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In 2017, Montr\u00e9al became the first Canadian Fast-Track City, setting the 2030 goal of zero new HIV infections. To inform local elimination efforts, we estimate the evolving role of prevention and sexual behaviours on\u00a0HIV transmission dynamics among gbMSM in Montr\u00e9al between 1975 and 2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Data from local bio-behavioural surveys were analyzed to develop, parameterize, and calibrate an agent-based model of sexual HIV transmission. Partnership dynamics, HIV\u2019s natural history, and treatment and prevention strategies were considered. The model simulations were analyzed to estimate the fraction of HIV acquisitions and transmissions attributable to specific groups, with a focus on age, sexual partnering level, and gaps in the HIV care-continuum.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The model-estimated HIV incidence peaked in 1985 (2.3 per 100 person years (PY); 90% CrI: 1.4\u20132.9 per 100 PY) and decreased to 0.1 per 100 PY (90% CrI: 0.04\u20130.3 per 100 PY) in 2019. Between 2000\u20132017, the majority of HIV acquisitions and transmissions occurred among men aged 25\u201344\u00a0years, and men aged 35\u201344 thereafter. The unmet prevention needs of men with\u2009&gt;\u200910 annual anal sex partners contributed 90\u201393% of transmissions and 67\u201373% of acquisitions annually. The primary stage of HIV played an increasing role over time, contributing to 11\u201322% of annual transmissions over 2000\u20132019. In 2019, approximately 70% of transmission events occurred from men who had discontinued, or never initiated antiretroviral therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The evolving HIV landscape has contributed to the declining HIV incidence among gbMSM in Montr\u00e9al. The shifting dynamics identified in this study highlight the need for continued population-level surveillance to identify gaps in the HIV care continuum and core groups on which to prioritize elimination efforts.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12879-022-07207-7","type":"journal-article","created":{"date-parts":[[2022,3,7]],"date-time":"2022-03-07T08:03:25Z","timestamp":1646640205000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Past dynamics of HIV transmission among men who have sex with men in Montr\u00e9al, Canada: a mathematical modeling study"],"prefix":"10.1186","volume":"22","author":[{"given":"Rachael M.","family":"Milwid","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yiqing","family":"Xia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla M.","family":"Doyle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Cox","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gilles","family":"Lambert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R\u00e9jean","family":"Thomas","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharmistha","family":"Mishra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Grace","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan J.","family":"Lachowsky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Trevor A.","family":"Hart","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-Claude","family":"Boily","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathieu","family":"Maheu-Giroux","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,3,7]]},"reference":[{"key":"7207_CR1","unstructured":"Alexander et al. 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Written informed consent was obtained from all study participants. The research described in this article has been performed in accordance with the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"CMD is supported by a doctoral award from the Fonds de recherche du Qu\u00e9bec \u2013 Sant\u00e9 (FRQS). JC has investigator-sponsored research grants from Gilead Sciences Canada and ViiV Healthcare. He has also received financial support for conference travel and advisory work for Gilead Sciences Canada, Merck Canada and ViiV Healthcare. SM is an associate editor at BMC ID. NJL has an investigator-sponsored research grant from Gilead Sciences Canada. TAH's salary and research is funded by an OHTN Chair in Gay and Bisexual Men\u2019s Health. TAH has also received funding as an Associate Editor from the American Psychological Association and the Association of Behavioral and Cognitive Therapies. TAH has also received research funding from CIHR, the OHTN, and the Canadian Foundation for AIDS Research, as well as funding from the CIHR Canadian HIV Trials Network. MM-G reports an investigator-sponsored research grant from Gilead Sciences Inc., outside of the submitted work, and contractual arrangements from the World Health Organization, the Joint United Nations Programme on HIV\/AIDS (UNAIDS), the Institut national de sant\u00e9 publique du Qu\u00e9bec (INSPQ), and the Institut d\u2019excellence en sant\u00e9 et services sociaux (INESSS) also outside of the submitted work. Other authors have no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"233"}}