Healthcare Delivery in Indigenous Communities Dr. Stuart Skinner, BSc, MD, FRCPC, DTM&H Division of Infectious Diseases, Regina Infectious Disease Clinic Assistant Professor, University of Saskatchewan May 3, 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 Provide an overview of the current status of HIV and HCV in Saskatchewan and successful community interventions to address these infections Discuss how this model can be built upon to address other chronic diseases, infectious diseases and health disparities for on-reserve populations Discuss the importance of community engagement and community led programming in health and wellness BC Elders Guide, Seniors BC, First Nations Health Authority, 1 st Edition BC Govt, 2014); Pages 8-9 Available on-line at www.seniorsbc.ca or www.fnha.ca
Access to Care Poor access to infectious disease care results in: Late diagnosis, decreased linkage, suboptimal medication adherence Poor outcomes, increased mortality, increased transmission Additional Access to Care Challenges for First Nations on Reserve Primary care services Testing/laboratory Medication availability and coverage Communication Transportation Jurisdiction
Figures from 2016 Annual Report www.skhiv.ca
SK Epidemic First Nations population -141,379 (2012) (13% of SK population) -49% on-reserve
Know Your Status Improve access to care and treatment of HIV for First Nations on-reserve Community developed education, testing, treatment and case management approach
HIV Treatment Outcomes (n=84) 100 90 80 70 60 50 40 30 20 10 0 BR AH Total On Treatment Suppressed
Successful outcomes are directly related to community engagement, partnerships and addressing the health system barriers to care Community led and driven Cultural safety Partnership Access to care Reduction of jurisdictional boundaries Patient centered Policy Community Health Care Providers
Hepatitis C 250.0 200.0 150.0 100.0 50.0 0.0 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016* FN on-reserve 131.1 118.8 168.3 136.4 189.2 138.7 168.4 139.9 185.3 203.6 Saskatchewan 60.8 69.5 62.7 56.1 62.2 63.3 56.1 53.4 62.7 Canada 36.5 35.7 33.3 31.1 29.4 29.3 29.5 29.4 Rate per 100,000 Hepatitis-C diagnosis rates for Saskatchewan First Nations living on-reserve, overall Saskatchewan population and Canadian population, 2007 to 2016
Liver Health Events Over 600 people tested for STBBI s and provided liver health education in 8 different communities Events planned in multiple other communities
The Wellness Wheel A community led program of integrated care between health providers and community Rates of diabetes cases, 1980-2005, SK
Successful and Current Interventions Achieved UN 90(?)/90/90 goals Hepatitis C micro-elimination projects in community Liver health awareness and events Piloting technological innovation and novel point of care approaches Focus groups and community led and developed programs Partnering Western and Indigenous approaches Accessible mental health and addiction programs Wellness Wheel: Multi-disciplinary mobile outreach clinic to address chronic and communicable disease Mobile outreach team Successful grant applications and publications CIHR implementation science grant 2017
Summary HIV, hepatitis C and infectious diseases disproportionately affect First Nations on-reserve who currently have the least access to care A community based and led program can achieve goals of 90(?)/90/90 for HIV and can be used as a basis for chronic disease management for First Nations Requires partnerships between committed health providers, local community health supports and community leaders
Acknowledgements The First Nation communities, including Chief and Councils and providers in Big River, Ahtahkakoop, Sturgeon Lake, Montreal Lake, Cote, Keesesekoose, Key, Okanese and File Hills, George Gordon, Kawacatoose, Muskowekan, Day Star, Thunderchild, Big Island Lake and Cowassess First Nations Chief Bruce Morin, Ruby McAdam and Derek Klein of Big River and Chief Larry Ahenakew, Carmen Little and Noreen Reed of Ahtahkakoop First Nation Leslie Ann Smith, Clarence Frenchman, Jolene Blocka, Tanys Isbister, Amanda St. Onge, Vanessa Ahenakew, Leegay Jagoe and all front line nursing and health care providers Dr. Kris Stewart, Dr. Mona Loutfy, Dr. Marina Klein, Dr. Nadine Kronfli Wellness Wheel Team: Drs. Carla Barkman, Kieran Conway, Fouche Williams, Megan Clark, Jarol Boan, Bonnie Richardson, Sarah Liskowich, Rachel Asiniwasis, Tom Perron, Rosie Courtney. Susanne Nasewich, Val Desjarlais, Dr. Mamata Pandey, Adam Clay, Josh Needham and Carla Crozier Maria Folk, Darla Parent, Deb Rodger, Mike Stuber, Dr. Alex Wong, Dr. Kumudinhi Karunakaran and RQHR ID clinic Saskatoon Positive Living Program and Westside Community Clinic Dr. Ibrahim Khan, Deb Kupchanko, Alex Campbell and First Nation Inuit Health Branch Dr. Jolee Sasakamoose and Indigneous People Health Research Centre Saskatchewan Health Authority and Saskatchewan Ministry of Health Canadian Institute of Health Research