Group proposes plan to stop HIV epidemic in Saskatchewan
SHARE outlines 90-90-90 strategy for testing, treatment and viral suppression
If Dr. Ryan Meili has his way, Saskatchewan will no longer be lagging behind other provinces in detecting, treating and preventing HIV infection.
"In terms of responding to an epidemic that is as serious as this, we haven't really made the grade," Meili said.
The province has made strides since implementing a four-year HIV Strategy, which wound down last year. The rate of new infections slowed.
However, Saskatchewan remains the only province where the incidence of HIV has not "decreased or leveled off at, near or below the national average of 5.9 cases per 100,000."
That's according to a report Meili co-authored, by the group called Saskatchewan HIV/AIDS Research Endeavour (SHARE).
Double national average
It cites incidence rates more than double the national average, the highest in the country at 11.5 cases for 100,000 in 2013.
An estimated 27 per cent of people infected with HIV don't know they are.
Among the 129 new cases in 2013, 68 per cent were among aboriginal people, 55 per cent were due to injection drug use, and 27 per cent were through heterosexual contact.
SHARE is proposing a bold attack on the epidemic, summed up as 90-90-90. That's 90 per cent of all people living with HIV tested and diagnosed, 90 per cent of people diagnosed are treated with anti-retroviral drugs, and 90 per cent of people treated reach virus levels so low they can't pass the infection on to someone else.
UNAIDS, the Joint United Nations Programme on HIV/AIDS, projects that this approach would end the AIDS epidemic by 2030.
It's a concept described as treatment as prevention, an approach already used successfully in British Columbia.
"We have a situation with HIV in Saskatchewan that is quite unique. IV drug use, a population that is moving quite a lot, so difficulty really finding where everyone is, getting them the testing and treatment they need," Meili commented. "There are big challenges involved. And the reality is that we haven't yet mobilized the resources and the type of plan we need to address those challenges."
Among those challenges is making testing and treatment more widely available outside the province's three largest centres — Saskatoon, Regina and Prince Albert.
To achieve this, SHARE is proposing a 10-point plan. It includes free, universal access to all HIV medications. Right now, people making too much money to qualify for coverage under the province's drug plan often struggle to pay for the treatment they need, Meili explained.
"It would only cost us not even $500,000 a year to cover everyone," he added.
Mirrors approach to tuberculosis
The 10-point plan mirrors the approach taken to battle tuberculosis, Meili said, involving a high level of co-operation and co-ordination between the province and Health Canada's First Nations and Inuit Health Branch.
Meili is now lobbying the province's health minister to adopt 90-90-90 as a goal, and follow through with the 10-point plan.
The idea is getting a warm reception from Saskatchewan's chief medical health officer, Dr. Saqib Shahab.
"It has been accepted by UNAIDS as a goal to aspire to, so certainly we fully recognize that," Shahab said. "That is a really laudable goal to reach."
As for SHARE's 10-point plan, "I think [on some points] we are well on our way", Shahab responded.
For example, the province's now-ended HIV Strategy has significantly increased testing around the province, doubling the testing rate, Shahab said.
"But we recognize that the testing rates may have been higher in the large urban centres," Shahab explained. "So we've pushed out access to testing in rural-remote locations, including access to point-of-care testing when required in emergent clinical situations."
He acknowledged access to testing must keep expanding.
Shahab said the number of HIV-positive people receiving treatment has increased, and in remote areas there have been initiatives such as outreach clinics and experiments with tele-health.