Download BC Centre for Excellence

Treatment as Prevention: Working in BC
Sept. 27, 2012
Irene Day, BC Centre for Excellence in HIV/AIDS
Vancouver Airport Marriott Hotel
www.pacificaidsnetwork.org
Treatment as Prevention: Working in B.C.
Irene Day, RN, BN, MBA
September 27, 2012
Director of Operations
BC Centre for Excellence in HIV/AIDS
Vancouver, BC
Original painting “City of Best Intentions” courtesy of Tiko Kerr, 2010
Page 1
History
The BC-CfE opened in 1992, the
largest research, treatment, and
education facility in Canada
• Provincial focus
• National relevance
• International impact
BC-CfE is responsible for HIV specific drug review, approval, and
reimbursement in close collaboration with Pharmacare through the JFMC
Page 2
Our Mandate
• Improve and prolong lives of people infected by HIV
• Procure and distribute HIV drugs guided
by the BC-CfE Therapeutic Guidelines
• Monitor outcomes to guide development
of new programs
• Share knowledge with health care professionals
• Contribute to the overall goal of
decreasing new HIV infections
Page 3
BC-CfE: Broad Expertise
•
Inter-professional team of experts
•
High impact research
• Clinical, Laboratory, Epidemiological
and Behavioral Sciences
•
Immediate knowledge translation
• Bench to bedside, to policy and back
• Translate research into programs, policy, and practice
• Continuous monitoring of outcomes
and immediate feedback
•
Surveillance and Forecasting
•
Impact Analysis
•
Cost-Effectiveness
Page 4
Original Core Programs and Initiatives
• Research Laboratory
• Epidemiology and Population Health
• The Drug Treatment Program (DTP)
• Clinical Research
Page 5
Emerging Core Programs and Initiatives
• Clinical Education and Training
• Addiction and Urban Health
• Gender & Sexual Health
• International Centre for Science in Drug Policy
• Health Economics
• International Initiatives
Page 6
Embedded in all teams
• Research
• Monitoring & Evaluation
• Continuous Quality Improvement
• Education
• Knowledge Translation
Page 7
British Columbia Facts:
Population: 4.4 Million (2011)
Health Care System:
Publicly funded – universal access
HIV testing lab: Centralized (BC-CDC)
Antiretroviral Therapy: Free for BC Residents, no
copayments, HIV ARV’s procured and distributed
# new HIV diagnoses: 289 - 201, declining (was
900ish)
Page 8
Objectives
1. Develop practical objectives for a case that can be used to
build political will for change
2. Identify relevant decision makers to approach to build
political will for improvement
3. Apply public health data in the practice setting to identify
local gaps in care for individual patients and populations
4. Gather specific examples of how public health data
combines with quality improvement methodologies to
improve care delivery and coordination
5. Include importance of applying patient voice
to facilitate improvement
Page 9
HAART stops HIV replication
HIV Viral load falls to undetectable
levels in plasma and sexual fluids
Sharp reduction in HIV transmission
Page 10
Building the Will
Costeffectiveness
data
Effectiveness
of intervention
known
Data that
shows gaps
in care
Business
Case for
Treatment
as
Prevention
Page 11
Bringing Partners Onboard
Effectiveness
of intervention
known
Costeffectiveness
data
Data that
shows gaps
in care
Business
case for
Treatment
as
Prevention
Government
• Premier of province
• Ministry of Health &
other related
ministries
Health Delivery
Organizations
• All health regions in
BC
• Private practices
Community
• Non-government
organizations
Page 12
Evidence
• What is the
evidence in
favour of
TasP?
CostEffectiveness
• Is TasP costeffective?
Gaps in Care
• What current
gaps exist in
treatment ?
Page 13
Evidence for HAART
• HIV Plasma Viral Load, a strong predictor of
outcome in HIV Infected Individuals
• High plasma viral load: Poor Prognosis
• Low Plasma Viral Load: Good Prognosis
• Antiretroviral Therapy renders plasma
viral load to undetectable levels
• Decreasing morbidity
• Decreasing mortality, and
• Prolongs life
• Antiretroviral Therapy used to prevent transmission
• Mother to Child Transmission
• Transmission among partner-to-partner
Page 14
Cost-Effectiveness of HAART
BC Drug Treatment Program
• Cost of medical management of 1 HIV
infection over a lifetime is $250,000
Page 15
Data Sources
• BC Centre for Disease Control
• HIV Provincial Lab
• HIV Provincial Surveillance
• STIs and HCV Surveillance
• BC Centre for Excellence in HIV/AIDS
• BC-CfE is a provincial program
• BC Drug Treatment Program (ART Distribution)
• Clinical Laboratory (Drug Resistance, CD4, HIV plasma Viral
Load, other),
• Linkages with other clinical, vital statistics, and administrative
databases (hospital separation, Physician’s billings, etc)
Page 16
Case for Improvement
• Good for the Person:
• Decreases morbidity
• Decreases mortality
• Increases survival
• Good for the Population
• Decreases transmission
• Good for the Pocket
• Save us money!
• Good for Politics
• Politicians like good news stories
Page 17
HIV+ tests by region by year
(rate per 100,000 pop)
20.00
15.00
British Columbia (-0.90, <0.0001)
Alberta (0.12, 0.68)
Ontario (0.04, 0.90)
Quebec (-0.45, 0.11)
Atlantic (-0.43, 0.13)
Prairies (0.88, <0.0001)
10.00
5.00
0.00
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Hogg et al, CAHR, 2012
Page 18
Page 19
Page 20
Page 21
Page 22
Thank you
Page 23