Transcript HIV Rounds Presentation - SK HIV Provincial Leadership Team

ACCESS PLACE
P. A. Update
January 31, 2012
101 – 15TH Street East
Prince Albert, SK
Services:
• Sexual Health Clinic
• Straight to the Point Harm Reduction Program
(Needle Exchange)
• Housing Project
• 601 North – Drop in Centre
• Positive Care Program
– Hepatitis C support, care and treatment
– HIV support, care and treatment
– Case Management
• Community education and outreach
Positive Care Program Team:
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Dr. K. Williams
Dr. S. Skinner
Dr. K. Stewart
Dr. L. Lanoie
Dr. V. Parekh
Dr. J. Mwana
Dr. M. Markentin
• 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
Our Partners in HIV and Hep. C
Care:
• Cooperative Health Center Lab
• Methadone Assisted Recovery Program
• Nursing Staff at Prince Albert Correctional
Centers
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Big River First Nation
Ahtahkakoop First Nation
Numerous other First Nations Communities
P. A. Metis Women – Donna Lerat
What is Happening:
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.
55 New Cases – January 1 – December 31 , 2011
New Cases By Gender
(n = 55)
Male
40.0%
60.0%
Female
Mean age of new clients, by gender
(n=55)
45
Males
40
Females
35
Females
30
Males
30.8
25
39.0
New Cases Risk Factors (n=55)
100.0%
95.0%
90.0%
85.0%
IUD
IDU
80.0%
MSM
75.0%
70.0%
65.0%
60.0%
Sexual
Transmission
55.0%
50.0%
45.0%
40.0%
83.6%
Reporting
Form Not
Received
35.0%
30.0%
25.0%
20.0%
15.0%
10.0%
5.0%
0.0%
Reporting
Sexual
Form Not
MSM Transmission Received
3.6%
5.4%
7.4%
Ethnic Origin– New Cases
(n = 55)
1.8%
5.5%
92.7%
Aboriginal
Caucasian
Unknown
70. 8 % of New Cases are Hep. Positive
• 43.6% of New HIV Cases have accessed the
Positive Care Program
New HIV Cases CD 4 Count Analysis
(n = 24)
CD4< 200
CD4 201 -350
31.6%
31.6%
CD4 351- 500
21.1%
15.7%
CD4 >500
New Cases on Treatment
(n = 24)
4.2%
TX
25.0%
Prophylaxis
Total Number Of HIV Clients (includes
new cases)
• 265 Client Charts
• 63 % (148)Active Clients -Regular Contact
Active Cases By Gender
(n = 148)
54.7%
45.3%
Male
Female
50.0
45.0
Mean Age of Active Clients by Gender
(n = 148)
Males
40.0
Females
35.0
30.0
25.0
20.0
15.0
10.0
5.0
0.0
39.4
31.9
0.7%
Active Client Ethnic Origin (n= 148)
8.8%
Aboriginal
Caucasian
90.5%
73.0 % of Active Clients are Hep. C Positive
African
Initial CD 4 Counts
Male CD 4 Analysis (n =67)
CD4< 200
19.4%
34.3%
16.4%
CD4 201 -350
CD4 351- 500
29.9%
CD4 >500
Female Client- CD 4 Analysis (n= 81)
CD4< 200
28.4%
33.3%
CD4 201 -350
CD4 351- 500
CD4 >500
19.8%
18.5%
Active Clients on Treatment, By Gender (n = 86)
80.0%
Male
70.0%
60.0%
Female
50.0%
Female
40.0%
Male
30.0%
20.0%
10.0%
0.0%
67.7%
57.3%
Overall Picture Male and Female
Initial CD 4 Counts- All Active Clients (n = 148)
24.3%
33.8%
CD4< 200
CD4 201 -350
CD4 351- 500
18.2%
23.6%
CD4 >500
• On prophylaxis: 6.1%
• On Treatment – 58.2 %
• On treatment obtaining an un-detectable viral
load -23.3%
A tool we use to monitor HIV Blood-work
TX
Started
Kaletre
Combivir
Normal Range
&
Test
:
TX Changed
Atripla
Dec.18,08
Aug 28,10
Aug.30 10
Sept13,10
Nov 8,10
Feb. 2, 11
June 9,11
Oct. 5,11
428
62
43
62
146
152
210
228
WARNING
DANGER
URGENT
DANGER
DANGER
DANGER
WARNING
WARNING
12.6
2.1
1.9
3.0
6.5
5.4
8.0
7.5
347
<40
0
0
Units
CD 4
CD 4 %
67,206
Viral Load
63,545
850
800
750
700
650
CD4
600
Blood Work Range
550
CD 4 %
500
450
Viral
Load
428
400
350
347
300
250
228
210
200
150
152
146
100
50
12.6
0
Dec.18,08
62
43
2.1
1.9
Aug 28,10
Aug.30 10
62
3.0
6.5
Sept13,10
Nov 8,10
Date of Bloodwork
5.4
8.0
7.5
0
Feb. 2, 11
0
June 9,11
0
Oct. 5,11
• In 2011 there were:
• 5 Deaths
• 6 pregnancies– all on treatment
What we see:
Adherence
Know thy patient
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
Methadone clients by gender
(n=200)
Male
44%
Female
56%
Mean age of methadone clients, by gender
35
34
33
Males
34.5
Females
32
31
30
29
30.0
28
27
Males
Females
Aboriginal status (n=169)
80.0%
71.6%
60.0%
Total = 88.2 % Aboriginal
40.0%
20.0%
13.0%
11.8%
Metis
Non-Aboriginal
3.6%
0.0%
Status Indian
Non-status Indian
Highest level of education (n=184)
Less than Gr 9,
16.8%
Complete post
secondary, 2.2%
Some post
secondary, 5.9%
Complete Gr 12,
15.1%
Grade 9 – 11,
59.5%
Less than grade 12 education:
76.3 % Methadone vs. 44.0 % Aboriginal vs. 31.5 % general pop
Abuse history, by gender (n=200)
100%
31.0%
80%
40.5%
52.9%
8.9%
60%
12.0%
40%
16.1%
60.2%
20%
47.5%
31.0%
0%
Males
Females
Yes
No
Not reported
Both genders
Type of abuse (self-reported, n=119)
100.00%
82.1%
81.5%
81.1%
80.00%
66.7%
60.00%
66.2%
51.9%
52.9%
62.1%
56.8%
P
S
40.00%
20.00%
0.00%
Males
Physical abuse
Females
Emotional abuse
Both genders
Sexual abuse
Hepatitis C status (n=175)
100.0%
87.0% (n=152)
80.0%
60.0%
40.0%
13.0% (n=23)
20.0%
0.0%
1
Positive
Negative
Deaths: Observed/Expected
Gronblah et al.
Deaths
70
Observed/Expected
Deaths/
Cohort Expected N
MTT
8.4
166
Vol Dc
3.8
34
Invol Dc
55.3
53
No Rx
63.1
98
60
50
40
30
20
10
0
MTT
Vol Dc
Invol Dc
Cohorts
No Rx
Death After Discharge from Methadone
% death/20months
30
25.8%
25
21.2%
20
15.5%
15
10
6.8%
5
0
In program
Woody et al, J Addict Med 2007
Failed
Contract
Other
Discipline
Other
Discharge
Psychiatric Comorbidity
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PTSD
Depression, Anxiety
Bipolar Disease
ADHD
Alcohol Related Neurodevelopmental Disorder
(ARND)