Providence Health Care

The HIV/AIDS Program at St. Paul’s Hospital (SPH) was established in the early 1980s and has had a longstanding and extensive collaboration with the Division of Infectious Diseases and the BC Centre for Excellence in HIV/AIDS (BC-CfE).  In 1997, SPH established the AIDS Ward at the peak of the AIDS epidemic in BC. This coincided with the emergence of Highly Active Antiretroviral Therapy (HAART) as the new standard of care for HIV/AIDS, in part due to research pioneered by the BC-CfE.  With the support of the provincial Ministry of Health, the BC-CfE widely implemented HAART programs in BC at no cost to eligible BC residents living with HIV, with a dramatic subsequent reduction in HIV/AIDS related morbidity and mortality. As a result, the AIDS Ward, under the leadership of Dr. Peter Phillips, was reprofiled in 2014 to support Urban Health Infectious Diseases.

Since 1996 we have known that HAART stops HIV replication, and as a result it restores health and prevents progression to AIDS and premature death. At the same time, BC-CfE research showed that HAART drives HIV to undetectable levels in biological fluids, which in turn renders HIV untransmissible and therefore stops HIV transmission. In 2006 in a landmark Lancet article the BC-CfE was the first to formally propose expanding HAART access to all HIV infected individuals, under the Treatment as Prevention^® (TasP^®) banner, to control HIV/AIDS morbidity, mortality and transmission globally.

In 2014, working together with the United Nations joint AIDS Program (UNAIDS) we, the BC-CfE, developed the TasP^® inspired 90-90-90 Target, designed to “End AIDS as a Pandemic by 2030”, defined as decreasing AIDS-related mortality and HIV new infections globally, each by 90%, using 2010 as the baseline. The proposed Target postulated that at least 90% of people living with HIV (PLHIV) should be diagnosed, at least 90% of those diagnosed should be on HAART, and at least 90% of those on HAART should have undetectable HIV levels by the end of 2020. In 2015, the Target was formally adopted by the United Nations, and Canada, and became known as the UN 90-90-90 Target.

On December 1^st, 2020, BC surpassed the 90-90-90 Target, with 92% of PLHIV diagnosed, 91% of them on HAART, and 95% virally suppressed. As a result, BC saw a decrease in AIDS related morbidity and mortality of over 90% and a decrease in new HIV infections by over 85%. These findings provided irrefutable confirmation that TasP^® works as originally postulated.  On December 1, 2023, the BC government and the BC-CfE jointly announced the virtual end of the domestic HIV epidemic (defined as a greater than 90% decrease in yearly AIDS related mortality and new HIV infections from the peak of the epidemic). This was the result of implementing TasP® since 2010, and the addition of Pre-Exposure Prophylaxis (PrEP) since 2018.

As outlined in our original proposal, in 2021, the UN 90-90-90 by 2020 Target became the UN 95-95-95 Target by 2025. By achieving our proposed UN Targets, the number of people newly infected with HIV will be expected to fall to 370,000/per year by 2025, and the number of people dying from AIDS-related illnesses would be expected to decrease to 250,000/year in 2025.

Earlier in 2021, the United Nations General Assembly convened a High-Level Meeting on AIDS. Ending AIDS as a public health threat by 2030 remains possible. On June 8^th, under the leadership of UN Secretary General, António Guterres, UN Members States, including Canada, ratified the UN 95-95-95 Target, as originally proposed by the BC-CfE.

Unfortunately, HIV/AIDS control suffered a substantial setback in 2025, as a result of the US administration’s decision to severely curb funding to support domestic and international health programs. Sadly, most of the G7 countries are also cutting support for international programs. As a result, we held a pan-Canadian Summit on HIV-Treatment as Prevention in Vancouver in June 2025. It became clear then that HIV rates are increasing rapidly across Canada, partly due to the uneven implementation of HAART & PrEP domestically, and in large part due to migration of people living with HIV across Canada, or into Canada. This has led us to mount a concerted effort to inform provincial and federal leaders, including the Prime Minister, of the urgent need to redouble Canada’s efforts to control HIV/AIDS.

Specifically, BC-CfE wrote to Prime Minister Mark Carney calling for the implementation of a “Canadian Plan for 2025-2030” that would highlight Canada’s role as a global leader in the ongoing fight against HIV/AIDS. In brief, the plan asks to redouble the Canadian efforts to meet the 95-95-95 Target at the earliest possible time, to ensure that Canada can “End HIV/AIDS as an Epidemic” by 2030. To do so, Canada must:

• Fully fund HAART and PrEP within the national Pharmacare program
• Enhance phylogenetic monitoring of clusters nationally
• Set up a centralized frequent reporting at PHAC
• Harmonize risk reduction policies across the country
• Address the overcriminalization of HIV transmission
• Enhance social/medical supports for priority populations.

In addition, consistent with Prime Minister Mark Carney’s call for Canadian global leadership, Canada should lead by example and urgently increase the support of the Global Fund.

Hope to Health Research and Innovation Centre (H2H R&IC).

In 2019, the BC-CfE extended its attention to the broader health needs of a similarly highly vulnerable and clinically complex inner-city population, opening the Hope to Health Research and Innovation Centre (H2H R&IC) in Vancouver’s Downtown East Side (DTES).  This new initiative harnessed the vast collection of knowledge in clinical care and education, monitoring and evaluation in both programmatic and public health domains, and data management that the BC-CfE has gained over its more than 30 years of success leading the fight against HIV locally, nationally and globally.  Importantly, this initiative leverages the ample evidence of the effectiveness of TasP® and STOP HIV/AIDS® related strategies to accelerate the control of contagious diseases (including infectious diseases, such as HIV, HCV, STIs, etc., or socially contagious diseases, such as type II Diabetes, COPD, Substance Use Disorders, etc.). Furthermore, the H2H R&IC harnesses the BC-CfE's proven record of successfully and meaningfully engaging with highly complex and harder-to-reach populations.

The H2H R&IC’s aim is to improve health of the most vulnerable and marginalized individuals who typically present with chronic substance use disorder (SUD) and serious mental illness (SMI) in addition to multiple and often undiagnosed or undermanaged acute and chronic comorbidities and significant social issues, including poverty and homelessness.

The H2H R&IC’s flagship program is a community- based comprehensive and client-centred primary care program (the H2H Primary Care Clinic, H2H- PCC), which offers specialized primary care services for clients that typically present with complex morbidities, including chronic SUD and SMI.  The H2H-PCC is supported by several clinical support services as well as specialty laboratory services, a central pharmacy, an onsite supervised consumption site (SCS) and a dedicated Innovation, Monitoring and Evaluation Unit (IM&E).  This high-risk medically and psychosocially complex inner-city population is, more often than not, unable to access or benefit from typical community health services, resulting in even relatively mild problems frequently becoming clinically urgent and often leading to an emergency department visit or hospital admission.  More appropriate low barrier, client centred, community primary care services can improve people’s health status, encourage clients to engage in SUD and other treatment, prevent acute exacerbations, and avoid emergency department visits and acute or even long-term hospital care.

The H2H supervised consumption site is a low barrier, harm reduction service open 24/7. This is often an entry point to care for people who use drugs and while designed to help prevent fatal overdoses, it also provides clinical care, harm reduction supplies and education, community connection and many other services.

The clinical-research environment provided by the H2H R&IC creates the opportunity to increase understanding of this population’s complex needs and enables the exploration, design, implementation, and evaluation of new and potentially more effective service models and interventions. To date, epidemiological, behavioural and public health studies at H2H R&IC have focused on clinical care and treatment for priority conditions (i.e.: HCV, HIV, syphilis, SUD) and assessing healthcare engagement (i.e., prescribed alternatives and harm reduction services for substance use disorders, access to primary care, psychosocial support and other topics). In addition, H2H R&IC has launched a series of ground-breaking studies of opioid use disorder treatment, which address important issues in clinical care such as titration, dosing, and testing new therapeutics. The opportunity to increase innovation across the clinical services is a unique feature of H2H R&IC, which means the application of new knowledge and research can be more directly applied into action.  This broad expertise in clinical care, quality improvement, monitoring and evaluation, research, and knowledge translation and in situ key underlying support structures in the areas of epidemiology, clinical education and training, data management and analytics and operations presented a unique opportunity to harness the BC-CfE to service vulnerable populations in BC.

In May 2024, the Ministry of Health (MoH) entered a shared cost arrangement (SCA) with the BC Centre for Excellence (BC-CfE). There are three primary aims of the contract: 1) expand services at the H2H R⁣ 2) develop an integrated monitoring and evaluation program to address syndemics; and 3) identify opportunities to expand TasP to other priority conditions.

The key deliverable for the 2024-2025 year is a significant increase in the H2H-PCC client volume, and the development of a preliminary plan to “franchise” a simplified H2H model of care as part of a collaborative network of inner-city sites in the future.  In addition, BC-CfE proposed to establish the first indoor supervised smoking and inhalation rooms (H2H-SIS) in the City. This will consist of six fully purposed units with separate ventilation to be built at the SCS in the latter part of the year. It is anticipated the SIR will generate about 1000 visits monthly within the first year of operation.

Expansion of TasP to additional target morbid conditions.

With the support of the MoH, the BC-CfE launched a doxycycline for the prevention of bacterial STI initiative in Dec 2023. A baseline evaluation confirmed elevated bacterial STI rates amongst BC-CfE Drug Treatment Program (DTP) participants.  Baseline syphilis rates, as a proxy for bacterial STIs, were elevated at 5.57 per 100 person years amongst gbMSM living with HIV, and 5.09 per 100 person- years amongst HIV PrEP participants (CROI 2024).  Through Q2-2024, the initiative has enrolled >2800 participants (98% cisgender men, median age 36 years), including ~23% reporting prior use of doxy for STI prevention, at enrolment. Early uptake was high among PrEP participants (85% of enrollees from PrEP program and 15% from the HIV treatment program).

In July 2023, the BC-Ministry of Health renewed the HCV-TasP mandate of the BC-CfE targeting priority populations.  Analyses of currently available HCV data in existing datasets are formally planned (e.g., BC Hepatitis Testers Cohort, Hope to Health Clinic data, STOP HIV/AIDS®, BC-CfE Drug Treatment Programs). In addition, we conducted an evaluation of Dried-blood spot (DBS) testing as a potential intervention to increase HCV and other STBBI screening rates at H2H.

Finally, as part of our extramural collaborations, the BC-CfE has continued involvement with the COPD program at VGH, the respirologists at SPH, and cardiologists at SPH, exploring opportunities to expand TasP COPD. We are also working with Drs. Janice Leung and Kevin Duan to assess lung function and respiratory disease prevalence among people who smoke unregulated substances.

In collaboration between the Hope to Health Clinic, the BC-CfE Clinical Trials Group, the VGH Chronic Pain Service, and H2H R&IC Pharmacy services has provided the opportunity to evaluate innovative approaches to the treatment of substance use (e.g. SiFi, other SUD clinical studies).