Share this article on:

Process Monitoring of an HIV Treatment as Prevention Program in British Columbia, Canada

Lourenço, Lillian MPH*; Lima, Viviane D. PhD*,†; Heath, Kate PhD*; Nosyk, Bohdan PhD*,‡; Gilbert, Mark MD§; Colley, Guillaume MSc*; Consolacion, Theodora PhD§; Barrios, Rolando MD*,‖; Hogg, Robert PhD*,‡; Krajden, Mel MD§; Konrad, Stephanie MSc; Murti, Michelle MD; Nelson, Joanne BSc#; May-Hadford, Jennifer MPH**; Haggerstone, James BSc††; Pick, Neora MD‡‡; Gustafson, Reka MD; Rusch, Melanie PhD§§; Day, Irene RN, MBA*; Montaner, Julio S.G. MD*,†

JAIDS Journal of Acquired Immune Deficiency Syndromes: 1 November 2014 - Volume 67 - Issue 3 - p e94–e109
doi: 10.1097/QAI.0000000000000293
Implementation and Operational Research: Epidemiology and Prevention

Background: In light of accumulated scientific evidence of the secondary preventive benefits of antiretroviral therapy, a growing number of jurisdictions worldwide have formally started to implement HIV Treatment as Prevention (TasP) programs. To date, no gold standard for TasP program monitoring has been described. Here, we describe the design and methods applied to TasP program process monitoring in British Columbia (BC), Canada.

Methods: Monitoring indicators were selected through a collaborative and iterative process by an interdisciplinary team including representatives from all 5 regional health authorities, the BC Centre for Disease Control (BCCDC), and the BC Centre for Excellence in HIV/AIDS (BC-CfE). An initial set of 36 proposed indicators were considered for inclusion. These were ranked on the basis of 8 criteria: data quality, validity, scientific evidence, informative power of the indicator, feasibility, confidentiality, accuracy, and administrative requirement. The consolidated list of indicators was included in the final monitoring report, which was executed using linked population-level data.

Results: A total of 13 monitoring indicators were included in the BC TasP Monitoring Report. Where appropriate, indicators were stratified by subgroups of interest, including HIV risk group and demographic characteristics. Six Monitoring Reports are generated quarterly: 1 for each of the regional health authorities and a consolidated provincial report.

Conclusions: We have developed a comprehensive TasP process monitoring strategy using evidence-based HIV indicators derived from linked population-level data. Standardized longitudinal monitoring of TasP program initiatives is essential to optimize individual and public health outcomes and to enhance program efficiencies.

*British Columbia Centre for Excellence in HIV/AIDS, Providence Health Care, Vancouver, Canada;

Division of AIDS, Department of Medicine, University of British Columbia, Vancouver, Canada;

Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada;

§British Columbia Centre for Disease Control, Vancouver, Canada;

Vancouver Coastal Health Authority, Vancouver, Canada;

Fraser Health Authority, Surrey, Canada;

#First Nations Health Authority, West Vancouver, Canada;

**Interior Health Authority, Kelowna, Canada;

††Northern Health Authority, Prince George, Canada;

‡‡Oak Tree Clinic, Provincial Health Services Authority, Vancouver, Canada; and

§§Vancouver Island Health Authority, Victoria, Canada.

Correspondence to: Julio S.G. Montaner, MD, British Columbia Centre for Excellence in HIV/AIDS, 667–1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6 (e-mail:

Supported by the BC Ministry of Health–funded “Seek and Treat for Optimal Prevention of HIV/AIDS” program.

J.S.G.M. is supported by the British Columbia Ministry of Health and by the US National Institutes of Health (1DP1DA026182 and R01DA036307). He has also received limited unrestricted funding from Abbvie, Bristol-Myers Squibb, Gilead Sciences, Janssen, Merck, and ViiV Healthcare. B.N. is supported by a Scholar Award from the Michael Smith Foundation for Health Research. V.D.L. is supported by a Scholar Award from the Michael Smith Foundation for Health Research, a New Investigator Award from CIHR, and 2 grants from the Canadian Institutes of Health Research (MOP-125948) and the US National Institute on Drug Abuse (R03DA033851-01). The remaining authors have no conflicts of interest to disclose.

Some of the results described here were presented at the 18th International Workshop on HIV Observational Databases, March 27–29, 2014, Sitges, Spain (abstract #18_178) and the Treatment as Prevention Workshop, April 1–4, 2014, Vancouver, Canada (abstract #5070).

The funders had no role in the design, data collection, data analysis, data interpretation or writing of the report.

Received April 01, 2014

Accepted July 15, 2014

© 2014 by Lippincott Williams & Wilkins