Project 464784

Human immunodeficiency virus (HIV) was once considered a terminal disease before the development of antiretroviral therapy (ART). ART prevents HIV from replicating and destroying blood cells responsible for fighting infections and preventing disease. Maintaining adequate numbers of these cells and suppressing HIV viral load protects against complications such as premature aging, heart disease and AIDS. Also, reducing HIV viral load substantially reduces the chances of infecting others. Despite the extraordinary potential for ART to combat HIV/AIDS, many people living with HIV do not take these medications regularly. This issue is especially concerning in Saskatchewan (SK) where the HIV diagnosis rate is almost three times higher than the Canadian average. On April 11, 2018, the SK government began providing ART free of charge to help reduce the financial burden for people living with HIV. Similar programs exist elsewhere, but none have been rigorously evaluated. Our research aims to determine the impact of a province-wide initiative offering free ART. We will analyze linked records of ART prescriptions, physician visits, hospitalizations and blood test results for all residents of SK. We will track changes over time for key HIV outcomes, including ART use, health services use, and markers of HIV suppression. We will also compare differences in the number of people maintaining strict adherence to their ART prescriptions before versus after the provincial initiative. Established models will be applied to pinpoint and measure the benefits overall, by sex, and for people who inject drugs. Further, given the substantial disproportionate disease burden born by Indigenous people, a specific analysis is critical, with particular attention to Métis and non-status First Nations. Evaluation of this significant initiative is essential to identify strengths, weaknesses and opportunities for improving the outcomes of people living with HIV here and nationally.