ART Impact Grant
Impact of a province-wide initiative to provide free antiretroviral therapy to people living with HIV, a population-based analysis in Saskatchewan
Human immunodeficiency virus (HIV) was once considered a terminal disease before the development of antiretroviral therapy (ART). ART prevents HIV from replicating and destroying blood cells responsible for fighting infections and preventing disease. Maintaining adequate numbers of these cells and suppressing HIV viral load protects against complications such as premature aging, heart disease and acquired immunodeficiency syndrome (AIDS). Also, reducing HIV viral load substantially reduces the chances of infecting others.
Despite the extraordinary potential of ART to combat HIV/AIDS, many people living with HIV do not take these medications regularly. This issue is especially concerning in Saskatchewan (SK) where the HIV diagnosis rate is almost three times higher than the Canadian average. On April 11, 2018, the SK government began providing ART free of charge to help reduce the financial burden for people living with HIV. Similar programs exist elsewhere, but none have been rigorously evaluated. Our research aims to determine the impact of a province-wide initiative offering free ART. Our specific objectives are as follows:
1) Compare population-wide utilization of ART, health services and HIV suppression before and after implementation of 100% ART coverage;
2) Compare differences in optimal adherence to ART medications before and after implementing 100% ART coverage.
We will analyze linked records of ART prescriptions, physician visits, hospitalizations and blood test results for all residents of SK. We will track changes over time for key HIV outcomes, including ART use, health services use and markers of HIV suppression. We will also compare differences in the number of people maintaining strict adherence to their ART prescriptions before versus after the provincial initiative. Established models will be applied to pinpoint and measure the benefits overall, by sex and for people who inject drugs. Further, given the substantial disproportionate disease burden borne by Indigenous people, a specific analysis is critical. We will give particular attention to Métis and Non-Status First Nations as they have been excluded from Non-Insured Health Benefits (NIHB) medication coverage. Evaluation of this significant initiative is essential to identify strengths, weaknesses and opportunities for improving the outcomes of people living with HIV in SK and nationally.
A Community Guiding Circle (CGC) will be created for this project. It will be led by employees of the Waniska Indigenous Centre and Dr. Cassandra Opikokew Wajuntah. The CGC will consist of Indigenous people with lived experience (PLE) of HIV and others including Elders and Knowledge Holders. The CGC will be gender diverse, inclusive to intersectionality and represent various geographic regions and nations reflective of the province. We will begin the circle in ceremony and then meet to discuss the study background, the research team and listen to initial reflections and perspectives of the community representatives.
Our initial focus will be charting wise ways to engage our members in the research process and incorporate their perspectives on patient-reported outcomes, experience measures and ethical data ownership. We strive to create an ethical space, thereby supporting the two-way flow of ideas and information between researchers, health care providers, policy makers and the community who are affected most by HIV and its consequences.
Following our initial meeting with the CGC and undertaking ceremony together, we will reconnect quarterly and when required to continue sharing ideas and undertaking analysis and mobilization of results. This one-year project will inform a resubmission of the grant that will include continued participation of the CGC and a focus on policy and program implications for Indigenous people, especially Métis and Non-Status First Nations.
The CGC will help to shape additional methods of knowledge exchange, particularly information sharing with Indigenous communities. Partnerships with the Federation of Sovereign Indigenous Nations (FSIN) and the Métis Nation Saskatchewan (MN-S) will ensure that findings from the pilot and subsequent project (if resubmission is successful) can be applied to policy and programming that is harmonious—establishing that the study is useful and impactful for Indigenous nations and communities. An Indigenous art installation will be commissioned for the community and research at the completion of the resubmitted project to reflect on the meaningfulness of the research journey. Finally, knowledge will be disseminated through traditional academic venues such as conferences, publications and via the vast networks connected to our interdisciplinary team.
Principal Investigators: David Blackburn and Alexandra King