“I was a nursing undergrad and became fascinated with communicable diseases, primarily because of the social aspects involved,” he recalls. “Yes, there are effective clinical interventions, but they often fail in the real world because of barriers related to socio-economic status and access to care. I wanted to change that.”
Today, O’Byrne is a professor of nursing at the Faculty of Health Sciences and the Ontario HIV Treatment Network (OHTN) Research Chair in Public Health and HIV Prevention. He is transforming how we prevent, diagnose and treat HIV, especially for marginalized populations.
HIV disproportionately affects minority groups, such as those who are transgender, of Indigenous or of African, Black or Caribbean descent, and gay, bisexual, and other men who have sex with men (gbMSM). So in 2008, O’Byrne co-created GayZone, where gbMSM could feel more comfortable accessing testing, helping to reduce the incidence of infections in this population.
Five years later, he led a project to provide post-exposure prophylaxis (PEP) — HIV medications for those who have been exposed to the virus — free of charge. “Many people who are at risk for HIV have lower socio-economic status and resources,” explains O’Byrne. “We wanted to ensure equitable access because these drugs can reduce risk of infection if taken within 72 hours of exposure, but can be very expensive if not subsidized.”
O’Byrne’s team then studied the HIV-exposed gbMSM patients accessing PEP, and found that 8.5% still ended up HIV positive within the year. Recognizing the need for more prevention services, he started a pre-exposure prophylaxis (PrEP) program to provide free medication and support for those at high risk who weren’t yet exposed.
“We’ve seen that PrEP interventions are highly effective, preventing HIV acquisition by over 90% when used with condoms and taken as prescribed,” says the researcher.
This past July, he went even further in his mission to prevent HIV transmission in the community, launching free at-home HIV-testing kits in Ottawa — a first in Canada.
“A lot of research shows that most HIV transmission happens by those who are unaware they are HIV positive,” explains O’Byrne. “Despite all the tools available — family doctors, HIV clinics, free testing — one in five people still don’t know they’re HIV positive. My hope is that at-home kits can identify and help them get the care they need, including medications that virtually eliminate HIV transmission.”
Of his many achievements, O’Byrne is especially proud that, almost 20 years later, he continues to work as a nurse practitioner at Ottawa’s Sexual Health Clinic, the only clinic in the country that is 100% nurse-led. “I’m in the trenches, connecting directly with patients and clinicians,” he says, “and I’m able to bring that real-life experience into everything I do — my research, my practice and my teaching.”
Article by Leah Geller