Characterising the HIV care cascade in Saskatoon, Saskatchewan, 2018 - 2021

BACKGROUND: Saskatchewan has experienced a unique HIV epidemic in Canada, driven largely by injection drug use and disproportionately affecting younger women through heterosexual transmission. HIV care in Saskatoon is primarily accessed at two clinical sites: the Royal University Hospital (RUH) and the Westside Community Clinic (WSCC). While the clinic at RUH is a specialized Infectious Diseases clinic, WSCC provides community-based access to primary care and addictions support. These clinics serve over 1200 active patients living with HIV. Offering different, yet complementary clinical care, the HIV care cascades of these two sites offer insights into the HIV epidemic over time, specifically, the characteristics of each of the care models; patient populations; intersectional considerations; and the impact of the COVID-19 pandemic on patient outcomes.
DESCRIPTION: With demographic and clinical data for diagnosed Persons With HIV (PWH) across the two clinic sites over a four-year period, from 2018 ' 2021, care continuum data is compared across the two sites during the four-year time periods, characterizing the HIV care cascade for Saskatoon, SK. The data demonstrates where the gaps in care exist between the two models.
LESSONS LEARNED: The community-based care model has seen a progressive advancement in cascade outcomes, while being relatively undisrupted during the COVID-19 period, with a consistent 79% PWH engaged in care. However, the pandemic period adversely impacted cascade outcomes for the hospital-based clinic, reflected by a drop from 67% to 56% of patients on ART, and an overall trend of moderate cascade outcomes over the four-year period of analysis. The rates of virologic suppression are noted to be lowest during the peak period of the pandemic lockdown in May 2020 for both clinic sites, (65% and 46% respectively) indicating a clear impact of the pandemic lockdown mandate. A marked shift in patient demographics over the analysis period includes an increase of younger females with new infections.
CONCLUSIONS: Gaps in the care continuum offer insights to advocate for adaptation of the community-based delivery model to develop targeted solutions to expand outreach, supporting the petition for more resources for access and engagement in care for a large cohort of PWH seeking care in Saskatoon.

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