Saskatchewan: The Provincial HIV Program After Two Decades, We Have a Strategy Again Provincial Primary Care TB Ed Day Oct. 28, 2011

Saskatchewan: The Provincial HIV Program

After Two Decades, We Have a Strategy Again

Provincial Primary Care TB Ed Day Oct. 28, 2011

Overview of the History of AIDS in Saskatoon

1. Appearance of HIV in North America.

2. When did HIV get to Saskatoon?

3. How did HIV get to Saskatoon?

4. Support for PLAs/PLWAs in Saskatoon.

5. Current epidemiology of HIV/AIDS in Saskatchewan.

6. Current approach to prevention and treatment of HIV/AIDS.


Appearance of HIV/AIDS in North America

• 1981: NEJM and MMWR reports of rare opportunistic infections, ex. PCP.

• Excessive demand for pentamidine.• Involving New York, Miami (Dade County)

and San Francisco in a “Gay Plague”.• “4-H Club”: homosexual, heroin, hemophilia,

Haitian.• Epidemiology implicated infection spread by

blood and sex.


Clinical Spectrum in 1981

• Only AIDS was recognized. No serologic test for HIV yet.

• Lymphadenopathy and lymphopenia were markers of involvement, as was thrush.

• Pneumocystis carinii pneumonia was recognized late and was often fatal. Therapy = pentamidine.

• Cryptococcal meningitis was recognized late and was often fatal.

• Kaposi’s sarcoma was new and aggressive.


Appearance of HIV/AIDS in Saskatoon

• Mostly imported from elsewhere: US, Toronto, Montreal, Vancouver (Calgary!).

• Young men returned home to Saskatoon to die.

• Little indigenous transmission.

• First cases: people with hemophilia and traveling gay men.


HIV/AIDS Clinic 1989

• 68 regular clinic attendees.

• 70% gay men.

• 10% hemophiliac.

• 20% all else.

• Less than 5% First Nations.


HIV/AIDS Support in Saskatoon

• AIDS Saskatoon: federally funded, relatively stable (formed 1987 for prevention/education).

• PLWA Network of Saskatoon (Persons Living With AIDS) (formed 1987, incorp. 1988)

• SAN (Saskatchewan AIDS Network).


Surviving HIV

• Prophylaxis for common opportunistic infections (sulfa for PCP, azithro for MAC).

• 1987 AZT monotherapy (good for 3 years).• 1990s advent of Protease Inhibitors: stable

suppression of HIV, immune reconstitution.• HIV is a chronic manageable disease.• HIV Clinic moves from Acute Care Medicine

to Chronic Diseases Management to Public Health 2011.


Organizing an Approach to AIDS

• Early 1990s: mass meetings in Regina to develop a Provincial Strategy.

• Resulted in a ministerial advisory committee.

• Resulted in a Provincial AIDS Co-ordinator position. Mostly did education.

• Interest decreased with the avavilability of Protease Inhibitors.



• Only AIDS is recognized. No serologic test for HIV is done before the AIDS- defining infection.

• Lymphadenopathy and lymphopenia were markers of involvement, as was thrush.

• Pneumocystis carinii pneumonia was recognized late and was often fatal. Therapy = TMP/SMX.

• Cryptococcal meningitis was recognized late and was often fatal.

• Kaposi’s sarcoma was new and aggressive.



• Pneumocystis accounts for about 60% of all AIDS- defining illnesses in Saskatchewan.

• TB accounted for a similar proportion of AIDS- defining illnesses in the developing world.


Fig. 1 HIV Cases in Saskatchewan,2000 to 2010

3440

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55

80

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Fig 2: HIV cases reported by Age and Gender in Saskatchewan, 2010 (Preliminary)

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male 1 22 34 28 22female 4 24 24 10 1

15-19 20-29 30-39 40-49 50+

Insert risk factors here

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Total MSM Total IDU Heterosexual

Fig. 3: Selected Risk Factors Among HIV Cases in Saskatchewan, 2000-2009

Fig. 4 HIV Cases by Selected self-reported Ethnicity in Saskatchewan, 2000 to 2009

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Aboriginal Non-Aboriginal

Proportion of HIV cases Reported by Health Jurisdictions, Saskatchewan, 2010

SCHR1%

SHR1%

KHR2%

HHR1%

P A/P Kland14%

NITHA7%

FNIH4%

RQHR21%

FHHR1%

P NHR2%

MCHR2%

SKHR44%

Proportion of HIV cases reported by Year & Health Jurisdictions

Proportion of HIV cases Reported by Health Jurisdictions, Saskatchewan , 2009

P A/P K HR12%

HHR0%

KTHR1%

P NHR2%

KHR1%

FNIH5%

FHHR1%

RQHR25%

SHR1%

SKHR46%

NITHA6%

HIV Provincial Leadership

Team

TB Working Group

SCOI

Training Prevention Education

CD Thematic Area

Immunization Manual

HIV Strategy Coordinators (6)

Epi & Surveillance

Funding & Evaluation

Clinical Diagnosis & Treatment

HIV TB Immunization

Chair: Dr. Johnmark OpondoAlternate: Jim Myres

Co Chair: Dr. Saqib Shahab

POPULATION HEALTH BRANCH

Role of Provincial Leadership Team

- HIV Program Coordination - Monitoring - - Evaluation of the Strategy - Clinical Guideline Development - Education/training for Health Care

Professionals - Public Awareness and Prevention

Prince Albert

HIV Strategy Coordinator - (F/T SUN position)

Saskatoon


Regina Qu’Appelle


HIV Program Director

(1.0 FTE) ADMIN

(1.0 FTE)

HIV Clinical Director

(.6 FTE )

HIV Pharmacy Consultant

(.5 FTE) /6 months

North


Prairie North


Sunrise


HIV MHO Consultant (.8 FTE)

Coordinators Role

- Workplan from Program Director

- Works closely with Program Director & Clinical Director

- Support to PLT - Team Facilitators - Implementors - Communicators - Network Builders


Saskatchewan HIV Strategy 2010-14Saskatchewan HIV Strategy 2010-14

Overarching goals are to:reduce the number of new HIV infections, improve the quality of life for HIV-infected

individuals, and reduce risk factors for acquisition of HIV infection.


2010-11 AccomplishmentsFunding allocated in Health Regions for:9 nursing positions including

6 HIV Strategy Coordinator positions in 6 RHAs6 social work/outreach positions 1 Medical Office Assistance position in ReginaHIV-dedicated Family Practitioner at an HIV ClinicAlso:HIV Strategy Evaluation FrameworkFunding for HIV Point of Care Testing


HIV Provincial Leadership Team

Clinical Directors (0.6 FTE). Medical Health Officer (0.8 FTE), including FNIH MHO. Pharmacist (0.5 FTE for 6 months). Program Director (1.0 FTE). Admin Support position (1.0 FTE).


HIV Provincial Leadership Team• This team will lead the implementation of the

HIV Strategy, specifically the four strategic pillars:

• Community Engagement and Education • Prevention and Harm Reduction • Clinical Management • Surveillance and Research


Community Engagement

• increase community engagement to address community-related risk factors, e.g.: inadequate housing

• increase leadership participation to address community related risk factors, e.g.: stigma and discrimination


Education

• increase knowledge of HIV among the residents of Saskatchewan through public awareness and prevention

• Increase capacity of service providers through education/training for health care professionals


Prevention and Harm Reduction• provide prevention (primary, secondary and tertiary) resources including

best practices to the regions.• establish centers delivering integrated, holistic prevention/well

being/harm reduction services, via mobile services where possible.


Clinical Management Objectives

• improve HIV client access to medical care• provide rapid initiation of treatment to HIV-

positive clients whenever appropriate• increase frontline support including capacity,

education and standards• promote the use of HAART regimens to

optimally treat the patient and reduce transmissibility of the virus

Movement Toward HIV Care In a Primary Care Setting

• West Side Community Clinic.

• Regular Clinics in Prince Albert, LaRonge, LaLoche, others.

• Dr. Skinner made a house call on a Northern Reserve.



Surveillance and Research Objectives

• improve the provincial HIV surveillance system

• increase knowledge of HIV epidemiology in appropriate audiences

• increase sharing of HIV epidemiology information to appropriate audiences


Moving forward in 2011-12

Funding for additional FTEs: 9 FTEs - outreach/social work Community Development Coordinators in 3 RHAs Enhanced RHA pharmacy support (Regina and Saskatoon)



Funding for: Provision of transportation for clients in 3 RHAs Continued HIV POC testing Wellness centre including harm reduction programming in 1

health region Public Awareness and Prevention Peer to Peer Network Programming (1 FTE)



Funding for CBO’s and stakeholders to develop programs which will assist in achieving the goals of the Strategy

RHA’s are crucial partners in developing these initiatives

Funding will be phased in over 3 years Funding amounts are determined on percentage

of new HIV cases and percentage of population the RHA’s represent

Final approval of proposals from the PLT

Documents

Saskatchewan: The Provincial HIV Program After Two Decades, We Have a Strategy Again Provincial Primary Care TB Ed Day Oct. 28, 2011