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 a slight 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. This increase may be partly due to the 18.9% increase in the number of HIV tests during the same time period.
- Even though there has been a slight 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.
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 are in care, on ART and virally suppressed all increasing from 2000 to 2015. Over this 16-year time period:
- The percent of diagnosed people who are in care increased from 81% (lower estimate: 63%) to 87% (lower estimate: 81%).
- The percent of diagnosed people who are on ART increased from 55% (range: 34 to 60%) to 81% (range: 70 to 82%).
- The percent of diagnosed people who are 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 link to care within three months of diagnosis increased from 67% in 2000 to 82% in 2014.
- The percent of newly diagnosed individuals who achieve 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 are currently on ART (81%, range: 70 to 82%), and over 90% of people on ART are virally suppressed.
- The results from the Ontario HIV Laboratory Cohort represent the most complete province-wide cascade estimates for people with diagnosed HIV living in Ontario.
- These estimates complement other data sources exploring cascade engagement among diagnosed people who have already entered HIV care in Ontario, including the Ontario HIV Treatment Network Cohort Study (OCS) and the Institute of Clinical Evaluative Sciences (ICES) administrative HIV cohort.
- 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.