B.C. Women's Hospital & Health Centre

Weight gain associated with antiretroviral therapy, particularly second-generation integrase strand transfer inhibitors (INSTIs), is an increasingly recognized concern. However, literature remains mixed regarding whether these effects differ by sex/gender. This scoping review aims to map the pattern, timing, severity and risk factors for weight gain among cis and trans women initiating or switching to second-generation INSTIs, such as dolutegravir, bictegravir or cabotegravir. Four databases (EMBASE, MEDLINE, Web of Science and CINAHL) were searched for studies reporting on weight gain after initiating or switching to second-generation INSTIs in cis and trans women or mixed cohorts with data disaggregated by sex/gender between 2010 and 2024. Three reviewers independently conducted the screening, and two reviewers extracted data. Forty articles were included. Most studies reported trends of increased and excessive weight gain in cis women compared to cis men taking dolutegravir or bictegravir-based regimens, although findings were inconsistent and the extent of weight gain varied. Weight gain was particularly pronounced among treatment-naive cis women, those of Black ethnicity or in African settings, and participants receiving dolutegravir in combination with tenofovir alafenamide. Studies on weight gain in cis women taking cabotegravir-based regimens and trans women on any regimen were scarce. Second-generation INSTIs, especially dolutegravir, appear to be associated with greater average and excessive weight gain among cis women, although this effect varies by setting, regimen and clinical context. Further research, especially in diverse populations, is needed to explore underlying mechanisms, determine risk factors and evaluate these trends in newer antiretroviral medications.

Trauma-informed approaches can promote the creation of systems that prioritize safety and empowerment to improve patient well-being. These approaches are especially important in sexual and reproductive health care, where patients are often asked to disclose sensitive and personal information. This disclosure is particularly relevant in the context of endometriosis, a condition that affects 10% of reproductive-aged women and causes debilitating pelvic pain. Our team led a trauma-informed social media campaign to raise awareness and improve the understanding of endometriosis by sharing research findings from a photovoice study focusing on Asian women's experiences of endometriosis during the COVID-19 pandemic in Canada (EndoPhoto Study). In this paper, we describe how we adapted and applied trauma-informed approaches to the development and implementation of the social media campaign. To do this, we followed five adapted trauma-informed principles: (1) support and collaboration, (2) trustworthiness and transparency, (3) safety, (4) empowerment and voice, and (5) cultural and gender sensitivity, and four steps: (1) frame the campaign, (2) create content and manage the campaign, (3) measure campaign impact, and (4) conduct postcampaign reflections. We co-designed this campaign with patient partners having lived experience of endometriosis to facilitate support and collaboration. Additionally, we shared details about the funders of this study to increase trust and transparency, moderated comments and deidentified images to promote participant safety, chose safer platforms to enhance empowerment and voice, avoided stereotypes, and shared authentic experiences of Asian women with endometriosis to support cultural and gender sensitivity. The campaign launched on Instagram and Pinterest in March 2025 to coincide with Endometriosis Awareness Month. The social media campaign received 8,540,528 total impressions over the course of the month and had engagement rates of 6.23% and 1.4% on Instagram and Pinterest, respectively.

Presumptive HIV therapy (PHT) is recommended for post-natal HIV prophylaxis (PNP) in situations at high risk of HIV vertical transmission (VT), for both prevention of transmission and as early treatment in cases of in utero transmission. The objective of this study was to describe the risk of VT and use PHT among newborns in Canada, and specifically, factors associated with the use of PHT. Data were analysed for all mother-infant pairs (MIPs) in the Canadian Perinatal HIV Surveillance Program (1997-2020), collected annually from 22 perinatal HIV centres in Canada. Infants were categorized as high risk (delivery viral load [dVL] ≥1000 copies/ml or maternal combined antiretroviral [cART] <4 weeks prior to delivery), moderate risk (dVL detectable and <1000 copies/ml, and maternal cART ≥4 weeks prior to delivery) and low risk (dVL undetectable and maternal cART ≥4 weeks prior to delivery). Neonatal prophylaxis and HIV transmission risk were compared between groups. A total of 4743 MIPs were included in the analysis. Overall, 13.3% of newborns received PHT; the most prescribed PHT regimens included combinations using zidovudine, lamivudine and nelfinavir (48.5%) or nevirapine (41.9%). While the most significant risk factor for transmission on univariate analysis was a detectable dVL ≥1000 copies/ml versus undetectable (odds ratio [OR] 27.91 [11.20-69.54]), the risk remained significantly increased at dVL between 400 and 999 copies/ml (OR 31.71 [8.31-120.98], but not at dVL between 50 and 399 copies/ml (OR 3.03 [0.72-12.81]). At dVL 50-399 copies/ml, 29.8% of infants received PHT, increasing to 46.7% at dVL 400-999 copies/ml, and 64.4% of infants at dVL≥1000 copies/ml. The overall risk of transmission was 6% in the high-risk group, 0.5% in the moderate-risk group and 0.2% in the low-risk group. PHT has been widely used in Canada in situations at high risk of VT, with 25% of newborns in this risk group receiving PHT as PNP. While PHT may reduce the risk of VT in high-risk situations and may be of benefit in cases of VT, these data also highlight ongoing gaps in perinatal HIV prevention in Canada.

BackgroundWhile individual sexually transmitted infections are linked with preterm births, their synergistic impact among pregnant people living with HIV (PLWH) remain unclear. We aimed to identify the impact of antenatal sexually transmitted infections and bacterial vaginosis on preterm birth in PLWH.MethodsWe completed a population-based cohort study using the British Columbia Perinatal HIV Surveillance Database, capturing all births in PLWH from January 1997 to December 2022. Univariate risk factors for preterm birth were identified using chi-squared tests, Fisher’s exact tests and t-tests, followed by a multivariate logistic regression analysis.ResultsOf 578 singleton pregnancies, 111 (19.2%) had preterm births, of which 34 (31%) delivered before 34 weeks gestational age. In our population, 11% were identified with a sexually transmitted infection or bacterial vaginosis (STIBV) in pregnancy. The preterm birth rate in PLWH with antenatal STIBV was 37% compared to 17% in PLWH without STIBV (OR: 2.18; 95% CI (1.50 – 3.16); p = .0003). Preterm deliveries were more common in individuals with concurrent Hepatitis C (OR: 2.42; p < .0001), antenatal diagnosis of Chlamydiatrachomatis (OR 2.17; p = .036), Trichomonasvaginalis (OR: 2.78; p < .001) and bacterial vaginosis (OR: 2.15; p = .003). After adjusting for ethnicity, history of preterm birth, substance use, concurrent Hepatitis C, CD4 count and viral suppression at delivery, STIBV remains an independent risk factor (OR: 2.09; 95% CI: 1.04 – 4.19; p = .039).ConclusionAmong PLWH, antenatal screening for sexually transmitted infections and bacterial vaginosis can identify individuals at the highest risk of preterm birth.

Temple syndrome is an imprinting disorder resulting from abnormal genomic or epigenomic aberrations of chromosome 14 including maternal uniparental disomy (matUPD), paternal deletion of 14q32, or aberrant methylation of the imprinting control regions at 14q32. Understanding the underlying molecular mechanism is essential to understanding the recurrence risk and physical effects. Currently, diagnosis requires the detection of aberrant methylation and copy number loss via methylation-sensitive assays such as methylation-specific multiplex ligation-dependent probe amplification, and short tandem repeat analysis to detect matUPD and the presence of epimutation. Therefore, a one-step approach that can detect aberrant methylation and underlying genetic mechanisms would be of high clinical value. Here we use nanopore sequencing to delineate the molecular diagnosis of a case with Temple syndrome. We demonstrate the application of nanopore sequencing to detect aberrant methylation and underlying genetic mechanisms simultaneously in this case, thus providing a proof of concept for a one-step approach for molecular diagnosis of this disorder.

Abstract IntroductionAutomated messaging through text (SMS) and instant messaging services (IMS) are low-cost solutions for patient follow-up in resource-constrained contexts. This study aims to evaluate a quality improvement (QI) initiative to improve caregiver response rates to an automated messaging system facilitating follow-up after hospital discharge of children in rural Uganda.MethodsThis initiative was implemented at Gulu Regional Referral Hospital in Northern Uganda from June 2022 to June 2024. Caregivers of children who were triaged through the Smart Triage digital platform were offered an automated follow-up program as part of routine care during this period. SMS and IMS (WhatsApp) messages prompting caregivers to report if their child had “improved” or “not improved” were sent seven days post-discharge. Non-responders and "not improved" cases were escalated to a phone call from a health worker. From April 2023 to June 2024, a QI initiative refined the messaging system to improve response rates. Data on message delivery, response rates, improvement strategies, and health outcomes were analyzed.ResultsOf 6826 participants, 6469 (95%) messages were successfully delivered. Response rates improved from 20% to 40%. In total, 1856 caregivers responded to the messages. Among the responses, 1244 (67%) of caregivers reported improvement and 612 (33%) reported no improvement. Follow-up phone calls for those “not improved” revealed 58 (9%) sought care, 12 (2%) were readmitted, and no deaths occurred. For non-responders, 206 (5%) sought care, 33 (0.7%) were readmitted, and 3 (0.07%) deaths occurred.DiscussionAutomated two-way text messages for post-discharge pediatric follow-up in Uganda yielded high delivery but moderate response rates. Iterative QI efforts increased response rates, highlighting the importance of tailored communication strategies. Automated messages can facilitate timely intervention for high-risk children and enable efficient collection of health outcomes offering a viable alternative to in-person follow-up in resource-poor settings.

ABSTRACT The COVID-19 pandemic posed a unique set of risks to pregnant women and pregnant people. SARS-CoV-2 infection in pregnancy is associated with increased risk of severe illness and adverse perinatal outcomes. However, evidence regarding the use of COVID-19 vaccines in pregnancy shows safety and efficacy. Despite eligibility and recommendations for COVID-19 vaccination among pregnant women and pregnant people in Canada, uptake remains lower compared to the general population, warranting exploration of influencing factors. The COVERED study, a national prospective cohort, utilized web-based surveys to collect data from pregnant women and pregnant people across Canada on COVID-19 vaccine attitudes, uptake, and hesitancy factors from July 2021 to December 2023. Survey questions were informed by validated tools including the WHO Vaccine Hesitancy Scale (VHS) and the Theory of Planned Behavior (TPB). Of 1093 respondents who were pregnant at the time of the survey, 87.7% received or intended to receive a COVID-19 vaccine during pregnancy. TPB variables such as positive attitudes toward COVID-19 vaccines (OR = 1.11, 95% CI = 1.08–1.14), direct social norms, and indirect social norms were significantly associated with vaccine acceptance. Perceived vaccine risks, assessed by the WHO VHS, were greater in those not accepting of the vaccine. Our study identified several key factors that play a role in vaccine uptake: perceived vaccine risks and safety and social norms. These findings may guide public health recommendations and prenatal vaccine counseling strategies.