It’s been a busy summer for Rachel Miller, a graduate student in the BC-CfE’s Molecular Epidemiology and Evolutionary Genetics Group. Miller won a scholarship to attend the 23rd annual International AIDS Conference and she also won a prestigious award for the abstract she’ll be presenting at the conference.
Miller is the recipient of the annual “International AIDS Society and Merck Sharpe & Dohme Prize for Operational and Implementation Research in Differentiated Service Delivery” for her abstract titled “SARS-CoV-2 Lockdown Associated with Expansion of HIV Transmission Clusters Among Key Populations”. The prize recognizes “outstanding research that addresses key knowledge gaps and links new evidence to strategic programme priorities in differentiated service delivery”.
Miller’s abstract, which includes Dr. Julio Montaner (BC-CfE Executive Director and Physician-in-Chief) and Dr. Jeffrey Joy (BC-CfE research scientist specializing in evolutionary genetics and bioinformatics) as senior co-authors, is also a success because it represents the combined efforts of the BC-CfE as a whole, and showcases the strengths of the BC-CfE’s partnerships across health authorities and agencies.
Miller’s abstract brought together researchers from the BCCDC, Vancouver Coastal Health, the Faculty of Health Sciences at Simon Fraser University, and the Bioinformatics Program and the Department of Medicine at the University of British Columbia. Within the BC-CfE, Miller worked with the Molecular Epidemiology and Evolutionary Genetics Group, the Laboratory Program, and the HIV Drug Treatment Program.
The research examined how COVID-19 related public health guidelines potentially introduced barriers to care and services for people living with, or at risk of acquiring HIV.
Researchers synthesized available data from BC’s HIV programs together with publicly available data to test SARS-CoV-2 related impacts on HIV transmission over the last year. We know that following the implementation of lockdown restrictions in late March 2020, there were statistically significant declines in antiretroviral therapy (ART) initiation, pre-exposure prophylaxis (PrEP) prescriptions, plasma viral load tests, HIV testing episodes, and new HIV diagnoses.
Thankfully, the declines seen for nearly all of these metrics rebounded within the following three months, although below pre-lockdown levels. Phylogenetic analyses revealed increased growth and increases in multiple indicators of transmission events in a limited number of clusters involving people who inject drugs, relative to clusters characterized by MSM populations. The difference in level of transmission seen between these groups may be due to differences in how the impact of the restrictions varies by population. For example, while the MSM population likely experienced unprecedented decreases in level of contact as a result of restrictions, people who inject drugs likely experienced reduced access to services like supervised consumption sites and harm reduction supplies.
The increased HIV transmission, though limited, shows the need for innovative and targeted solutions to offset potential negative impacts of COVID-19, or any pandemic-related lockdowns on HIV treatment and prevention efforts.