1. ACCESS PLACE P. A. Update 101 – 15 TH Street East Prince Albert, SK January 31, 2012

2. Services: Sexual Health Clinic Straight to the Point Harm Reduction Program (Needle Exchange) Housing Project 601 North – Drop in Centre

3. Positive Care Program – Hepatitis C support, care and treatment – HIV support, care and treatment – Case Management Community education and outreach

4. Positive Care Program Team: Dr. K. Williams Dr. S. Skinner Dr. K. Stewart Dr. L. Lanoie Dr. V. Parekh Dr. J. Mwana Dr. M. Markentin

5. Marlene Allen- Nurse Manager Chasity Vermette – HIV Outreach Nurse Shelley Crawford – Hep. C Nurse Clinician Barb Bowditch – Case Manager Kathy Hunker- Nurse Practitioner Jacqueline Natomagen – Medical Office Assistant Karen Bear – Housing Coordinator

6. Our Partners in HIV and Hep. C Care: Cooperative Health Center Lab Methadone Assisted Recovery Program Nursing Staff at Prince Albert Correctional Centers

7. Big River First Nation Ahtahkakoop First Nation Numerous other First Nations Communities P. A. Metis Women – Donna Lerat

8. What is Happening:

9. 2011 New HIV Cases – Prince Albert Parkland Health Region Note: New HIV statistics are taken from the actual positive lab reports and reporting forms. Data Compiled by Positive Care Program Charts.

10. 55 New Cases – January 1 – December 31, 2011

11. Mean age of new clients, by gender (n=55)

13. Ethnic Origin– New Cases

14. 43.6% of New HIV Cases have accessed the Positive Care Program

15. New Cases on Treatment

16. Total Number Of HIV Clients (includes new cases) 265 Client Charts 63 % (148)Active Clients -Regular Contact

18. 73.0 % of Active Clients are Hep. C Positive

19. Initial CD 4 Counts

22. Overall Picture Male and Female

23. On prophylaxis: 6.1% On Treatment – 58.2 % On treatment obtaining an un-detectable viral load -23.3%

24. A tool we use to monitor HIV Blood-work : Normal Range & TX Started Kaletre Combivir TX Changed Atripla Test Units Dec.18,08Aug 28,10Aug.30 10Sept13,10Nov 8,10Feb. 2, 11June 9,11Oct. 5,11 CD 4 428 624362146152210228 WARNINGDANGERURGENTDANGER WARNING CD 4 % 12.62.11.93.06.55.48.07.5 Viral Load 67,206 63,545 347<4000

26. In 2011 there were: 5 Deaths 6 pregnancies– all on treatment

27. What we see:

30. Adherence Know thy patient

31. Our study Retrospective chart review, 200 random patients Goal: describe population of methadone clients by examining medical charts for demographic and social characteristics at time of admission

34. Aboriginal status (n=169) Total = 88.2 % Aboriginal

35. Less than grade 12 education: 76.3 % Methadone vs. 44.0 % Aboriginal vs. 31.5 % general pop

39. Deaths: Observed/Expected

40. 6.8% 21.2% 25.8% 15.5% Woody et al, J Addict Med 2007

41. Psychiatric Comorbidity PTSD Depression, Anxiety Bipolar Disease ADHD Alcohol Related Neurodevelopmental Disorder (ARND)