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ACCESS PLACE
P. A. Update
101 – 15TH Street EastPrince Albert, SK
January 31, 2012
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:
• 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
• 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
Mean age of new clients, by gender(n=55)
Ethnic Origin– New Cases
• 43.6% of New HIV Cases have accessed the Positive Care Program
New Cases on Treatment
Total Number Of HIV Clients (includes new cases)
• 265 Client Charts• 63 % (148)Active Clients -Regular Contact
73.0 % of Active Clients are Hep. C Positive
Initial CD 4 Counts
Overall Picture Male and Female
• 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 :
Normal Range
&
TX Started Kaletre
Combivir
TX Changed
Atripla
Test Units
Dec.18,08 Aug 28,10 Aug.30 10 Sept13,10 Nov 8,10 Feb. 2, 11 June 9,11 Oct. 5,11
CD 4 428 62 43 62 146 152 210 228
WARNING DANGER URGENT DANGER DANGER DANGER WARNING WARNING
CD 4 % 12.6 2.1 1.9 3.0 6.5 5.4 8.0 7.5
Viral Load 67,206 63,545 347 <40 0 0
• 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)
Male44%
Female 56%
Males
Females
34.5
30.0
27
28
29
30
31
32
33
34
35
Mean age of methadone clients, by gender
Males
Females
Aboriginal status (n=169)
71.6%
3.6%
13.0% 11.8%
0.0%
20.0%
40.0%
60.0%
80.0%
Status Indian Non-status Indian Metis Non-Aboriginal
Total = 88.2 % Aboriginal
Highest level of education (n=184)
Grade 9 – 11, 59.5%
Less than Gr 9, 16.8%
Complete Gr 12, 15.1%
Some post secondary, 5.9%
Complete post secondary, 2.2%
Less than grade 12 education:
76.3 % Methadone vs. 44.0 % Aboriginal vs. 31.5 % general pop
Abuse history, by gender (n=200)
31.0%
60.2%47.5%
16.1%
8.9%
12.0%
52.9%
31.0%40.5%
0%
20%
40%
60%
80%
100%
Males Females Both genders
Yes No Not reported
Type of abuse (self-reported, n=119)
81.5% 82.1% 81.1%
66.7%
52.9%56.8%
51.9%
66.2%62.1%
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
Males Females Both genders
Physical abuse Emotional abuse Sexual abuse
SP
Hepatitis C status (n=175)
87.0% (n=152)
13.0% (n=23)
0.0%
20.0%
40.0%
60.0%
80.0%
100.0%
1
Positive Negative
Deaths: Observed/Expected
Deaths/Cohort Expected NMTT 8.4 166Vol Dc 3.8 34Invol Dc 55.3 53No Rx 63.1 98
Gronblah et al.
Deaths
0
10
20
30
40
50
60
70
MTT Vol Dc Invol Dc No Rx
Cohorts
Ob
se
rve
d/E
xpe
cte
d
Death After Discharge from Methadone
0
5
10
15
20
25
30
In program FailedContract
OtherDiscipline
OtherDischarge
% d
eath
/20m
on
ths
6.8%
21.2%
25.8%
15.5%
Woody et al, J Addict Med 2007
Psychiatric Comorbidity
• PTSD• Depression, Anxiety• Bipolar Disease• ADHD• Alcohol Related Neurodevelopmental
Disorder (ARND)
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