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.
Provincial Primary Care TB Ed Day Oct. 28, 2011
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.
Provincial Primary Care TB Ed Day Oct. 28, 2011
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.
Provincial Primary Care TB Ed Day Oct. 28, 2011
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.
Provincial Primary Care TB Ed Day Oct. 28, 2011
HIV/AIDS Clinic 1989
• 68 regular clinic attendees.
• 70% gay men.
• 10% hemophiliac.
• 20% all else.
• Less than 5% First Nations.
Provincial Primary Care TB Ed Day Oct. 28, 2011
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).
Provincial Primary Care TB Ed Day Oct. 28, 2011
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.
Provincial Primary Care TB Ed Day Oct. 28, 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.
Provincial Primary Care TB Ed Day Oct. 28, 2011
Clinical Spectrum in 2011
• 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.
Provincial Primary Care TB Ed Day Oct. 28, 2011
Clinical Spectrum in 2011
• 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.
Provincial Primary Care TB Ed Day Oct. 28, 2011
Fig. 1 HIV Cases in Saskatchewan,2000 to 2010
3440
26
40
55
80
101
127
174
200
170
0
50
100
150
200
250
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Nu
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f C
ases
Fig 2: HIV cases reported by Age and Gender in Saskatchewan, 2010 (Preliminary)
0
5
10
15
20
25
30
35
40
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ses
male 1 22 34 28 22female 4 24 24 10 1
15-19 20-29 30-39 40-49 50+
Insert risk factors here
0
20
40
60
80
100
120
140
160
180
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Nu
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of
Ca
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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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20
40
60
80
100
120
140
160
180
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
Year
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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
HIV Strategy Coordinator - (F/T SUN position)
Regina Qu’Appelle
HIV Strategy Coordinator - (F/T SUN position)
HIV Program Director
(1.0 FTE) ADMIN
(1.0 FTE)
HIV Clinical Director
(.6 FTE )
HIV Pharmacy Consultant
(.5 FTE) /6 months
North
HIV Strategy Coordinator - (F/T SUN position)
Prairie North
HIV Strategy Coordinator - (F/T SUN position)
Sunrise
HIV Strategy Coordinator - (F/T SUN position)
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
POPULATION HEALTH BRANCH
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.
POPULATION HEALTH BRANCH
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
POPULATION HEALTH BRANCH
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).
POPULATION HEALTH BRANCH
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
POPULATION HEALTH BRANCH
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
POPULATION HEALTH BRANCH
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
POPULATION HEALTH BRANCH
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.
POPULATION HEALTH BRANCH
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.
Provincial Primary Care TB Ed Day Oct. 28, 2011
POPULATION HEALTH BRANCH
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
POPULATION HEALTH BRANCH
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)
POPULATION HEALTH BRANCH
Moving forward in 2011-12
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)
POPULATION HEALTH BRANCH
Moving forward in 2011-12
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