HIV report authors look to stop epidemic

Saskatchewan still has the highest rate of HIV in Canada, but an action plan being suggested by the Saskatchewan HIV/AIDS Research Endeavor (SHARE) aims to change that.

“How do we achieve better response to the HIV epidemic in Saskatchewan than we’ve seen so far?” SHARE co-lead and physician Ryan Meili said.

They have an idea, and released a 10-point strategy  that includes having a plan with clear leadership, fully funding HIV medications and ensuring testing can reach all areas of the province no matter how remote.

The suggested steps come from a series of meetings held earlier this year that combined experts from across the country, including HIV leader Julio Montaner from the BC Centre for Excellence in HIV/AIDS. The goal is to reach 90-90-90, a plan set out by the World Health Organization, that aims to have 90 per cent of people who have HIV diagnosed, 90 per cent of those people on treatment, and 90 per cent of those people with such a low amount of virus that it cannot be transmitted.

The biggest first step for Saskatchewan is creating a plan that is proportional to the problem, Meili said. A previous HIV strategy that was in place from 2011 to 2014 said the acute care costs of HIV were around $40 million.

“The amount of money, energy and attention that went into the HIV strategy initially wasn’t really at the scale or at the degree of influence necessary to really adapt to that great cost and the high need that is represented by HIV in the province,” Meili said.

“We really need a better plan, and one that is proportional to the problem, that has a clear leadership structure for implementation and the resources in place to make that successful.”

That leadership structure needs to go further than the provincial leadership team from the province’s recent HIV Strategy, he said, because previously there weren’t a lot of resources or decision making power.

Meili said they are in continued conversation with the Ministry of Health, and there has been openness and interest in SHARE’s work.

“There’s recognition there that while there has been some progress, we’re nowhere near where we need to be in terms of controlling both the incidence of HIV in the province as well as the degree of morbidity and mortality – how sick people are getting and how many people are actually of dying from AIDS right here in the province,” he said.

Saskatchewan’s chief medical health officer, Dr. Saqib Shahab, attended some of the benchmark meetings. He said that they have seen some great successes with the first HIV strategy, but there are still some ongoing challenges.

“While initially the epidemic was primarily concentrated in people who inject drugs, increasingly it’s heterosexual  [transmission],” he said.

The approach to tackling HIV in Saskatchewan could follow the tuberculous treatment delivery model where care transitions between First Nations programs and provincial programs, rural and urban, Meili said.

Shahab said the TB program is constantly morphing. He said TB care has historical reasons for being a vertical system, and today the program has more linkages with community partners and First Nations.

“Would we today have developed the same structure? Maybe, maybe not,” he said.

Both Shahab and Meili talk about a need for increased support, outreach and testing in rural/remote communities in the province.

The SHARE report is looking to the longterm; Meili said there can be a couple of quick wins such as getting full coverage of HIV medications.

“That’s a very simply thing that can make a big difference for patients and for providers who don’t have to spend their time chasing funding, actually get people on treatment right away,” he said.

Currently the province covers 93 per cent of the HIV medications, about $8 million annually, according to Shahab, the remaining part is a small fee that people pay, but that can be covered for people who are low income or on social assistance.

The remaining portion is less than $500,000, said Meili, and added it would be worth the investment. Not only does it help sick people, it reduces the risk of transmission of the virus.

With the report out, SHARE is now waiting to hear from the provincial government, said Meili.