The Wellness Wheel: A Mobile Outreach Clinic to Address HIV and HCV in Saskatchewan First

Nations

Dr. Stuart Skinner, Division of Infectious Diseases, Regina Qu'Appelle Health Region

Clinical Assistant Professor, University of SaskatchewanJune 23, 2017

stuart.skinner@usask.ca

Faculty Disclosure

• Relationships with commercial interestes:– Grants/Research Support: Gilead Sciences, Viiv Healthcare, Abbvie

and Merck Canada– Speakers Bureau/Honoraria: Viiv Healthcare, Merck Canada– Consulting Fees: Merck Canada, Viiv Healthcare, Abbvie

Objectives

• Improve access to care and treatment of HIV and HCV for First Nations on-reserve

• Develop these clinics in partnership with local First Nations communities and leaders

• Establish a model that can be utilized for other chronic diseases

Sero-prevalence of HIV among respondents who provided a Dried Blood Spot specimen and awareness of HIV positive status

(n=1,045)Sero-prevalence Number Percent

Positive 54 5.2Negative 991 94.8

Awareness of HIV positive status

Aware 29 53.7

Unaware 23 42.5

5

Aware = positive HIV lab result and who reported that their last HIV test result was positiveUnaware = those who had never been tested or who did not receive the result of their last test or who did not know the resultof their last test or who reported that their last HIV test was negative but had a positive HIV lab result.

A-Track Surveillance Team

SK Epidemic

First Nations population-141,379 (2012)

(13% of SK population) -49% on-reserve

Know Your Status

• Community developed education, testing, treatment and case management approach – Nurse led

• Partnership between community, Health Canada, clinicians and province

• Uses remote medicine, cell phone, outreach, education and point of care interventions

Technology

• Electronic health records

• Cell phone/text messaging

• Tele-health

• Remote presence

• Portable fibroscan

Hepatitis C and Addictions Care

The Wellness Wheel: HIV/HCV and Chronic Disease

Rates of diabetes cases, 1980-2005, SK

• Currently 10 sites directly serving 24 SK First Nations

• Chronic disease, community led model

• 9 primary care and specialist physicians providing integrated care with other health professionals and community

The Wellness Wheel

Summary

• HIV and Hepatitis C disproportionately affect First Nations on-reserve in SK who have the least access to care with current health care delivery systems

• A community based and led program can achieve UN goals of 90/90/90

• This system can be used as a basis for chronic disease management for First Nations

Acknowledgements• All First Nation communities including Chief and Council members,

particularly Big River and Ahtahkakoop First Nations• Leslie Ann Smith, Clarence Frenchman, Jolene Blocka, Tanys Isbister, Amanda

St. Onge, Noreen Reed and all front line nursing and health care providers• Wellness Wheel Team: Drs. Thanh Lu, Megan Clark, Jarol Boan, Bonnie

Richardson, Sarah Liskowich, Rachel Asiniwasis, Mona Loutfy, Rosie Courtney. Susanne Nasewich, Val Desjarlais, Dr. Mamata Pandey, Adam Clay, Josh Needham and Carla Crozier

• Dr. Ibrahim Khan and First Nation Inuit Health Branch• Regina Qu’appelle Health Region and Saskatchewan Ministry of Health