Summary

 

HIV testing

  • In 2016, the number of HIV tests in Ontario increased to 525,544, which is equivalent to a testing rate of 37.6 tests per 1,000 people.
  • While testing was relatively stable for most of the past decade, the number of tests increased by 19.0% between 2013 and 2016. The testing rate (number of tests per 1,000 people) also increased by 15.4% during this time.
  • The recent increase in testing appears to be due to a rise in nominal testing and testing among males and men who have sex with men (MSM). This is likely the result of a combination of programming- and policy-related factors, such as the improved availability of HIV testing, the success of testing campaigns and other promotion efforts, and/or the release of provincial HIV testing guidelines in 2012 with recommendations on test frequency.[1]
  • There was a greater increase in HIV testing for males compared to females over the past decade, and the last three years were the first where the male testing rate exceeded the female rate. The increase in testing for males appears to be driven by testing among MSM. Of note, this report does not include the approximately 200,000 HIV-negative prenatal tests conducted among females each year, as they are part of an HIV testing program that is offered to all pregnant individuals.
  • As HIV test volume has increased, the percent of tests that are HIV-positive (test positivity rate) has decreased. The overall positivity rate decreased to 0.17% in 2016, meaning that for every 10,000 tests conducted, about 17 were HIV-positive.
  • HIV-positive test results were more common for males and for people testing anonymously. In 2016, the positivity rate was four times higher for males compared to females, and between four to five times higher for anonymous testing compared coded and nominal testing. The higher positivity rate among males is largely driven by the higher risk of HIV infection among MSM, while the higher anonymous positivity rate suggests this type of testing attracts people at higher risk of HIV infection.

[1] AIDS Bureau, Ministry of Health and Long-Term Care. Ontario HIV Testing Frequency Guidelines: Guidance for Counselors and Health Professionals. April 2012. Available online: http://www.catie.ca/sites/default/files/HIV-testing-frequency-guidelines.pdf

To read the full report go here

New HIV diagnoses

  • Overall, the number and rate of new HIV diagnoses in Ontario have decreased over the past decade. Between 2007 and 2016, the number of new diagnoses each year fell from 1,013 to 881 and the annual rate of new diagnoses per 100,000 people dropped from 7.9 to 6.3.
  • Despite an overall decrease in new diagnoses over the past 10 years, there has been an increase in recent years. Between 2013 and 2016, there was a 10.5% increase in the number of new diagnoses and a 7.2% increase in the rate of new diagnoses per 100,000 people. The increasing trend since 2013 may reflect a combination of factors, such as increase in the number of new HIV infections or HIV tests, a shift towards more targeted testing and/or an increase in migration of HIV-positive people to Ontario. That the number of HIV tests increased by 18.9% during this time suggests the increase in diagnoses may be partly due to HIV testing.
  • Even though there has been an increase in diagnoses in recent years, the diagnosis rate in 2016 (6.3 per 100,000 people) was still lower than in all years prior to 2013.
  • The recent increase in new diagnoses was more pronounced among females – with the diagnosis rate increasing by 2.5% for males and 29.3% for females between 2013 and 2016. The increase among females appears to be driven by diagnoses in individuals who were White, Indigenous and/or who use injection drugs.
  • While there has been a greater relative increase in diagnoses for females compared to males in recent years, the diagnosis rate has consistently been three to four times higher for males. In 2016, the diagnosis rate per 100,000 people was 10.1 for males and 2.5 for females.
  • Over the past decade, the majority of new male HIV diagnoses were gay, bisexual and other men who have sex with men and/or White, while the majority of new female diagnoses were African, Caribbean and Black. Compared to males, a higher percent of new female diagnoses were Indigenous and/or people who use injection drugs.
  • HIV diagnoses were not distributed equally across the province. In 2016, the rate of new diagnoses per 100,000 people was highest in Toronto (15.0) and Ottawa (8.8) and lowest in the Central East health region (2.3).
  • Differences in diagnoses between 2015 and 2016 varied by health region. Ottawa, Eastern, Central West and Southwest regions all experienced an increase in the number and rate of diagnoses from 2015 to 2016. Diagnoses decreased in the Toronto, Northern and Central East regions.

To read the full preliminary report go here

 Diagnosed, linkage to care, in care, on antiretroviral treatment, and virally suppressed

  • In 2015, there were 16,110 people living with diagnosed HIV in the Ontario HIV Laboratory Cohort. This represents the cohort’s estimate of the number of people with diagnosed HIV who are living in the province (upper estimate: 17,423).
  • The number of people with diagnosed HIV in Ontario has almost doubled compared to the 8,859 estimated to be living with diagnosed HIV in 2000 (upper estimate: 11,389).
  • Engagement in Ontario’s cascade has improved over time, with the percent of diagnosed people who were in care, on antiretroviral treatment (ART) and virally suppressed all increasing from 2000 to 2015. Over this 16-year time period:
    • The percent of diagnosed people who were in care increased from 81% (lower estimate: 63%) to 87% (lower estimate: 81%).
    • The percent of diagnosed people who were on ART increased from 55% (range: 34 to 60%) to 81% (range: 70 to 82%).
    • The percent of diagnosed people who were virally suppressed doubled from 41% (range: 23 to 46%) to 80% (range: 67 to 81%).
  • Time from HIV diagnosis to linkage to care and viral suppression has also improved over time.
    • The percent of newly diagnosed individuals who linked to care within three months of diagnosis increased from 67% in 2000 to 82% in 2014.
    • The percent of newly diagnosed individuals who achieved viral suppression within six months of diagnosis increased from 22% in 2000 to 41% in 2013.
  • Estimates for 2015 suggest that the majority of people with diagnosed HIV living in Ontario were on ART (81%, range: 70 to 82%), and over 90% of people on ART were virally suppressed.
  • Overall, the Ontario HIV Laboratory Cohort demonstrates improved survival and cascade engagement among diagnosed people living with HIV, likely reflecting the availability of ART regimens that are more effective and easier to take, changes to treatment guidelines to recommend earlier initiation of ART after diagnosis, and the success of care and treatment initiatives.

To read the full report go here
To read the report with cascade estimates by sex, age and health region go here