ontario between 2015 to 2018.

This report contains projected provincial-level estimates based on PrEP medication dispensation data from more than 2,000 pharmacies across Ontario. The estimated number, percent or rate of PrEP users is described overall, by sex, age, prescriber specialty, payment type and by region between July 2015 to June 2018. The estimated number of physicians prescribing PrEP by prescriber’s region between March 2018 to February 2019 is also described.

Key findings of the report include:

  • By mid-2018, approximately 3,000 people were on PrEP in Ontario: an 8-fold increase from mid-2015 (estimated 374 PrEP users).
  • Between mid-2015 and mid-2018, the vast majority (97%) of PrEP users were male.
  • While males in the 30-39 age category consistently made up the greatest proportion of PrEP users, the greatest relative increase in male PrEP users between 2015 to 2018 was in the 19-29 age category.
  • In the middle of 2018, the majority of estimated PrEP users were prescribed PrEP by family and general practitioners (68%), followed by infectious disease (14%), and internal medicine (5%) physicians.
  • While approximately 77% of PrEP users used private insurance to cover the cost of the medications in mid-2018, the proportion of PrEP users using public coverage increased between 2015 and 2018as more public coverage became available.
  • By mid-2018, almost 60% of the estimated PrEP users were dispensed PrEP from a pharmacy in the Toronto core region but between 2015 to 2018 the relative increases were greatest in regions outside Toronto core.
  • Over 700 physicians prescribed PrEP at least once between March 2018 and February 2019, over 40% of whom were located in the Toronto core region.

OHESI releases new report on HIV testing in Ontario 2017

The Ontario HIV Epidemiology and Surveillance Initiative (OHESI) is pleased to announce the release of a new report titled “HIV testing in Ontario, 2017”.

View report

Reporting on HIV testing data in Ontario is critical to measuring our success in the HIV prevention, engagement and care cascade. A robust testing program ensures that high risk individuals receive regular HIV tests and that people who are living with HIV can learn their status and be linked to care. HIV testing is also an important gateway to services for people who are HIV-negative to be linked to prevention services. Trends in HIV testing can be useful for measuring the success of HIV testing initiatives.

In the 2017 HIV Testing Report, OHESI describes the trends in HIV testing in Ontario over the past decade (2008-2017), with a focus on HIV tests in 2017. The report includes analyses broken down by type of test (nominal, coded, and anonymous), sex, age, HIV exposure category, and geographic location (health regions), as well as information specific to rapid/point-of-care (POC) and prenatal HIV testing. Metrics described in the report include the number and percent of HIV tests, rates of HIV tests per 1,000 people, and HIV test positivity rates (i.e. the percent of HIV diagnostic tests with a confirmed HIV-positive result), among other analyses. For more information on HIV diagnoses in Ontario, please see the OHESI new report on HIV diagnoses in Ontario, 2017

Some of the key findings of the report:

  • In 2017, there were 574,035 HIV tests in Ontario – equivalent to an HIV testing rate of 40.4 tests per 1,000 people.
  • While the number of tests conducted remained relatively stable between 2008 and 2013, it increased by 29.9% between 2013 and 2017. The HIV testing rate per 1,000 people also increased by 24.1% during this time.
  • In 2017, the vast majority of HIV tests (95.9%) – including POC tests – were nominal and the remainder were coded (1.6%) or anonymous (2.5%).
  • In recent years, the number and rate of HIV tests were similar among males and females. In 2017, 50.1% of people tested were males and 49.9% were females. For the first time in 2017, the number of HIV tests among males was greater than the number of HIV tests among females.
  • Between 2013 to 2017, the rate of HIV tests per 1,000 people was consistently highest in the 25 to 29 age category and increased for all age groups over time. Over this time period, the HIV testing rate per 1,000 people increased for all age groups by an average of 25%.
  • Between 2013 and 2017, the percent of HIV tests in males attributed to men who have sex with men (MSM) increased from 23.7% to 30.9%.
  • In 2017, the HIV testing rate per 1,000 people was highest in Toronto (68) followed by Ottawa (46). The number of HIV tests and the HIV testing rate increased between 2016 and 2017 in all health regions.
  • Between 2013 and 2017, the number of point-of-care (POC) tests decreased by 31.7% from 29,362 to 20,068 through more targeted testing to priority populations, while the POC test positivity rate increased from 0.47% to 0.59%.
  • Between 2013 and 2017, the estimated number of prenatal HIV tests was stable and the estimated proportion of women receiving prenatal laboratory testing who had an HIV test increased from 97.3% to 97.8%.

The information in this report can also be found in the Data and figures section of the OHESI website.

Stay tuned for future reports from OHESI!

OHESI releases new report on HIV diagnoses in Ontario 2017

The Ontario HIV Epidemiology and Surveillance Initiative (OHESI) is pleased to announce the release of a new report titled “New HIV diagnoses in Ontario, 2017”.

View Report 

This report describes, updates and expands on the trends in HIV diagnoses in Ontario over the past decade (2008-2017) with a focus on new HIV diagnoses in 2017. It presents analyses by sex, age, race/ethnicity, geographic location and priority populations (i.e. subgroups of Ontarians who experience a higher risk of HIV).

This report is the first to use data from the Laboratory Enhancement Program (LEP) to better understand trends in new HIV diagnoses in Ontario. This new information allowed us to:

  • reduce double counting by removing HIV diagnoses with a documented history of a previous HIV-positive test result within Ontario
  • Identify HIV diagnoses with a documented history of a previous HIV-positive test result outside of Ontario (‘out-of-province’ diagnoses). These individuals were initially diagnosed (and likely infected) outside of the province, and then moved to Ontario and were tested again. To help target prevention programs, it is important to exclude these diagnoses for some analyses. At the same time, it is important to report on all new HIV diagnoses so the health system can plan services for all people living with HIV in the province.


A few key findings of the report include:

  • The number of new HIV diagnoses has increased each year since 2014. In 2017, there were a total of 916 new HIV diagnoses. When ‘out-of-province’ diagnoses were removed, there were 797 new HIV diagnoses.
  • Gay, bisexual and other men who have sex with men still account for the largest proportion of HIV diagnoses while women account for approximately 1 of 5 new HIV diagnoses.
  • Between 2012 to 2017, the proportion of new HIV diagnoses has decreased among White men and increased among Black men while, over the same period, the proportion of new diagnoses has increased among White women and decreased among Black women.
  • Toronto has the highest number and rate of new HIV diagnoses in Ontario, almost twice the rate of the next highest health region (Ottawa).


Stay tuned for the 2017 HIV Testing Report, coming soon!


OHESI releases Women & HIV in Ontario factsheet

We are excited to announce the release of a factsheet about women and HIV in Ontario. This factsheet was developed in collaboration with the Women & HIV/AIDS Initiative (WHAI), the Ontario HIV Epidemiology and Surveillance Initiative (OHESI), and the OHTN Cohort Study (OCS). The purpose of this factsheet is to highlight which women are most at risk for HIV and the service needs and challenges for women living with HIV in Ontario.

Download Women & HIV in Ontario factsheet.

The intent of the fact sheet is not to be exhaustive, but to provide an overview of the key issues we must address to end the HIV epidemic for women in Ontario. The information is gathered from multiple sources, including surveillance data, communicated research findings, published literature, and conference proceedings. We included the most recent and rigorous data available to draw attention to specific issues.

We hope this factsheet helps support the development and implementation of services and policies that meet the needs and priorities of women living with or at risk of HIV.

For more information on WHAI or to contact a WHAI coordinator, visit
For more information on the OHTN Cohort Study (OCS), visit

OHESI releases new factsheet to mark World AIDS Day 2018

World AIDS Day provides an opportunity to remember those who lost their lives to HIV/AIDS, educate people about the impacts and prevention of HIV infection, celebrate our accomplishments, and support those in the continued fight against the pandemic. Today we release a new OHESI factsheet to commemorate World AIDS Day.

Download 2017 Testing and Diagnosis factsheet.

Over the course of the Ontario epidemic, HIV infections have declined and outcomes have improved, but new infections persist. Our continued effort is necessary to reduce the number of people affected by HIV and the disproportionate burden experienced by those at greatest risk (priority populations). The Ontario HIV Epidemiology and Surveillance Initiative (OHESI) plays a critical role by providing information that informs effective policies and programs in Ontario.

This factsheet includes an update for 2017 testing and diagnosis data. In summary, HIV testing in Ontario continues to increase with testing rates similar for males and females. There were 916 new diagnoses in Ontario; these diagnoses include a number of individuals originally diagnosed (and who likely became infected) elsewhere and later moved to Ontario and tested again. Excluding those previously diagnosed out of province, there were 797 new diagnoses. Regional breakdowns and breakdowns for males and females, by age and priority population, are included on the factsheet.

World AIDS Day brings us together to remember those who have passed on, to share knowledge, and to support the response to HIV/AIDS. We support this event with reinvigorated optimism and a strategy for the future.

Please join the OHESI mailing list to have access to the most up to date information on HIV/AIDS in Ontario.

OHESI releases new report presenting HIV indicators by public health unit

OHESI is pleased to announce the release of a new technical report: HIV in Ontario by public health unit: Testing, new diagnoses and care cascade.

Download the report on “HIV in Ontario by public health unit.”

Timely, relevant HIV epidemiological data are critical for public health units (PHUs) to monitor their local HIV epidemic, and to plan and evaluate local health promotion and prevention programs. PHU-level data is not only important for the health units themselves, but also for AIDS Service Organizations and other community-based organizations whose catchment areas may be better represented by these smaller geographic boundaries.

This newly released report is the first OHESI knowledge product to present HIV indicators at the PHU level. The data included in the report span the breadth of the HIV prevention, engagement and care cascade and include testing and diagnosis, as well as later care cascade indicators (i.e., the percent of diagnosed individuals who are in care, on antiretroviral treatment and virally suppressed). These indicators were derived from databases at the laboratory at Public Health Ontario.

A few key findings of the report include:

  • Diagnoses were distributed unevenly across Ontario and there were relatively small numbers in most PHUs. Between 2013 and 2017, the cumulative number of diagnoses ranged from 2,220 in Toronto to zero in Huron County, and there were fewer than 25 cumulative diagnoses in 21 PHUs.
  • Toronto and Middlesex-London had the highest diagnosis and positivity rates, followed by Ottawa, Hamilton and Windsor-Essex (not necessarily in that order).
  • While test rates were generally similar by sex in each PHU, diagnosis rates were higher for males than females in almost all PHUs. The overall diagnosis rate was four times higher for males than females.
  • PHUs with the largest numbers of diagnosed people living with HIV (for example, Toronto, Ottawa, Peel, Hamilton, Middlesex-London) generally ranked in the middle to lower end in terms of the measures of engagement in the HIV care cascade (i.e., the percent who were in care, on antiretroviral treatment or virally suppressed).

We hope you find the data in this report useful. Moving forward, OHESI aims to produce similar reports in the future.

OHESI releases factsheet summarizing Ontario’s HIV care cascade

This new knowledge exchange product is OHESI’s first factsheet and summarizes data from two previously published OHESI technical reports titled ‘HIV care cascade in Ontario‘ and ‘HIV care cascade in Ontario by sex, age and health region‘. These cascade data include the number of people who are living with diagnosed HIV in Ontario and the percent who are in care, on antiretroviral treatment and virally suppressed. Click here to check out the factsheet.

Stay tuned for additional reports and factsheets that include testing and diagnosis data up to 2017.

Refining HIV surveillance on new HIV diagnoses in Ontario


  • In Ontario, the number of new HIV diagnoses has increased in recent years. Challenges to interpreting diagnosis trends include:
    • The double-counting of individuals diagnosed through anonymous testing (duplicate diagnoses).
    • The inclusion of people who were diagnosed outside of the province and later moved to Ontario and tested again (‘out-of-province’ diagnoses).
  • In recent analyses led by OHESI, removing duplicates decreased the number of diagnoses in 2017 from 935 to 916. Also removing ‘out-of-province’ diagnoses further reduced this number to 797.
  • These analyses also suggest that the overall increase in new diagnoses between 2016 and 2017 was the result of an increase in ‘out-of-province’ diagnoses, rather than an increase in new HIV transmissions in the province.

Surveillance data on new HIV diagnoses are often used by front-line service providers and policy makers to inform their work. Information collected on diagnoses, such as sociodemographics and HIV risk factors, is commonly used to:

  • guide the planning and delivery of appropriate HIV care.
  • inform HIV prevention initiatives and evaluate their success (as new diagnoses are often used as an indirect way of measuring new infections).

This blog post describes the challenges of using Ontario surveillance data for the above purposes, OHESI’s recent work in refining these data and the impact of these refinements on recent trends.

Information collected during HIV testing in Ontario

Before discussing refinements to HIV surveillance, it is important to understand the HIV testing process and how information on newly diagnosed individuals is collected in Ontario.

When a person is tested for HIV in the province, the health care provider ordering the test fills out an HIV test requisition form. This form collects information on the person tested, including sex, date/year of birth, HIV risk factors and either the person’s name (nominal testing) or an anonymous code (anonymous testing).

When a person tests positive for HIV, Public Health Ontario sends a second form – the Laboratory Enhancement Program (LEP) questionnaire – to the health care provider who ordered the initial test. The purpose of this second form is to supplement the HIV test requisition and provide a more comprehensive understanding of who is being diagnosed with HIV in Ontario. Data collected on the LEP form includes some of the same information documented on the requisition form, as well as other information, such as race/ethnicity, country of birth and HIV testing history.[1]

Double-counting of diagnoses

In Ontario, a new diagnosis is defined as an individual’s first HIV-positive test result in the province. This means that if a person receives more than one HIV-positive test in Ontario (see Box below), only the first test is counted as a new diagnosis in order to avoid double-counting. Duplicate diagnoses are identified and removed when test information is entered into the laboratory surveillance databases at Public Health Ontario.

Why might a second HIV diagnostic test be conducted?

There are several possible reasons. For example, some physicians order an HIV test to confirm an individual’s diagnosis when the person first enters care.

Anonymous testing provides an important option for people concerned about privacy; however, it complicates the accurate collection of surveillance information and can result in an individual being counted twice in the data. With anonymous testing, duplicate diagnoses are difficult to identify due to the lack of identifying information collected on the person tested. For example, someone who initially received an HIV-positive diagnosis through anonymous testing, and later had a nominal HIV test when entering care, may be counted twice as a new diagnosis.[2] Individuals who receive more than one anonymous HIV-positive test may also be counted twice.

When people are double-counted, the number of new diagnoses included in Ontario surveillance reports is higher than the actual number of diagnoses.

‘Out-of-province’ diagnoses

Interpretation of diagnosis trends is also complicated by individuals who were initially diagnosed outside of Ontario and then moved to the province and tested for HIV again (for example, as part of the immigration process or when entering care). These ‘out-of-province’ diagnoses are counted as a new diagnosis in Ontario and their inclusion means that trends can be influenced by migration patterns to the province, in addition to other factors. This makes it difficult to interpret trends. For example, an increase in new diagnoses could be due to more HIV transmissions occurring in Ontario, more HIV-diagnosed individuals moving to and being re-tested in Ontario, or a combination of both.

Refining Ontario’s HIV surveillance data

OHESI (a collaboration between Public Health Ontario and the Ontario HIV Treatment Network, AIDS Bureau of the Ontario Ministry of Health and Long-Term Care, and Public Health Agency of Canada) is dedicated to providing the best possible provincial surveillance numbers for Ontario. By refining the new diagnosis data, we may be able to better estimate the actual number of people who receive a first time HIV-positive diagnosis in Ontario, as well as improve our ability to interpret trends.

Recently, OHESI conducted new analyses to determine how information collected on HIV testing history (on the LEP form) could help improve these data. This LEP-based information includes when and where an individual has previously tested positive for HIV.[3]

In these new analyses:

  • diagnoses with history of a previous HIV-positive test result within Ontario were removed in order to reduce double-counting (as these diagnoses are duplicates and would have already been counted as a new diagnosis with their first positive test in Ontario).
  • individuals with history of a previous HIV-positive test result outside of Ontario (‘out-of-province diagnoses) were removed in order to better assess trends in new HIV infections that occurred in the province (as these individuals were most likely infected with HIV outside of Ontario).

Note: Diagnoses with history of a previous HIV-positive test result are referred to as ‘previous positives’ in the remainder of this post.

What is the impact of removing previous positives?

Trends in the number of new diagnoses in Ontario between 2008 and 2017 are shown in the figure below, along with the impact of excluding previous positives.


Line graph showing new diagnoses with previous positives removed (over time)

The top line displays the trend in new diagnoses when the LEP is not used to remove any previous positives. This line shows a decrease in diagnoses in the earlier part of the past decade, followed by an increase between 2013 and 2017.

When the LEP form is used to address double-counting and remove duplicate diagnoses with history of a previous positive test result within Ontario (the middle line), the trend is identical but there are an average of 22 fewer diagnoses each year.

When ‘out-of-province’ diagnoses are also removed (the bottom line), the difference is more noticeable. In this scenario, the trend is identical until 2016 and then – instead of continuing to increase – the number of new diagnoses in Ontario decreases to 797 in 2017.

Taken together, these data suggest that the increase in new diagnoses between 2016 and 2017 (as observed in the top and middle lines) was the result of an increase in ‘out-of-province’ diagnoses, rather than an increase in new HIV transmissions in the province. Further, these data suggest that the number of new HIV infections occurring in Ontario in recent years may be closer to 800 than 900, and possibly lower (information on HIV testing history is missing for about half of diagnoses each year).[4]


Moving forward, OHESI will use information collected on HIV testing history to refine Ontario diagnosis data.

Future OHESI knowledge exchange products will exclude diagnoses with history of a previous positive within Ontario to reduce double-counting. Importantly, OHESI will continue to include ‘out-of-province’ diagnoses to provide an accurate picture of how many people and who require HIV care in the province. However, in separate tables and figures, OHESI will also exclude ‘out-of-province’ diagnoses in order to better understand trends in new HIV infections and guide HIV prevention priorities.

We hope these refinements will enhance the usefulness of surveillance data for people working in HIV.


  1. Race/ethnicity, country of birth and HIV testing history were added to the HIV test requisition in 2018.
  2. In Ontario, an average of 115 people are diagnosed with HIV through anonymous testing each year. However, it is unclear how many of these individuals also receive an additional anonymous and/or nominal HIV-positive diagnostic test and are double-counted.
  3. Information on HIV testing history has been collected on the LEP since the questionnaire was introduced in 1999, but is not available for every diagnosis. Approximately 50% of new HIV diagnoses have both 1) an LEP questionnaire returned, and 2) the HIV testing history section of the questionnaire completed.
  4. Additional caution is needed when using new HIV diagnoses as an indirect measure for new HIV infections. This is because many people are not diagnosed in the year they become infected with HIV. OHESI is currently working with mathematical modelers to better estimate the number of new HIV infections.

OHESI releases new report on HIV testing trends in Ontario

OHESI is pleased to announce the release of a new report titled “HIV testing in Ontario, 2016”.

Download report

HIV testing is an early step in the HIV prevention, engagement and care cascade and an important gateway to a continuum of services. A person who receives an HIV-negative test result can be linked to supports to remain HIV-uninfected, while those receiving an HIV-positive result can be promptly linked to care and treatment. As we have learned more about HIV prevention strategies for HIV-negative individuals (for example, pre-exposure prophylaxis and services to address syndemic health issues), and the role of earlier treatment of people living with HIV in improving health and reducing HIV transmission, the importance of HIV testing has only increased.

The Ontario HIV/AIDS Strategy prioritizes the reduction of barriers to HIV testing in order to achieve its goals of preventing new HIV infections and promoting early HIV diagnosis. Over the past decade, several initiatives have been implemented in Ontario to achieve these goals, such as the expansion of anonymous testing sites in 2006, an HIV testing blitz program aimed at gay and other men who have sex with men in Toronto and Ottawa in 2011-2012 and the release of HIV testing frequency guidelines in 2012. In this time, new testing technologies have also been developed and made available in Ontario, including point-of-care tests that can provide results within minutes and HIV tests with shorter window periods.

The newly released OHESI report being announced today supports the strategy in monitoring trends in HIV testing. This new report contains data on the number of HIV tests from 2007 to 2016 and breaks this information down by age, sex, test type (i.e. nominal, anonymous, coded), exposure category and geography. This report also contains information on the percent of HIV tests that were HIV-positive (i.e. positivity rates). Testing trends are not only important for evaluating the success of testing initiatives and identifying populations for prioritization, but also provide insight into trends in new HIV diagnoses (published in a separate OHESI report).

We hope this report is useful for evaluating and guiding HIV policy and programming work across the province.

OHESI releases new report on cascade trends by sex, age and health region

OHESI is pleased to announce the release of a new report titled “HIV care cascade in Ontario by sex, age and health region: Linkage to care, in care, on antiretroviral treatment and virally suppressed”.

Download report

In recent years, the HIV care cascade has become a core framework for those working in HIV. In its simplest form, the cascade refers to the continuum of steps that people living with HIV progress through in order to achieve viral suppression, including testing and diagnosis, linkage to and retention in care, and initiation of and adherence to antiretroviral treatment. As more research has shown the importance of viral suppression for both improving health and eliminating the risk of HIV transmission to a sex partner, the cascade has become an essential framework for evaluating and identifying gaps in HIV care.

With the release of the Ontario HIV/AIDS Strategy in 2016, Ontario joined other jurisdictions around the world in re-orienting HIV policies and programming to focus on the HIV cascade. In support of the priorities set out in the strategy, OHESI published a report summarizing trends in HIV cascade engagement among the approximately 16,000 people with diagnosed HIV living in Ontario. Importantly, this report was the first to draw upon a new data source that was created using centralized diagnostic and viral load testing databases housed at Public Health Ontario. The analyses in the report demonstrated improvement in the proportion of people with diagnosed HIV who were in care, on antiretroviral treatment and virally suppressed over time. Missing from the report, however, were cascade estimates by demographics and other breakdowns important for informing policy and front-line programming.

The newly released OHESI product being announced today builds upon this previous report by presenting cascade estimates by sex, age and health region in Ontario. The good news is that estimates have generally improved over time for both sexes, as well as across age categories and health regions. However, the report also demonstrates lower cascade estimates for people of younger ages and those living in the Northern health region, and slightly lower estimates for females and those living in Ottawa. These results support the need to understand reasons for variations in cascade engagement, which could lead to prioritizing interventions for specific populations.

Stayed tuned for an OHESI factsheet based on the findings from this report, as well as another knowledge exchange product presenting cascade estimates by priority populations, where possible. These populations are outlined in Ontario HIV/AIDS strategy and include gay, bisexual and other men who have sex with men, including trans men; African, Caribbean and Black people; Indigenous people; people who use drugs; and women at-risk, including trans women.