Healthcare Delivery in Indigenous Communities

Dr. Stuart Skinner, BSc, MD, FRCPC, DTM&HDivision of Infectious Diseases, Regina Infectious Disease Clinic

Assistant Professor, University of SaskatchewanMay 3, 2017

stuart.skinner@usask.ca

Faculty Disclosure• Relationships with commercial interestes:– Grants/Research Support: Gilead Sciences, Viiv

Healthcare, Abbvie and Merck Canada– Speakers Bureau/Honoraria: Viiv Healthcare,

Merck Canada– Consulting Fees: Merck Canada, Viiv Healthcare,

Abbvie

Objectives • Provide an overview of the current status

of HIV and HCV in Saskatchewan and successful community interventions to address these infections

• Discuss how this model can be built upon to address other chronic diseases, infectious diseases and health disparities for on-reserve populations

• Discuss the importance of community engagement and community led programming in health and wellness

BC Elders Guide, Seniors BC, First Nations Health Authority, 1st Edition BC Govt, 2014); Pages 8-9Available on-line at www.SeniorsBC.ca or www.fnha.ca

Access to Care• Poor access to infectious disease care results in:

– Late diagnosis, decreased linkage, suboptimal medication adherence– Poor outcomes, increased mortality, increased transmission

• Additional Access to Care Challenges for First Nations on Reserve– Primary care services– Testing/laboratory– Medication availability and coverage– Communication– Transportation– Jurisdiction

Figures from 2016 Annual Reportwww.skhiv.ca

SK Epidemic

First Nations population-141,379 (2012)

(13% of SK population) -49% on-reserve

Know Your Status • Improve access to care and

treatment of HIV for First Nations on-reserve

• Community developed education, testing, treatment and case management approach

HIV Treatment Outcomes (n=84)

0102030405060708090

100

BR AH Total

On Treatment

Suppressed

Successful outcomes are directly related to community engagement, partnerships and addressing

the health system barriers to care

– Community led and driven– Cultural safety– Partnership– Access to care– Reduction of jurisdictional boundaries– Patient centered

Community

Health Care ProvidersPolicy

Hepatitis C

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016*FN on-reserve 131.1 118.8 168.3 136.4 189.2 138.7 168.4 139.9 185.3 203.6Saskatchewan 60.8 69.5 62.7 56.1 62.2 63.3 56.1 53.4 62.7Canada 36.5 35.7 33.3 31.1 29.4 29.3 29.5 29.4

0.050.0

100.0150.0200.0250.0

Rate

per

100

,000

Hepatitis-C diagnosis rates for Saskatchewan First Nations living on-reserve, overall Saskatchewan population and Canadian population, 2007 to 2016

Liver Health Events• Over 600 people tested for

STBBI’s and provided liver health education in 8 different communities– Events planned in multiple other

communities

The Wellness WheelA community led program of integrated care

between health providers and community

Rates of diabetes cases, 1980-2005, SK

Successful and Current Interventions• Achieved UN 90(?)/90/90 goals• Hepatitis C micro-elimination projects in community• Liver health awareness and events• Piloting technological innovation and novel point of care approaches• Focus groups and community led and developed programs• Partnering Western and Indigenous approaches• Accessible mental health and addiction programs• Wellness Wheel: Multi-disciplinary mobile outreach clinic to address chronic and

communicable disease• Mobile outreach team• Successful grant applications and publications• CIHR implementation science grant 2017

Summary• HIV, hepatitis C and infectious diseases disproportionately affect

First Nations on-reserve who currently have the least access to care

• A community based and led program can achieve goals of 90(?)/90/90 for HIV and can be used as a basis for chronic disease management for First Nations

• Requires partnerships between committed health providers, local community health supports and community leaders

Acknowledgements• The First Nation communities, including Chief and Councils and providers in Big River, Ahtahkakoop,

Sturgeon Lake, Montreal Lake, Cote, Keesesekoose, Key, Okanese and File Hills, George Gordon, Kawacatoose, Muskowekan, Day Star, Thunderchild, Big Island Lake and Cowassess First Nations

• Chief Bruce Morin, Ruby McAdam and Derek Klein of Big River and Chief Larry Ahenakew, Carmen Little and Noreen Reed of Ahtahkakoop First Nation

• Leslie Ann Smith, Clarence Frenchman, Jolene Blocka, Tanys Isbister, Amanda St. Onge, Vanessa Ahenakew, Leegay Jagoe and all front line nursing and health care providers

• Dr. Kris Stewart, Dr. Mona Loutfy, Dr. Marina Klein, Dr. Nadine Kronfli• Wellness Wheel Team: Drs. Carla Barkman, Kieran Conway, Fouche Williams, Megan Clark, Jarol Boan,

Bonnie Richardson, Sarah Liskowich, Rachel Asiniwasis, Tom Perron, Rosie Courtney. Susanne Nasewich, Val Desjarlais, Dr. Mamata Pandey, Adam Clay, Josh Needham and Carla Crozier

• Maria Folk, Darla Parent, Deb Rodger, Mike Stuber, Dr. Alex Wong, Dr. Kumudinhi Karunakaran and RQHR ID clinic

• Saskatoon Positive Living Program and Westside Community Clinic• Dr. Ibrahim Khan, Deb Kupchanko, Alex Campbell and First Nation Inuit Health Branch• Dr. Jolee Sasakamoose and Indigneous People Health Research Centre• Saskatchewan Health Authority and Saskatchewan Ministry of Health• Canadian Institute of Health Research