HIV/AIDS Communiqué - Volume 7 Number 1 - Spring 2008

Table of contents

• The Public Health Agency of Canada’s National HIV and Retrovirology Laboratories Accredited by the World Health Organization
• ACAP Evaluation
• The Canadian HIV Vaccine Initiative
• CIHR Update
• The Specific Populations HIV/AIDS Initiatives Fund Update
• Communiqué article re. Framework
• Government of Canada Funding for HIV/AIDS
• New National HIV/AIDS Knowledge Exchange Fund RFP Results
• NACHA Policy Forum

The Public Health Agency of Canada’s National HIV and Retrovirology Laboratories Accredited by the World Health Organization

The Public Health Agency of Canada’s National HIV and Retrovirology Laboratories (NHRL), in Ottawa, have been accredited by the World Health Organization (WHO) and designated as one of only four specialized HIV drug resistance laboratories in the world.  Laboratories worldwide were invited to apply for WHO accreditation in this specialty.  In June 2007, an independent committee of global consultants in HIV drug resistance (HIVDR) were presented with detailed reports on candidate laboratories in a blinded fashion.  After a careful review of all reports, the NHRL was selected as one of the few laboratories to meet the most stringent requirements set out by the expert panel and was granted WHO accreditation.

As part of the WHO Global Strategy for HIV Drug Resistance Prevention, Surveillance and Monitoring, the HIV Drug Resistance Network (ResNet) was created from an international network of HIVDR consultants.  ResNet ensures that quality-assured, comparable data for surveillance of transmitted and secondary HIVDR is produced at a regional, national, and global level. Through accreditation, ResNet aims to create a network of laboratories with differing expertise moving from sub-regional to regional and to the specialized HIVDR laboratories.  The accreditation process is open to laboratories worldwide and is based on successfully fulfilling the following criteria: a standardized, formal application process; a site visit to assess the laboratory’s work practices and facilities; and satisfactory performance in standardized proficiency testing.

The NHRL’s internationally recognized experience and leadership in HIV laboratory science was acknowledged by the WHO expert committee through accreditation.  With new initiatives and existing programs, the NHRL is committed to achieving two WHO ResNet goals.  The laboratory will provide training and technical support to personnel from national HIV drug resistance laboratories in resource-poor countries and will continue to lead the way in the development of alternative methods of specimen collection, storage, and HIVDR analysis.

Accurate laboratory testing and reporting of HIVDR is critical to both the patient and policy makers.  WHO estimates that at least 6.5 million people in resource-poor countries are in urgent need of antiretroviral therapy.  If an individual who is not taking ideal anti-HIV therapy, the HIV can become resistant to medication and treatments can fail.  Transmission of a drug-resistant virus can also lead to treatment failure in someone who has never taken these drugs.  In Canada, there are more than 20 types of HIV medications that can be selected from to treat drug-resistant HIV however, in resource-poor countries selection may be limited to only six types of HIV medication.  Accurately determining the rate of drug resistance in these countries is vital to ensuring that as many people as possible get started on the most appropriate treatment regimens.

For more information, please contact Paul Sandstorm by e-mail, paul_sandstrom@phac-aspc.gc.ca.

ACAP Evaluation

The AIDS Community Action Program (ACAP) continues to support Federal Initiative priorities through its work across Canada. In particular, ACAP is strengthening its ability to monitor and evaluate community-based programming and to demonstrate the significant contribution of community-based activities to the Canadian response.

The Project Evaluation and Reporting Tool (PERT) is an example of how the community is involved in monitoring and evaluating ACAP. PERT is a self-reporting questionnaire that has been developed in consultation with the community and stakeholders to help monitor and document the effectiveness of participating Public Health Agency of Canada (PHAC) grants and contributions programs, and to assess the impact of community-based programs on the health of Canadians and communities. Three PHAC regions (Atlantic, British Columbia and Manitoba/Saskatchewan) piloted PERT with ACAP-funded projects. During the pilot, all comments and feedback received from project participants were documented and forwarded to a validation committee, which rolled up key issues that needed to be addressed. The validation process will assess contextual and operational validity, and provide a synthesis for changes and improvement. This will benefit community-based funded projects by helping them report on their progress and outputs.

The Project Data Collection and Analysis System (PDCAS), which is a web-based version of PERT, has also been launched and is being used by ACAP-funded projects in the three regions. Orientation and training sessions were provided to program consultants, evaluation consultants and funded organizations. The second quarterly reporting period (April 1, 2007, to September 30, 2007) was administered using PDCAS.

PERT has enabled PHAC regional offices to better gather data by using the same collection tool to provide accurate information on the value created by funded projects and the results achieved. For example, in British Columbia, 8 ACAP-funded projects reported recruiting 31 new volunteers from October 2006 to March 2007; created 11 new collaborative partners; and reached out to 2,170 people living with HIV/AIDS, 1,640 women at risk, including Aboriginal women, and 3,479 youth at risk. In addition, the region reported delivering 274 workshops and 159 community programs and referring 409 individuals to social services and 694 to medical care over the same period.

In the Manitoba and Saskatchewan Region (October 2006 to March 2007), 9 ACAP-funded projects reported recruiting 84 new volunteers with a total volunteer base of 407. The total number of hours contributed by volunteers during this period was just over 5,300. Funded projects reported 11 new collaborative partners and reached out to over 7,000 members of priority populations. Specifically, the projects provided outreach to 4,567 gay and bisexual men and transgendered people; 2,512 people who use drugs; 335 inmates; 266 people living with HIV; and 105 women at risk. In addition, funded projects reported delivering 137 community programs and 117 workshops and/or presentations. These activities reached over 7,000 people. Funded projects reported in-kind contributions during this period totalling over $200,000.

In the Atlantic Region (October 2006 to March 2007), ACAP-funded projects reported total in-kind contributions of $315,715 for the 11 participating projects. Six hundred and seventeen volunteers contributed 9,983 hours over this period. There were 87 partnerships identified with the most cited result being increased outreach to target populations. Of the 11 projects, 9 were intended to influence policy. Policy areas included the following: access to methadone maintenance and other drug treatment programs (3); provincial HIV/AIDS strategy work related to access to coordinated care, treatment, and support (1); provincial school curriculum revision (1); provincial harm reduction policies; (1), socioeconomic policies for people living with HIV/AIDS (2); and the decision to pilot a drug court (which represents a meaningful policy shift by recognizing drug dependency as a key social issue that impacts the courts and sentencing) (1).

At the time of reporting, four of the projects were able to demonstrate methods on how they had influenced policies related to the provision of infant formula for HIV-positive women; the establishment of new methadone maintenance treatment clinics; and the development of a provincial substance use strategy. Another example of innovation in the Atlantic Region is the combined ACAP and hepatitis C time-limited project funding to community-based organizations for 2006-2008. This approach emerged from regional consultations and a review of the data relating to at-risk populations. Based on this review, prevention work targeting youth has been identified as a common priority for both programs.

The Ontario Region has continued its innovative collaborative work with the province. In partnership with its provincial counterpart, the AIDS Bureau of the Ontario Ministry of Health and Long-Term Care and with technical support from the Ontario HIV Treatment Network, a common reporting tool has been developed. This tool allows recipients of provincial and federal funding to complete a single report for submission to both funders. The Ontario Community HIV/AIDS Reporting Tool (OCHART) has allowed for comprehensive data collection, as well as new opportunities for data-sharing with various stakeholders. Perhaps most importantly, the tool has made it easier for funders, not only to analyse data, but also to present the results of data analysis back to the reporting communities. For example, data from the OCHART was the basis for the second annual evaluation report, The View from the Frontlines which identifies emerging trends throughout Ontario in community-based prevention, education, and support programming. The report was launched at a community knowledge, transfer, and exchange day on January 24, 2008. The region is also aligning OCHART with PERT, a process that will be ongoing, while the latter is being validated and revised.

Last year’s View from the Frontlines has been widely disseminated and is available online at
http://www.ochart.ca/View2007en.pdf. This year’s report will be available online soon.

In the Alberta Region, PERT was implemented with the Alberta Community Council on HIV (ACCH) in October 2007. ACAP and provincial HIV/AIDS funding for community-based organizations in the region are currently pooled, managed, and distributed through the Alberta Community HIV/AIDS Fund (ACHF), which is administered by the ACCH. Alberta ACAP evaluation and program consultants are also currently working with the ACHF steward to design an ACHF-specific narrative report that incorporates PERT questions. This narrative report will be used biannually by ACHF-funded AIDS service organizations across the region to collect data on outputs and short-term outcomes that can be compared to ACAP data collected across Canada.

For further information, please contact: Fiona Chin-Yee at fiona_chin-yee@phac-aspc.gc.ca.

The Canadian HIV Vaccine Initiative

The Canadian HIV Vaccine Initiative (CHVI) – a historic collaboration between the Government of Canada and the Bill and Melinda Gates Foundation – was announced on February 20, 2007. The five participating government departments and agencies (Canadian International Development Agency, Public Health Agency of Canada, Industry Canada, Canadian Institutes of Health Research, and Health Canada) have been actively implementing the five program areas of this important initiative since the announcement.

The following are three recent developments concerning the CHVI:

Website:

• A new website for the CHVI was launched in early February 2008
  (www.chvi-icvv.gc.ca).

Consultations on CHVI Funding Programs:

• A face-to-face consultation was held in Ottawa, February 10-12, 2008, to inform the development of new funding programs focussing on the following:
  • HIV vaccine discovery and social research;
  • HIV vaccine clinical trial capacity building and networks; and
  • HIV vaccine-related policy development and community engagement.

The results of discussions will inform the development of a Request for Proposals/Application, which is expected to be launched this spring.

Consultation on CHVI Pilot Scale Manufacturing Facility:

• A web-based consultation for the CHVI pilot scale manufacturing facility for HIV clinical trial lots has been completed. An invitation to submit applications is expected to be launched this spring.
  

For more information on the CHVI, please contact Steven Sternthal, by e-mail, at steven_sternthal@phac-aspc.gc.ca.

CIHR Update

Draft CIHR HIV/AIDS Research Initiative Strategic Plan 2008 – 2013

Under the leadership of the Canadian Institutes of Health Research (CIHR) HIV/AIDS Research Advisory Committee (CHARAC) and in consultation with national HIV/AIDS research leaders, community partners and clinicians, the CIHR Institute of Infection and Immunity (III) has developed a draft strategic plan to guide the CIHR HIV/AIDS Research Initiative from 2008 to 2013. Stakeholders are invited to review and comment on the draft plan until February 25, 2008. The draft CIHR HIV/AIDS Research Initiative Strategic Plan 2008-2013 is available at: http://www.cihr-irsc.gc.ca/e/35589.html.

Research Funding Opportunities

CIHR launched a variety of new strategic research funding opportunities in HIV/AIDS in December 2007. The new opportunities include:

• Centres for Population Health and Health Services Research Development in HIV/AIDS
• Capacity Building Workshop (Community-Based Research)
• Seed Grant (Community-Based Research)
• Fellowships – Priority Announcement
• Operating Grant  - Priority Announcement

Please visit the CIHR Funding Opportunities website at: http://www.cihr-irsc.gc.ca/e/26637.html for more detailed information on these and other CIHR programs.

For more information on the CIHR HIV/AIDS Research Initiative, please contact Susan Lalumière at slalumiere@cirh-irsc.gc.ca.

The Specific Populations HIV/AIDS Initiatives Fund Update

The Specific Populations HIV/AIDS Initiatives Fund Request for Proposals was released in
June 2006. The goal of the fund, which replaces the HIV/AIDS Capacity Building Fund, is to support national projects that prevent HIV infection; increase access to appropriate diagnosis, care, treatment, and support; and increase healthy behaviours amongst Canada’s populations most affected by HIV/AIDS and most vulnerable to infection.

The fund, which was developed as part of the realignment of all national HIV/AIDS funding streams with the goals of the Federal Initiative to Address HIV/AIDS in Canada, has population-specific policy, program and social marketing priorities. These priorities were identified by PHAC through its ongoing assessment of data related to the HIV/AIDS epidemic in Canada, stakeholder consultation, and the federal role in supporting the activities, outputs, and vision of Leading Together: Canada Takes Action on HIV/AIDS (2005-2010).

The review and approval process was completed for all applications, and work is now underway for all projects (described below):

Red Road HIV/AIDS Network Society

Bloodlines
The objective of the project is to provide accurate, culturally relevant and meaningful educational information for Aboriginal people living with HIV/AIDS and their family and friends, as well as frontline workers, health care providers, program planners and policy makers.
They plan to fulfill their objective by nationally launching two new issues of their well-known Bloodlines magazine.

Action Séro-Zéro

Marketing social communautaire auprès des hommes gais à l'échelle nationale
Through the establishment of a national advisory committee and local committees, as well as the creation, launch and evaluation of a national social marketing campaign, Action Séro-Zéro aims to reduce the incidence of HIV/AIDS in the gay community. The results of this campaign will be disseminated and made available in all parts of Canada. This plan will facilitate the implementation of activities, as well as reinforce the message of HIV/AIDS stigma and discrimination.

Canadian AIDS Treatment Information Exchange

Managing Your Health for People Living with HIV/AIDS
The capacity-building project objective is to provide front-line service providers with an extensively revised edition of the successful document, Managing Your Health for People Living with HIV. This document will be used as a guide for service providers, while providing support to their HIV-positive clients, who will receive a copy for personal use.

Canadian Treatment Action Council

Creating an integrated community-centred pilot project for the Health Canada Progressive Licensing Framework: testing the life cycle approach to drug management in the HIV/AIDS community
The objectives of this policy and program analysis project are to improve involvement of people living with HIV/AIDS in the review of national policy and programs that affect their access to care, treatment, and support; solidify collaborative relationships with government and other bodies; undertake more in-depth policy analysis and development work; and respond in a more timely manner to emergent national policy issues.

Pauktuutit Inuit Women’s Association

Ajjigijaunningittuq: Addressing the HIV Needs of Inuit in Urban Centres
The objective of the capacity-building project is to improve the quality of life of Inuit infected with, or affected by, HIV by improving access to Inuit-centred prevention, diagnosis, care, treatment, and support provided by AIDS service organizations (Aboriginal and non-Aboriginal-specific organizations), as well as other health, medical, and/or social service providers.

Canadian Working Group on HIV and Rehabilitation

Navigating the Maze
The objective of this policy and program analysis project is to promote opportunities for optimal labour force participation for people living with HIV/AIDS (PHAs), with security and/or continuity of needed supports. The project objective will be achieved through promoting improved integration and coordination of income/benefits and employment policies and programs for PHAs and working with relevant government departments/ministries to identify and develop mechanisms for communication.

Canadian Aboriginal AIDS Network

Fostering Community Leadership to End HIV/AIDS Stigma and Discrimination
The project objective is to increase levels of awareness and knowledge about HIV/AIDS amongst Aboriginal leadership by at least 10 per cent through a social marketing campaign. The project intends to end stigma and discrimination and create community environments that may become more responsive and conducive to establishing needed education, prevention, testing, and diagnostic, care, treatment, and support programs.

For more information, please contact Sonia Hamel by e-mail, at sonia_hamel@phac-aspc.gc.ca.

Communiqué article re. Framework
January 2008

Work is underway on the development of a national framework for research planning and knowledge exchange in Canada, in collaboration with governments, researchers, funders, community-based and national non-governmental organizations, public health practitioners, front-line service providers and people living with HIV/AIDS. The purpose of the framework is to identify the ways in which we can harness and strengthen existing capacities, and foster new opportunities in the generation and use of information related to HIV/AIDS in Canada.

To date, PHAC has undertaken a series of key informant interviews with individuals from across sectors. This work builds on some initial work that was carried out in 2006, including an environmental scan on the state of HIV/AIDS research in Canada, and an overview of research priorities.

PHAC and its partners are currently exploring the best way to move forward with the development of the framework. One option being considered is to strike an expert panel to guide this work.  The panel would be comprised of representatives from across the various sectors.  Its role would be to articulate a vision of where we, collectively, need to be regarding HIV/AIDS research planning and knowledge exchange in Canada.  Building from an assessment of where we are now, the panel would then identify the development of mechanisms and strategies to bring us closer to this vision.

Broad consultations with stakeholders will occur as the work progresses. It is important that all sectors are involved in improving the generation and use of knowledge to support policies, programs and decision-making related to HIV/AIDS prevention, diagnosis, treatment, care and support.

For more information, please contact Geneviève Tremblay at (613) 946-3637 or genevieve_tremblay@phac-aspc.gc.ca.

Government of Canada Funding for HIV/AIDS

This past fall saw several media reports concerning federal government funding for HIV/AIDS under the Federal Initiative to Address HIV/AIDS in Canada and the recently launched Canadian HIV Vaccine Initiative (CHVI).

Both Minister Clement and Dr. David Butler-Jones, Chief Public Health Officer of Canada, have publicly responded to the concerns raised in the media and by Canadian HIV/AIDS stakeholders. In a web statement issued on December 5, 2007, Dr. Butler-Jones re-iterated that the Public Health Agency of Canada (PHAC) is committed to a comprehensive, long-term approach against HIV/AIDS in Canada and around the world.

Minister Clement, at a meeting with national HIV/AIDS partners on December 6, 2007, indicated that the federal government will invest more than $84 million towards HIV/AIDS in 2008-2009 – more than has ever been spent in Canada’s history - and that these investments will support both the Federal Initiative and the CHVI.

The Minister and Dr. Butler-Jones have both stated that in addressing HIV/AIDS, it is important to strike the right balance between innovative vaccine research and community programs that meet the needs of people living with, or vulnerable to, the disease. At a meeting with national HIV/AIDS partners, Health Portfolio officials outlined how $5.2 million annually will be re-allocated from the Federal Initiative to the CHVI over five years and how these resources leveraged an additional $85 million in new federal spending to support the CHVI. These officials also released further details regarding the Memorandum of Understanding between the Government of Canada and the Bill and Melinda Gates Foundation, under which the latter is investing $1 for every $3 in newly invested federal HIV/AIDS resources to support the CHVI.

Also at this meeting, PHAC officials highlighted the impacts of a government-wide expenditure review set out in the 2004 and 2005 federal budgets on Agency grants and contributions (Gs&Cs) programs. In 2007-2008, Federal Initiative Gs&Cs were reduced by $2.6 million. No decisions have been taken concerning funding in subsequent years pending a PHAC review of its Gs&Cs programs.

For further information, please contact Nina Arron at 613-957-1345 or nina_arron@phac-aspc.gc.ca.

New National HIV/AIDS Knowledge Exchange Fund RFP Results

Last fall, the results of the new National HIV/AIDS Knowledge Exchange Fund (KEF) Request for Proposals were released, naming the Canadian AIDS Treatment Information Exchange (CATIE) as the successful organization. CATIE will be creating a National Network for Excellence in HIV/AIDS Knowledge Exchange and will be the knowledge broker for HIV/AIDS information. CATIE will be providing the full spectrum of HIV/AIDS prevention, care, treatment and support information and, to fulfill its new role, will be consulting with frontline organizations about their needs over the winter. This time will also be a transition period as the Canadian Public Health Association's (CPHA) HIV/AIDS Information Centre transfers distribution duties, library, and archives to CATIE. Both CATIE and the CPHA will be working to ensure as smooth a transition as possible, to minimize any service disruption to the frontlines. The HIV/AIDS Information Centre will be closing its doors on March 31, 2008, and CATIE will be assuming its new duties, and launching as the new HIV/AIDS Knowledge Broker, on April 1, 2008.

The KEF aims to strengthen the response of front-line organizations involved in the delivery of prevention, diagnosis, care, treatment and support to people living with, and at risk of, HIV/AIDS by incorporating an active and continuous exchange of HIV/AIDS-related knowledge. As the HIV/AIDS knowledge broker, CATIE will gather, synthesize, and disseminate relevant research, epidemiological data, and best practices to front-line organizations to increase their capacity to plan and deliver programs and services. This service will be provided through a single point-of-contact via a website, toll-free telephone number, publications, and workshops. For more details on CATIE, please visit its website, at http://www.catie.ca.

For more information, please contact Sherrill MacDonald by e-mail, sherrill_macdonald@phac-aspc.gc.ca.

NACHA Policy Forum

On September 18-19, 2007, the National Aboriginal Council on HIV/AIDS (NACHA) held its first Aboriginal HIV/AIDS policy forum. This event was a joint effort between NACHA and the Canadian Aboriginal AIDS Network (CAAN) and was held in conjunction with CAAN’s Skills Building Forum.

Dr. David Butler-Jones, Chief Public Health Officer of the Public Health Agency of Canada (PHAC), spoke at the closing banquet of the event and emphasized PHAC’s commitment under the Federal Initiative to address HIV/AIDS among Aboriginal peoples. He stressed the importance of strategically addressing the range of factors, which will not only improve health outcomes, but will also support the strategies to combat HIV/AIDS and make them more effective.

The goals of the forum were to discuss, understand, and strengthen the relationship between policies and effective action to help slow the HIV/AIDS epidemic amongst Aboriginal populations. Issues discussed included barriers, gaps, and information needs; research and epidemiology; prevention, care, treatment, support, and harm reduction; successes and wise practices; and Inuit-, Métis- and First Nations-specific needs.

NACHA-specific workshops included the following:

Homelessness and HIV in the Inuit Community – This workshop focussed on the impact of homelessness, inadequate housing, and lack of affordable housing relating to the health and well-being of HIV-positive Inuit.

Métis-Specific Responses – This session explored the challenges of developing Métis-specific responses, including the importance of Métis identity, culture, politics, and standing; the necessity of invigorating community-based and participatory action research approaches; and the need to develop appreciation for critical elements of politics and programs that acknowledge, affirm, and involve Métis people.

First Nations and the Determinants of Health – This session explored the determinants of health through discussions on residential schooling and its effects on the Aboriginal HIV/AIDS epidemic, and on whether existing long-term goals to improve the social determinants of health will help to reverse HIV/AIDS trends.

Northern and Rural Issues – In this session, discussion focussed on the unique issues and challenges of the Inuit experience from an isolated community perspective.

Leadership Strategy Consultation – This workshop explored ways the Aboriginal community may better engage its leadership. Discussions focussed on the concept of ‘leadership,’ its meaning, and its potential to influence the Aboriginal HIV/AIDS epidemic.

Rapid Testing Issues – In this session, discussion focussed on the new rapid HIV test, including its potential benefits and pitfalls for the Aboriginal community.

For more information, please contact Grafton Spooner by e-mail, grafton_spooner@phac-aspc.gc.ca.