Saskatchewan’s first HIV Testing Day

On June 27th, Saskatchewan held it’s first provincial HIV Testing Day. Events were organized across cities and communities, as far north as Pelican Narrows, as far east as Kamsack, as far west as Meadow Lake and as far south as Regina! A list of where testing events were held can be found on the SK HIV Collaborative’s website here.

The origin of this provincial testing day is a great example of how community-driven initiatives can lead to widely-adopted health promotion strategies. In the summer of 2016, the Saskatoon Indian and Metis Friendship Centre (SIMFC) coordinated a city-wide HIV testing day (also on June 27). Leveraging partnerships with AIDS Saskatoon, PLWA Network, Saskatoon Tribal Council and the Saskatoon Health Region, this SIMFC-led coalition organized a full day testing fair. The Saskatoon Health Region provided a mobile testing van, which was stationed in the parking lot of White Buffalo Youth Lodge in Saskatoon’s core neighbourhood. Replete with snacks and resource tables hosted by each partner organization, the day was well received by the community and local organizations. Planning for next year’s testing day began soon after!

On March 22 of this year, an HIV Strategy Coordinators education session was co-organized by SISHA (Saskatchewan Indigenous Strategy on HIV/AIDS), SHARE (Saskatchewan HIV/AIDS Research Endeavour) and CATIE, to follow on the heels of All Nations Hope’s gathering in Saskatoon. At this education session, the idea of a provincial testing day was pitched to the group by SIMFC. Strategy Coordinators learned of the process created by SIMFC and AIDS Saskatoon to create a framework for a provincial testing day. Over the course of an afternoon, educational sessions were presented on U=U, HIV criminalization and a debrief of local findings of health care experiences. The Strategy Coordinators spent the rest of the day planning how to roll out a provincial testing day for this summer. To the infinite credit of the Strategy Coordinators, they pulled together a provincial testing day very quickly – all of which was made possible by the lessons learned by SIMFC and the coalition of Saskatoon agencies!

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REACH 2.0 welcomes Sugandhi del Canto

Sugandhi is the Executive Director at SHARE (the Saskatchewan HIV/AIDS Research Endeavour) and has recently joined the REACH team on behalf of Saskatchewan. She worked in the field of HIV since 2003, beginning with a position at the Native Friendship Centre in Montreal as the HIV/AIDS Prevention and Education Coordinator. She has also worked at CTAC (Canadian Treatment Action Council), CAMH (Centre for Addiction and Mental Health) and, up until her recent return to academia, was the Prairie HIV/HCV Educator at CATIE. Sugandhi moved to Saskatoon in 2010 to begin a Master’s program in the Department of Community Health and Epidemiology at the University of Saskatchewan. She holds a B.A. in International Development Studies from McGill University and is currently finishing up her PhD, a mixed methods study of built environments and healthy food access. She has served on the boards of the Canadian Women’s Health Network and ASAAP, the Alliance for South Asian AIDS Prevention. She is the inaugural President of the City Centre Food Cooperative, a local initiative to provide affordable fresh food to Saskatoon’s downtown and suBio photo_sugandhirrounding areas.

She also knits. A lot.

Please feel free to connect with Sugandhi to REACH activities and possible collaborations in Saskatchewan!

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The Saskatoon Needs Assessment Study

The Saskatoon Needs Assessment study is a community-based research project led by SHARE in partnership with AIDS Saskatoon and the Saskatoon Indian and Metis Friendship Centre (SIMFC). This project came about when both AIDS Saskatoon and SIMFC approached SHARE, noting that their clients were experiencing challenges accessing health care in the city, and wanted data to corroborate anecdotal evidence. In the first phase of the study, 22 people living with HIV participated in individual, semi-structured interviews; in the second phase, 3 focus groups and 2 interviews were completed with a total of 32 health care providers. Analysis of interview data uncovered themes related to experiences in acute care, relationships and social networks, addictions, advocacy and self-empowerment. These findings were presented at a community forum at AIDS Saskatoon in late 2016, and preliminary analysis of the focus group themes are nearly complete. The complete findings of the study will be shared at an auxiliary session of All Nations Hope’s upcoming SK Indigenous HIV Conference March 21 and 22. May 6th, 2017 SHARE will be hosting a session summarizing study findings will be presented at the upcoming CANAC conference in Regina.

Building off the findings of the Saskatoon Needs Assessment, a second study, the Patient-Provider Toolkit, began late last year, expanding the scope of data gathering to Prince Albert and Regina. Using the same two-phased approach of interviews with people living with HIV and focus groups with care providers, this study differs from the Saskatoon study in two ways. In the Patient-Provider Toolkit study, the definition of care provider is expanded to include a wider circle of care provision, such as home care, addictions and mental health and kin networks. Secondly, the findings of this study will be used to create an interactive and multimedia toolkit to support both patients and care providers in optimizing health care experiences. The Patient-Provider toolkit’s research team, who were integral in project development and provide leadership on data collection and analysis, include representation from All Nations Hope, SIMFC, the Elizabeth Fry Society and Prince Albert Parkland Health Region. Most importantly, this research team includes two women living with HIV, who insights and experiences guide the work of this project.

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News from Saskatchewan!

Work continues on data collection and analysis in the second phase of the Saskatoon Needs Assessment study. This study is looking at the experiences of people living with HIV in accessing health care. The second phase of the study examines this from the perspective of health care providers, and what they identify as barriers, gaps and facilitators for patients. An abstract is being developed for submission to the CANAC Conference to be held in Regina, in May 2017.

Based on the above work, a complementary study, the Patient – Provider Toolkit, is underway. It is looking at learning from the experiences of HIV patients in two other locations, Prince Albert and Regina. This project also aims to develop a toolkit that will help move the research findings into the field of practice. A Project Coordinator has been hired and a work has begun to prepare for the first round of data collection in early 2017.

Efforts to establish a pilot project Point of Care Testing continue. The intent of the pilot is to assess the feasibility and sustainability of HIV rapid testing in a community setting where testing is offered by allied health professionals (ie. not a doctor or a nurse). At present, work is focusing on how to conduct the pilot while being mindful of current provincial legislation, which stipulates that testing can only be offered by doctors, nurses and lab technicians.

A grant proposal was submitted to the Public Health Agency of Canada’s Community Action Fund regarding the development of a provincial database. The database will map programs, research and innovation across the province and thereby make more evident opportunities to focus, connect, and collaborate across varied stakeholder groups – health regions, First Nations, community based agencies, managers, program analysts, researchers, and service providers.

Lastly, on-going work in the area of provincial and regional partnership development and capacity building continue. In November, SHARE reached out to the School of Public Health at the University of Saskatchewan, the Northern Inter–Tribal Health Authority and the Meadow Lake Tribal Council to join together as new partners in collaborative community based research. November also saw the strengthening of SHARE’s relationship with the Saskatchewan HIV Collaborative, the provincial body which oversees HIV program and service delivery.

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REACH 2.0 Welcomes New Community Based Research Associate

REACH 2.0 is excited to welcome Michael Quennell who joined the Saskatchewan HIV/AIDS Research Endeavour (SHARE) in October 2016, as a Community Based Research Associate.  He has a Master’s of Science in Community Health and Epidemiology from the University of Manitoba.  Michael has a diverse background in primary health care and community health development that has included senior management in community based primary health care, policy advice, project management, strategic and operational planning, program development, research, and evaluation across the province of Saskatchewan, and various levels of government – federal, First Nations, Metis, provincial and municipal as well as the CBO sector. Much of his work has involved working with Tribal Councils, First Nations and other Indigenous communities and organizations in health care system development.  A large part of his work has included community engagement, partnership development, strategic planning and capacity building.  He has previously served on the Board of Directors of several non-for-profit organizations including the Saskatoon Community Clinic, Regina John Howard Society, and Regina New Dance Horizons.  His interests to date have included child and youth development, primary health care, community capacity building and population health.  He looks forward to working with community alongside other researchers to further develop and strengthen the community driven research aimed at improving access and care for those affected by and living with HIV/AIDS.

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REACH funded Community-Based Research in Saskatchewan

SHARESaskatchewan HIV/AIDS Research Endeavour (SHARE), AIDS Saskatoon, and the Saskatoon Indian Metis Friendship Centre are currently interviewing people living with HIV from the core neighbourhoods of Saskatoon to document their personal experience with health and access to health services. This qualitative grounded theory approach hopes to establish a better understanding of the realities of living with HIV in a community that is vulnerable to poor social determinants of health and substance abuse. This qualitative study will be used to inform a subsequent gap analysis that will explore the experiences of healthcare professionals providing services in the core neighbourhoods, with attention focused on challenges or gaps in service that negatively impact people living with or affected by HIV.

SHARE is supporting the Saskatoon Indian and Metis Friendship Centre to review, collect and evaluate materials that will be used to develop training materials for the Friendship Centre’s education activities and events. This project hopes to identify current best practices for educating the public from across the country about HIV/AIDS with special attention on Indigenous approaches. Every effort is being made to ensure that this is accomplished in a culturally sensitive manner.

SHARE is also organizing a research team who will develop trial study and evaluation of the process and impact of Community Point of Care Testing (POCT) in Saskatoon. With the support of AIDS Saskatoon and the Saskatoon Health Region stakeholders, SHARE will review the concerns of key provincial, regional, and community stakeholders who manage policies that influence the use of POCT in community settings. Community POCT is essential for dealing with the current HIV epidemic in Saskatchewan in rural communities. The purpose of this study will be to integrate stakeholder concerns into a community POCT trial process that can be used to help inform policy makers and health region administrators and facilitate the acceptance and use of POCT testing across Saskatchewan.

We’re very excited about these initiatives and look forward to providing updates as these projects progress!

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Where are we now? The Western Canada HIV Supported Housing Project

The Western Canada HIV Supported Housing: Outcome Tools Development Project (led by Dr. Cathy Worthington, University of Victoria and Floyd Visser, The SHARP Foundation) recognized a need for common outcome measures and outcome evaluation to support program delivery and sustain funding for HIV supported housing services, especially those services for people living with HIV/AIDS with complex needs. Housing is a key structural factor in HIV transmission and in determining the health of HIV; this study will create the foundation for outcome studies in participating HIV Supported Housing services.

Four agencies have been involved in the project: The SHARP Foundation (Calgary, AB), McLaren Housing Society (Vancouver, BC), Dr. Peter AIDS Foundation (Vancouver, BC), and Sanctum Housing (Saskatoon, SK). In March 2015, the project brought together stakeholders from the four HIV Supported Housing agencies, as well as individuals from public health, the homeless-serving sector, government, and academia at a two-day workshop. The project team discussed their needs for outcome measurements and established a plan to develop program-specific logic models to help inform the outcome measurement tool development process.

Over the summer, interviews will be conducted with service users and their family members at each of the four agencies to ensure that their perspectives on required outcome measures are included. The project team will meet in Fall 2015 to discuss their progress to date and to draft a common outcome measures tool. A database will be created and staff will be trained so that outcome measures can be collected and used for subsequent research.

This project will be instrumental in measuring the impact of HIV Supported Housing services on their clients and community and will help to leverage funding for these integral programs.

(Written by Kaylee Ramage)

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The Prairie HIV-HCV Benchmark Meeting, March 4-6, 2015, Regina

It is well recognized across the country that the HIV and HCV epidemics in the prairies continue to pose major challenges to clinicians, communities, and policy makers. Saskatchewan has been disproportionately impacted by HIV and HCV rates in Canada and both epidemics are more than double the national average. The unique epidemiological features of these epidemics necessitate specific provincial strategies for clinical care. These include the high prevalence of HIV among injection drug users, Aboriginal people, HCV co-infection, and women.

Efforts implemented as part of Saskatchewan’s HIV Strategy (2010 – 2014) have seen positive results in terms of reducing new infection rates. While these efforts have demonstrated progress, significant challenges related to high incidence, late diagnosis, limited engagement, and poor outcomes persist.  As virus transmission has migrated out of cities and into the rural and remote parts of the prairies, the challenges related to accessing HIV and HCV testing and care have only increased. As a result there is an ongoing need for optimized clinical care for those who are living with HIV and HCV in Saskatchewan.

The Prairie HIV-HCV Benchmarking Meetings were held in Regina, Saskatchewan on March 4th – 6th, 2015 with invited guest speakers and attendees: infectious disease specialists, clinicians, pharmacists, nurses, indigenous and community stakeholders from across Western Canada and Saskatchewan. The goal of the meetings was to develop consensus about a set of clinical strategies that could best address HIV and HCV related challenges in Saskatchewan and to publicize the need for these strategies. The Benchmark Meetings comprised of a provincial stakeholder meeting that was used to inform and guide two clinically focused meetings and a public awareness event.

For the provincial stakeholder meeting, HIV-HCV experts from across Western Canada (i.e., Dr. Julio Montaner from BC, Dr. Stephen Shafran from AB, Dr. Michael Schwandt and Margaret Poitras from SK, and Mike Payne and Carla Pindera from MB) presented on the current status of the HIV and HCV epidemics in their respective provinces and reviewed strategies being used to treat and support those infected or affected by these diseases. The facilitated discussion that followed the presentations explored the similarities, differences, lessons learned, and how this information could inform the HIV and HCV testing and care needs in Saskatchewan.

For the clinically focused meetings, clinicians who specialize or treat HIV and HCV patients met to review the current state of these epidemics and clinically related issues impacting treatment and prevention in the different regions across Saskatchewan. This information was used to formulate a common vision for the current state of clinical care. Consensus was reached for a formal clinical strategy entitled, Getting to 90-90-90: 10 Key elements of a successful plan for HIV in Saskatchewan. The strategy will be further articulated in the coming months and released to the public with the Prairie HIV-HCV Benchmark Meeting Report at a late date (TBD).

The public awareness event was offered to a broad audience of community members, stakeholders, and students. Dr. Ryan Meili, Dr. Julio Montaner, Margaret Poitras, and Dr. Mona Loutfy presented on their personal experiences treating patients and clients who are living with HIV and made recommendations for improved HIV and HCV treatment and care in Saskatchewan.

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Building Research Capacity Through Community Assessment and Engagement with the Saskatoon Indian and Metis Friendship Centre

The Saskatoon Indian and Metis Friendship Centre (SIMFC) is a designated Aboriginal service organization that provides a number of diverse services to improve the quality of life for Aboriginal people in Saskatoon, including supportive services directed at Aboriginal people living with HIV/AIDS (APHA).

Together, the researchers of SHARE and SIMFC have secured a catalyst grant to develop the community based research capacity of SIMFC through a joint research project that will explore the attitudes, experiences, and motivations of APHA in their need for and ability to seek and obtain access to healthcare services in Saskatoon. This will include working with HIV stakeholders (e.g., healthcare professionals, social services, CBOs) to identify gaps and barriers in healthcare services and to develop recommendations for the improvement of healthcare services that impact the quality of life for APHA. SIMFC has identified health as an important priority in developing service capacity that meets the needs of their HIV positive clients.

Previous research in Saskatoon, and across Canada, has found that inequities exist in the amount and type of access to healthcare that APHA receive compared to the general population, leading to greater risk for HIV transmission, less access to treatment, and more complex health issues leading to poorer health outcomes. By working with community members to define and outline health service needs, this research will be used to inform, support, and improve services provided to the APHA population.

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