Focusing Our Efforts Ontario s Proposed HIV/AIDS Strategy to 2025

Focusing Our Efforts Ontario s Proposed HIV/AIDS Strategy to 2025 Frank McGee, AIDS & Hepatitis C Programs Ontario Harm Reduction Conference 2015 October 26, 2015

Our successes! We are doing well in Ontario 80% of people diagnosed in Ontario have a first viral load within 3 months of diagnosis People in HIV care in Ontario exceed UN targets for retention in care and viral load OHTN model: we have averted over 7000 infections, saving the system $2.2B over 10 years HIV diagnoses have been trending downward for a decade We are a well networked and information driven sector 2

Harm reduction programs for people who use drugs Harm Reduction Advisory Committee Injection Drug User Outreach Program & IDU Outreach Network Ontario Harm Reduction Distribution Program Ontario HIV & Substance Use Training Program Needle exchange programs at 36 health units Ottawa Safer Inhalation Program Hepatitis C Teams Ontario Naloxone Program Methadone Maintenance Treatment Initiatives 3

VISION Proposed HIV/AIDS Strategy to 2025: Focusing Our Efforts By 2025, new HIV infections will be rare in Ontario and people with HIV will lead long healthy lives, free from stigma and discrimination. MISSION To reduce the harm caused by HIV for individuals and communities and its impact on the health care system by ensuring all in Ontario have timely access to an integrated system of compassionate, effective, evidence-based sexual health and HIV prevention, care and support services. 4

GOAL 1 Improve the health and well being of populations most affected by HIV. GOAL 2 Promote sexual health and prevent new HIV, STI and Hepatitis C infections. GOAL 3 Diagnose HIV infections early and engage people in timely care. GOAL 4 Improve the health, longevity and quality of life for people living with HIV. GOAL 5 Ensure the quality, consistency and effectiveness of all provincially funded HIV programs and services. 5

HIV is a concentrated epidemic in Ontario. There is an estimated 30,000 people living with HIV in Ontario (2011). 2013-14 - % of new HIV diagnoses ACB (HIVendemic) 13% IDU 8% Heterosexual (high & unknown risk) 14% Gay & Bisexual MSM 61% Populations most impacted: people with HIV/AIDS gay and other MSM, incl. transmen African, Caribbean, Black Ontarians Indigenous Peoples people who use drugs women from these populations or in relations with them, incl. transwomen Indigenous people have a rate of HIV infection 1.7 times the non-indigenous population. Women account for 21% of new HIV diagnoses (2014). Women from African, Caribbean, Black communities 48% of new diagnoses among women (2013-14). Other populations at heightened risk include people who are incarcerated, immigrants, refugees and people without status, and people who are engaged in sex work.

Strategic Approach #1 Focus on populations most affected by HIV Social determinants of health Strategically tailor HIV services to priority populations Syndemics HIV prevalence HIV in priority populations Increase access to HIV and other health and social services for people at risk of HIV and of poor health 7

Ontario s Treatment Cascade 2015 PHAC preliminary estimate 100% 14%-28% 65%-75% 52%-60% 43%-52% 28%-42% 8 Note: Data reported as current estimate, but some data comes from Remis (2009, 2011, 2012), PHO Lab (2007-2008) and OCS (2011)

Ontario s HIV treatment cascade Post-diagnosis 100 90 80 70 60 50 40 30 20 10 0 100% 80%-86.6% Of those linked to care 82%-86% are retained 66%-74% Of those retained in care 63%-84% are undetectable 41%-63% Diagnosed Linked to care Retained in care Undetectable viral load Low estimate High estimate Source: personal communication, Ann Burchell & Sandra Gardner, July 15, 2014 based on reported data from PHAC, Robert Remis, 9 and the OHTN Cohort Study. Note: Data is reported as current estimate, but lab data based on 2007/08, PHAC estimates from 2011, OCS from 2011 and Remis data from 2009, 2011, 2012.

Strategic Approach #2: Develop an Ontario model Prevention, Engagement and Care Cascade E N G A G E M E N T HIV/HCV/STI Prevention & Sexual Health with populations most impacted by HIV HIV, HCV & STI Testing Linked to care Retained in care Low viral load Increased longevity, quality of life & Prevention of HIV infection Peer Programs Active referral networks 10

Examples of strategy recommendations to improve service access for people who use drugs Rooted in principles of harm reduction, choice, self-determination and human rights/social justice (among others!) Strengthened epidemiological information and monitoring of cascade indicators for people who use drugs Strengthening care networks including collaboration between ASOs, HCV teams, HIV clinics and health units to: Increase capacity to provide non-stigmatizing services to people who use drugs Increase efficiency at linking people who use drugs to care and support Work with public health to make providing full range of harm reduction materials part of the Ontario Public Health Standards 11

This work has been ongoing and is well underway ASOs & HCV Teams Updated logic model to guide funded programs Program Plan changes: Reporting on service network development/participation Reporting on engaging priority populations Population-specific Networks (GMSH, WHAI, ACCHO) MOUs with ASOs Strengthening network capacity-building activities through consistency of processes and through local and provincial collaboration HIV Testing Rapid and Anonymous Testing evaluation Shifting HIV testing resources towards priority populations OHTN Health unit/aso collaborations HCV Team/Health unit collaborations Development of targeted testing clinics Epidemiology Unit Monitoring the prevention, engagement and care cascade Priority population focus 12

This work has been ongoing and is well underway HIV Clinics ASO/HIV clinic MOU process HIV Clinical Care Guidelines HIV Clinic Network focus on cascade improvements: retention in care adherence support Provincial Interest Program Ministry/LHIN process for ongoing monitoring Other work npep guidelines with Public Health Ontario npep local network development through ASOs HIV Case Management model in development OCHART 2.0 13

The targets: 90-90-90 In 2014, UNAIDS adopted the global targets of: 90% of all people with HIV will know their HIV status (current ON est. 72%-86%) 90% of all people diagnosed with HIV will receive sustained HIV treatment (81% in care) In Ontario, in 2011, in the OHTN Cohort Study*, about: 87% of participants were in care 77% were taking HIV treatments 76% had fully suppressed virus 90% of all people receiving HIV treatment will have viral suppression (72% suppressed) * Published in JAIDS: Journal of Acquired Immune Deficiency Syndromes, 1 Sept. 2015. 14 Modelling suggests that achieving these targets by 2020 will enable the world to end the global epidemic by 2030.

Questions? Comments? For more information contact: frank.mcgee@ontario.ca 15