COLLABORATIONS AND SOLUTIONS IN HIV, HCV AND STI RESEARCH

Saskatchewan

Exploring alternative methods to HIV testing to meet the UNAIDS 90-90-90 targets

On April 26, 2018, the National HIV/AIDS Laboratories, National Microbiology Laboratory – Public Health Agency of Canada (PHAC) collaborated with REACH 2.0 and the National Collaborating Centre for Infectious Diseases (NCCID) to bring together over 50 participants from across Canada to reflect on methods for HIV testing. The session featured four testing technologies that provide alternatives to the standard approach to HIV testing. These approaches have the potential to expand HIV testing options in Canada when scaled up and implemented in a sustainable manner:

  • Self-testing: Performing an HIV test on oneself, either alone or in the presence of a health or service provider.
  • Pharmacy-delivered point-of-care testing: Training pharmacists to test for and deliver HIV results to clients.
  • Multiplex testing: Screening for multiple infections such as HIV, hepatitis B and C, as well as syphilis
  • Dried blood spot (DBS) testing: Collecting blood samples on filter paper within a community setting – once the sample has dried, it can be sent by regular mail to a laboratory for further testing.

Over the course of the presentations and the discussions that ensued, we identified three salient themes:

  1. Stigma, confidentiality and the ways in which testing is advertised.

Participants noted that positive messaging was key to encouraging testing and reducing HIV-associated myths around transmission. Digital strategies could be another way to increase testing while respecting privacy. Creating supportive and culturally safe environments were also discussed – specifically, the importance of relationship-building and establishing trust. Peers are a bridge between communities and health care providers.

  1. Local community engagement and local partnerships.

Community buy-in and strong leadership are essential for successful implementation and sustainability of testing initiatives. This means investing time to engage with policy-makers, community-based organizations, practitioners and government to establish appropriate mechanisms for linkage to care and treatment. From a program science perspective, participants urged researchers to gather data that assessed the quality of the relationship between clients and providers in order to truly evaluate any testing initiatives.

  1. Facilitators for the implementation of new testing strategies.

Supportive, culturally-appropriate and culturally-safe relationships were major components of success. Further, upstream approaches that engage stakeholders are fundamental to improving the cascade of care – testing is but the first step towards a holistic approach to integrated health care. Lastly, work closely with peers to engage communities and improve navigation through complex health systems.

A final point worth noting is that, while the implementation of new testing approaches is timely and needed, we should also look to improving our current “standard” approach to HIV testing. What do you think?

Thank you to everyone who participated in the session, to the event organizers and to each of the panelists. An extra big thank you to Dr. John Kim from the National HIV/AIDS Laboratory for pitching the idea for this event, and to Geneviève Boily-Larouche from the National Collaborating Centre for Infectious Diseases (NCCID) for compiling the session evaluations and preparing an excellent summary of the discussions. This report will be available soon!

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New Implementation Science Research Design Tool

The Centre for Implementation Science at King’s College London has recently developed the ImpRes Tool. Its purpose is to support research teams who are in the process of designing implementation research and work to implement evidence-based interventions into practice.See: http://www.kingsimprovementscience.org/files/ImpRes_Guide_April_2018.pdf?utm_source=EIC+Stakeholders&utm_campaign=7c2e35f8b4-EMAIL_CAMPAIGN_2018_04_22&utm_medium=email&utm_term=0_ea81bd44fe-7c2e35f8b4-295895941

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MB HIV Collective Impact Network April Symposium Great Success!

A Great Success!
The Symposium was an overwhelming success with over 95 people in attendance on April13. The purpose of the event was for knowledge exchange, idea generation and for network building. We had people from Saskatchewan, Ontario, Nova Scotia as well as people from all over Manitoba!
We were pleased to have 18 posters including a quilt as a poster!
We particularly appreciated the many out-of-town presenters and participants who were able to attend.
Many thanks to all the helpers who made this happen: including volunteers, staff, students, & our Stewardship Team.
We will be preparing a report. Watch for it in our next Monthly e-news in June!

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Indigenous Health: The Mysteries and Myths of the HIV Crisis in Saskatchewan

The Saskatchewan Health Research Foundation (SHRF) and the Canadian Academy of Health Sciences (CAHS) Saskatchewan Regional Network will be hosting a half-day conference on May 4, in Saskatoon, to discuss Indigenous Health: The Mysteries and Myths of the HIV Crisis in Saskatchewan.

This joint effort will bring together health researchers, government officials and other key stakeholders to learn about current efforts, explore potential areas for collaboration, and create next steps to turn our present efforts in research and programming into improved prevention and health outcomes.

The panel of speakers includes Drs. Carrie Bourassa, Alexandra King, JoLee Sasakamoose and Lynn Thompson.

Registration is limited to 150 attendees, and there is no cost to attend. Registration deadline is April 27: Please click here to RSVP. For more information, please contact SHRF at communications@shrf.ca.

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Saskatchewan announces universal coverage for HIV medication

On April 10th, the Government of Saskatchewan released the 2018 budget. Full highlights can be found here, and there was some good news:

  • Universal coverage of HIV medications thanks to an investment of $600,000
  • HIV supports in the form of $50,000 each towards AIDS Saskatoon and West Side Community Clinic, two organizations that provide critical social and health services to people accessing care in Saskatoon

More specifically, the funding for AIDS Saskatoon will be used to strengthen their successful in-hospital peer support program, which has seen notable results in increasing linkage and retention in care.

The government’s focus on austerity continues, however, and it remains to be seen how efforts to address the social determinants of health – from an upstream perspective – will be affected by this fiscal approach.

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Dried blood spot testing research in Saskatchewan

Dried blood spot (DBS) testing has been around for decades but is gaining attention in Canada as a way to increase HIV and HCV testing, as well as simplify testing approaches. Compared to the standard venipuncture used for confirmatory testing, DBS greatly simplifies blood collection, transport and conservation. It also has potential to increase testing among harder-to-reach populations – especially when the test can be offered outside of clinical settings – and is well suited for testing among people who may have compromised veins from injection drug use.

SHARE (the Saskatchewan HIV/AIDS Research Endeavour), has secured a CIHR planning grant to develop an HIV and HCV DBS testing study for Saskatchewan. In partnership with AIDS Saskatoon, All Nations Hope, the Northern Inter-Tribal Health Authority and Wellness Wheel, work has begun to convene an early summer meeting with key stakeholders. By bringing together a mix of researchers, people with lived experience, frontline organizations, elders and knowledge keepers, laboratory experts and policy-makers, the aim of the meeting is to identify and address barriers to DBS implementation in Saskatchewan. The meeting will also create space to discuss the ethics of bio-sampling (also known as ‘DNA on loan,’ to quote Dr. Alexandra King), which is a particularly hot topic in Saskatchewan. The goal of the meeting is to develop a holistic study that will support culturally-responsive policy change, broaden the scope of who can offer testing and to increase the array of testing options across the province.

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Know Your Status (because you matter)

The Know Your Status (KYS) HIV program was developed by Big River First Nation (BRFN) and grew to include Ahtahkakoop Cree Nation (ACN) and Saskatoon Tribal Council (STC). KYS’s holistic approach to health and linkage to care has increased HIV and hepatitis C testing across many communities in Saskatchewan. A culturally-responsive HIV care cascade works: ACN has successfully achieved the UNAIDS goal of 90-90-90.

But much work remains across Saskatchewan – the need to increase HIV and hepatitis C testing is urgent, and no program is without challenges. The 2nd annual KYS forum, Knowledge to Action, was hosted by STC in Saskatoon on February 13 and 14, 2018, in partnership with BRFN and ACN. Tribal Chiefs Mark Arcand (STC) and Larry Ahenakew (ACN) opened the forum alongside Michel Sidibé, Executive Director of UNAIDS, who has since remarked on the disparity in Indigenous health outcomes in Canada. Over the two days of the forum, panel and concurrent presentations ranged from on-reserve liver health events and dried blood spot testing to Speaking from the heart workshops for HIV positive people who want to be speakers. There was a first-glimpse screening of Strong Medicine: HIV Treatment, a video collaboratively produced by CATIE to promote the message that happy, healthy lives are possible with HIV medications.

For a re-cap of dried blood spot testing at STC, check out CATIE’s webinar recording, series #3: Reaching the Undiagnosed: Dried blood spot testing for Hepatitis C and HIV – a new approach for the rural and remote communities.

For more information about KYS, check out A Toolkit for HIV programs in Saskatchewan First Nations.

To learn more about cultural responsiveness in Saskatchewan, check out the Federation of Sovereign Indigenous Nation’s Culturally Responsive Framework.

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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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