Of 644 SHAPE participants, three were excluded due to incomplete baseline surveys, 256 were excluded due to having an HIV diagnosis date prior to January 1, 2000, 53 were excluded due to initiating ART outside of BC, and seven were excluded because ART-naïve status at the time of entry into the DTP could not be confirmed. After applying exclusion criteria, we had 325 participants that were included in this analytic sample.

Demographics and health status

Of the 325 (50.5% of 644) participants from the SHAPE baseline survey eligible for inclusion in this analysis, 198 (61%) were diagnosed with HIV in the pre-STOP HIV/AIDS era and 127 (39%) were diagnosed during the post-STOP HIV/AIDS era. The median age of individuals at diagnosis in the analytic sample was 37 years old (Q1-Q3: 30–46), 26.2% were women, 72.3% were men, < 2% were transgender or non-binary individuals, 38.8% identified as gay, 48.3% lived within the Vancouver Coastal Health Authority, and 64.2% had insufficient food security (see Table 1).

Table 1 Characterizing sociodemographic profiles and treatment experiences among people living with HIV before and after the implementation of the provincial STOP HIV/AIDS program in British Columbia, Canada

Participants diagnosed with HIV during the STOP HIV/AIDS era were more frequently men (81.9% vs. 66.2%; p = 0.004), identified as gay (45.7% vs. 34.3%; p = 0.039), and had completed high-school or greater (79.5% vs. 61.6%; p = 0.001) in comparison to those diagnosed prior to the implementation of the provincial program. There was no significant difference between participants in the pre- vs post-intervention eras (median age of 37 and 38, respectively, p = 0.258). PLWH diagnosed during the post-intervention era were less likely to report a history of incarceration as an adult versus PLWH diagnosed prior to the provincial initiative (30.7% vs 48.0%; p = 0.002). History of homelessness was prevalent overall, with 59.6% and 50.4% reported being homeless currently or previously, prior to and during the post-intervention era, respectively, although there was no statistical difference between the two groups (p = 0.103).

Coinfection of HCV (18.1% vs. 48.2%; p < 0.001), HBV (6.3% vs. 16.2%; p = 0.008), self-reported ever using heroin (26.8% vs. 39.9%; p = 0.015), and lifetime injection drug use (36.2% vs. 53.0%; p = 0.003) were less frequent among post-intervention participants. Indication of significant depressive symptoms (CES-D 10 scale scores of ≥ 10 [18, 19]) remained highly prevalent across eras (pre-STOP HIV/AIDS: 50.6%; post-STOP HIV/AIDS: 55.4%; p = 0.415).

HIV experiences of care

There were important differences in the clinical experiences around HIV diagnoses reported in this analysis, with participants in the post-STOP era reporting fewer HIV diagnoses with a family doctor (20.5% vs 32.3%) and a greater proportion of HIV diagnoses with walk-in clinics (44.9% vs 39.4%) and hospitals (20.5% vs 11.1%) compared to PLWH diagnosed in the pre-STOP HIV/AIDS era (p = 0.042) (see Table 1). Participants diagnosed in the post-STOP HIV/AIDS era reported higher use of clinical services such as follow-up appointments with their diagnosing physician (46.5% vs 32.8%,%, p = 0.014), nurse consultations (41.7% vs 17.7%, p < 0.001), appointments with another medical professional (33.9% vs 22.7, p = 0.028), and visits with specialists (70.1% vs 57.1%, p = 0.018), than pre-STOP HIV/AIDS participants (see Fig. 1). Furthermore, the resources allocated in the regional health authorities as part of the STOP HIV/AIDS program for psycho-social supports led to increased utilization of nutritionist appointments (25.2% vs 13.1%, p = 0.006), social workers (28.3% vs 17.7%, p = 0.008), and peer support (26.0% vs 16.2%, p = 0.031), in the post-STOP HIV/AIDS era. Desire for HIV care and supportive services following HIV diagnosis did not differ significantly (p > 0.05) between participants in the two groups (see Fig. 2). However, participants diagnosed in the post-STOP HIV/AIDS era were less likely to report a desire for counselling (post-intervention 14% vs pre-intervention 17%), peer support (14% vs 21%), substance use counselling (11% vs 10%), medication adherence assistance programs (6% vs 9%), a nutritionist (10% vs 15%), a social worker (11% vs 14%), and housing assistance (13% vs 19%). This is a reflection of increased provision and availability of nursing, outreach, and psycho-social services, addressing much needed gaps in care identified in the cohort diagnosed with HIV prior to the STOP HIV/AIDS implementation.

Fig. 1

Use of HIV Care and Support Services following HIV diagnosis prior to and during the STOP HIV/AIDS program implementation. * = statistically significant difference (p ≤ 0.05)

Fig. 2
figure 2

Desire for HIV Care and Support Services following HIV diagnosis prior to and during the STOP HIV/AIDS program implementation

HIV treatment outcomes

Median CD4 count at time of ART initiation was significantly higher among post-STOP HIV/AIDS participants with 410 cells/ul (Q1-Q3: 220–620) compared with 270 (170–430) (p = 0.001). Additionally, there was a significantly lower proportion of participants with treatment interruptions reported within five years following ART initiation in the post-STOP HIV/AIDS era (during 17.3% vs prior 48.0%; p < 0.001) (see Table 1).

When adjusted for age, gender, sexual orientation, and history of injection drug use, STOP HIV/AIDS era participants were 5.97 times more likely to initiate ART than pre-STOP HIV/AIDS participants (adjusted hazards ratio [aHR] 5.96, 95% CI 4.47–7.97; p < 0.001) (see Table 2). Median time to ART initiation for STOP HIV/AIDS era participants was within 1.5 months of HIV diagnosis, compared to 27.5 months for participants prior to the provincial initiative (see Fig. 3A).

Table 2 Multivariable Cox regression analysis of time to ART initiation
Fig. 3
figure 3

Kaplan Meier plots for time to ART initiation and virological suppression by STOP era

In the adjusted multivariable model, the STOP HIV/AIDS era participants were significantly more likely to reach viral suppression than prior to STOP HIV/AIDS era participants (aHR 2.03, 95% CI 1.58–2.60; p < 0.001) (see Table 3). Median time to virological suppression for STOP HIV/AIDS era participants was 2.3 months versus 4 months for prior to STOP HIV/AIDS participants (see Fig. 3B).

Table 3 Multivariable Cox regression analysis of time to virological suppression

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