Ontario Harm Reduction Conference April 30 to May 2, 2017 Toronto, Ontario

Transcription

1 Ontario Harm Reduction Conference April 30 to May 2, 2017 Toronto, Ontario Views expressed in the attached document do not necessarily represent those of the Ministry of Health and Long Term Care or those of Kingston Community Health Centres. If you have any questions related to the document, you are encouraged to contact the source.

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3 Public health challenges and opportunities in addressing complex health issues in persons who inject drugs (PWID) in Middlesex-London, Ontario Shaya Dhinsa with contributers Dr. Gayane Hovhannisyan, Todd Coleman, Tamara Thompson May 1, 2017

4 February 2016 Background Infectious disease physicians noticed increasing number of new HIV cases Initial concerns were related to local correctional facility 7 HIV cases reported by mid-month (~1 case/week)

5 Reported count and rate of new cases of HIV in Middlesex- London and Ontario, Count Rate (per 100,000) MLHU Count MLHU Rate Ontario rate Source: Public Health Ontario Infectious Diseases Query, data extracted January 6, 2017

6 Characteristics of HIV cases Of the 58 cases (2016) 70% in PWID 11 of 58 (19.0%) cases diagnosed at Elgin- Middlesex Detention Centre (EMDC) 9 of 58 (15.5%) were underhoused or homeless Majority of cases in Those years old (50.0%) Males (63.8%)

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8 Reported count and rate of new cases of Hepatitis C in Middlesex-London and Ontario, Count MLHU Count MLHU Rate Ontario Rate Rate (per 100,000) Source: Public Health Ontario Infectious Diseases Query, data extracted January 6, 2017

9 Reported count and crude rate of new cases of Invasive Group A Streptococcal Disease (igas) in Middlesex-London and Ontario, Count MLHU Count MLHU Rate Ontario Rate Rate (per 100,000) Source: Public Health Ontario Infectious Diseases Query, data extracted January 6, 2017

10 Count of injection drug use associated Endocarditis cases per year* Courtesy of Dr. Michael Silverman MD, FRCP, FACP, Chair/Chief Infectious Diseases LHSC and St Joseph s Hospital, Western University, London

11 Declared Public Health June 2016 Emergency Due to rapid rise in HIV and other infections in PWID Purpose: To alert local PWID To advise stakeholders working with these communities To alert health care providers

12 HIV Leadership team HIV Leadership Team established to develop comprehensive HIV strategy Enhanced surveillance Primary and secondary prevention Harm reduction Treatment Literature review, expert consultations to identify effective strategies to address HIV epidemic in PWID Over 50 provincial and national experts and other stakeholders consulted

13 COMMUNITY STAKEHOLDER ENGAGEMENT

14 Potential causes of emerging infections in PWID Changes to drugs of choice Oxycontin de-listed in 2012 Increased use of tamper-proof prescription opioids Increased use of crystal meth in London Unsafe injection techniques Lack of awareness of proper techniques Sharing injection supplies Effects of being high

15 Potential causes of emerging infections in PWID Lack of access to clean injection supplies Sharing injection supplies in prison No needles syringe programs in correctional facilities Some gaps in community needle syringe programs

16 Gaps in Services Access to more services Supervised Injection Site Low-barriers/high thresholds Respite centre 24-hr space for women and transgender people Need for increased harm reduction supplies delivery

17 Mental health Gaps in Services Supporting people who lack decision-making capacity Under-resourced areas in London Gaps identified through mapping Street-level outreach Lack of capacity for service provision

18 EVIDENCE-INFORMED STRATEGIES TO ADDRESS HIV AND OTHER INFECTIONS IN PWID

19 Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS PROGRAM) In late 1990s BC saw a dramatic increase in HIV in PWID during a short period of time 60% of their drug use population was infected with HIV. Saskatchewan is also currently experiencing and epidemic of HIV in PWID Both BC and Saskatchewan implemented STOP HIV approach. Reached out to both provinces to learn from their experiences

20 STOP HIV/AIDS PROGRAM $48 million, four-year ( ) pilot project funded by the government of British Columbia Purpose reduce the number of new HIV infections through: finding people living with HIV linking them to HIV care and treatment supporting adherence to increase the quality of life of people living with HIV Based pm the principles of early treatment as prevention (TaSP)

21 Adaptation of STOP model MLHU internally reallocated $270,000 to adapt key elements of the STOP HIV/AIDS model developed in British Columbia for hardto-reach populations. The model includes street level outreach workers that work in teams (or pods ) and it has been proven effective in engaging hard to reach HIV-positive individuals and connecting them to care.

22 Community-based HIV Care Hospital based HIV care limited in its ability to reach PWID Population requires extensive case management due to low adherence Adapt BC approach to having multiple providers, including family doctors providing HIV treatment Community Based HIV Program providing treatment to HIV positive patients previously difficult to treat maintaining viral load suppression due to the absence of funding, suspended intake of new patients

23 Client Based Care Model with Integration of Primary Care and Addiction Services Addictions services key part to successful HIV control uptake among HIV-positive individuals with concurrent addiction disorders positively influences likelihood of adherence to treatment London unique with high rate of concomitant opioid and crystal methamphetamine use No medical detox beds available in London

24 Harm Reduction Services Large harm reduction program Over 2.7 million needles in 2016 MLHU contracts the services to Regional HIV/AIDS Connection Centralized fixed needle exchange program (NEP) 1 main site, 4 satellite sites, including 2 shelters Mobile van delivers and collects needles throughout London

25 Expanding Harm Reduction Services Mapping of HCV cases in PWID in London indicates gaps where clients can t access harm reduction supplies Working to increase the number of satellite fixed sites, such as: Pharmacies Shelters

26 Supervised Injection Services (SIS) SIS Feasibility Study results released in London Feb 2017 studies also conducted in Toronto, Ottawa and Thunder Bay 86% participants willingness to use SIS Study recommended 2 sites which will be further investigated through public consultation

27 Correctional Facility Areas identified to develop and improve: -increase HIV testing -initiating opioid maintenance therapy Harm reduction Need provincial support to introduce harm reduction in correctional facilities

28 Point of Care (POC) Testing Identified as a gap in the community particularly in areas identified with increased HIV Increased targeted HIV testing for PWID Connecting with care, enabling retention Not knowing HIV status complicates efforts to reduce spread and moving people into care and treatment Enhance capacity for testing in the community setting Sexual Health Public Health Nurses at MLHU trained to provide POC

29 Thank you Questions?