1. HIV Collaborative September 28 2011 Native Health and the STOP initiative: Greatest Strength and Challenge Melissa Nicholson, RN STOP/TAHAH Christina Chant, RN STOP/TAHAH

2. 2 Vancouver Native Health Society: Non-Profit Aboriginal Service Organization Clinic: Primary & specialist medical care POP: HIV/AIDS Nursing & Social Supports Low barrier drop-in Food security & hot meals Drug & Alcohol Counselling Intensive Case Management team Other: Dental Care / Food Baskets / Child & Family Support Non-Profit Aboriginal Service Organization Clinic: Primary & specialist medical care POP: HIV/AIDS Nursing & Social Supports Low barrier drop-in Food security & hot meals Drug & Alcohol Counselling Intensive Case Management team Other: Dental Care / Food Baskets / Child & Family Support

3. Vancouver Native Health Society  To improve and promote the physical, mental, emotional and spiritual health of individuals, focusing on the Aboriginal community residing in Greater Vancouver

4. Health Care in Marginalized Communities Our philosophy of care includes providing care to those turned away or refused care from other mainstream healthcare agencies due to discrimination (including how they dress, their hygiene, personality disorders, mental health and addiction issues, and ethnicity). We provide low barrier threshold services. Our focus is the therapeutic relationship.

5. Positive Outlook Program  Working within the framework of our model, our primary mandate is to provide care, treatment and support services to 939 HIV+ clients  Through flexible approaches we recognize the complexity of needs that exist as a result of the unique state of each individual client  Patient centered care  Working within the framework of our model, our primary mandate is to provide care, treatment and support services to 939 HIV+ clients  Through flexible approaches we recognize the complexity of needs that exist as a result of the unique state of each individual client  Patient centered care

6. Weaving Relationships Through Storytelling  “Where you from?”  Listening to people’s stories and learning the context of the lives  Building therapeutic relationships  Walking with people on their journey  Providing all aspects of health care based on their story and their needs

7. Strength: Towards Aboriginal Health and Healing (TAHAH)  A community-based intensive case management program developed to engage urban Aboriginal peoples with low CD4s (under 100) and who are not connected with services into primary health care  Program includes a nurse, case manager, elder and three peer community health counsellors (CHCs)

8. TAHAH: Towards Aboriginal Health and Healing  TAHAH stabilizes all psycho-social, legal and economic crises and immediate primary health issues

9. Aboriginal Health and Healing Community Based Research Project

10.  Goal: Decrease M&M, HIV transmission & health care costs by identifying “occult” HIV positive persons from the VNHS patient population.  Background data: 3500 patients seen/yr (500 know HIV positive; aprox 2500 18-65 yr olds eligible for HIV screening). In 2010, there were 338 HIV tests with 2 new positives (0.6 %). 2011 Objective: Minimum of 1000 completed tests, with stretch target of 2000 tests.  Strategy: Serial interventions (PDSA format) to address provider & patient barriers to HIV testing.  Provider barriers : lack of time & buy-in, stress of managing new +ve dx  Patient barriers: lack of readiness, awareness of risk & time  Goal: Decrease M&M, HIV transmission & health care costs by identifying “occult” HIV positive persons from the VNHS patient population.  Background data: 3500 patients seen/yr (500 know HIV positive; aprox 2500 18-65 yr olds eligible for HIV screening). In 2010, there were 338 HIV tests with 2 new positives (0.6 %). 2011 Objective: Minimum of 1000 completed tests, with stretch target of 2000 tests.  Strategy: Serial interventions (PDSA format) to address provider & patient barriers to HIV testing.  Provider barriers : lack of time & buy-in, stress of managing new +ve dx  Patient barriers: lack of readiness, awareness of risk & time HIV Testing Experience – VNHS 2011

12. Implemented Testing Interventions 1.Establish Shared HIV testing Objective among clinical staff. 2.Implement HIV test data tracking system (MOA data entry). 3.Introduce RN Point of Care testing (Youth clinic, Nurse First & MD referral). 4.POC Posters/ awareness campaign / MOA solicitation. 5.MD Reminders (from MOA / automated Lab requisition). 6.Staff CME – HIV generalized screening (Epidemiology, opt out testing; testing simplifications). 1.Establish Shared HIV testing Objective among clinical staff. 2.Implement HIV test data tracking system (MOA data entry). 3.Introduce RN Point of Care testing (Youth clinic, Nurse First & MD referral). 4.POC Posters/ awareness campaign / MOA solicitation. 5.MD Reminders (from MOA / automated Lab requisition). 6.Staff CME – HIV generalized screening (Epidemiology, opt out testing; testing simplifications).

13. Interventions Soon to be Initiated/tested  “New HIV positive protocol” – POC & WB versions; immediate links to POP RN & peer counselor  Written Pre-test information sheet  ?Group Preventive Care Visits  ?CME – linked disease screening package  ?Increased RN position for HIV Nurse first screening  “New HIV positive protocol” – POC & WB versions; immediate links to POP RN & peer counselor  Written Pre-test information sheet  ?Group Preventive Care Visits  ?CME – linked disease screening package  ?Increased RN position for HIV Nurse first screening

14. Interpretation:  On track to meet minimum testing objectives of 1000 tests (3 fold increase from 2010; % positive = 1%).  Changes have been sustained to date but more work required.  Hopeful that further interventions will increase slope of testing curve.  New Barriers: paid incentives for testing.  On track to meet minimum testing objectives of 1000 tests (3 fold increase from 2010; % positive = 1%).  Changes have been sustained to date but more work required.  Hopeful that further interventions will increase slope of testing curve.  New Barriers: paid incentives for testing.

15. Acknowledgments: Doreen Littlejohn, RN, Positive Outlook Program Coordinator Dr. Denielle Elliott, Dr. David Tu, Dr. Mark Tyndall, and artist Trevor Jones.