Supplementary Information Tables: 2013–14 Departmental Performance Report

Horizontal Initiatives

Federal Initiative to Address HIV/AIDS in Canada (FI)
Preparedness for Avian and Pandemic Influenza (AI/PI) Initiative
Canadian HIV Vaccine Initiative (CHVI)

Federal Initiative to Address HIV/AIDS in Canada (FI)

Name of horizontal initiative: FI
Name of lead department: Public Health Agency of Canada
Lead department PAA Programs: 1.1 Public Health Infrastructure, 1.2 Health Promotion and Disease Prevention
Start date: January 13, 2005
End date: Ongoing
Total federal funding allocation (from start to end date): Ongoing

Description of the horizontal initiative (including funding agreement): The FI strengthens domestic action on HIV and AIDS, builds a coordinated Government of Canada (GC) approach, and supports global health responses to HIV and AIDS. It focuses on research, prevention and access to diagnosis, care, treatment and support for those populations most affected by HIV and AIDS in Canada. The FI also supports and strengthens multi-sectoral partnerships to address the determinants of health. It supports collaborative efforts to address factors which contribute to the transmission and acquisition of HIV. People living with and vulnerable to HIV and AIDS are active partners in FI policies and programs.

Shared outcomes:
First-level outcomes:

  • Increased knowledge and awareness of the nature of HIV/AIDS and ways to address the disease;
  • Increased individual and organizational capacity;
  • Increased Canadian engagement and leadership in the global context; and
  • Enhanced engagement and collaboration on approaches to address HIV/AIDS.

Second-level outcomes:

  • Reduced stigma, discrimination, and other barriers;
  • Improved access to more effective prevention, care, treatment and support;
  • Internationally informed federal response; and
  • Increased coherence of the federal response.

Ultimate outcomes:

  • Prevent the acquisition and transmission of new infections;
  • Improved quality of life for those at risk and living with HIV/AIDS;
  • Contribute to the global effort to reduce the spread of HIV/AIDS and mitigate its impact; and
  • Contribute to the strategic outcomes of partner departments.

Governance structures:

The Responsibility Centre Committee (RCC) is the governance body for the FI. It is composed of directors from the nine responsibility centres that receive funding through the FI. Led by the Agency, the RCC promotes policy and program coherence among the participating departments and agencies, and ensures that evaluation and reporting requirements are met.

The Agency is the federal lead for issues related to HIV and AIDS in Canada and is responsible for overall coordination, communications, social marketing, reporting, evaluation, national and regional programs, policy development, surveillance and laboratory science, and leadership on international health policy and program issues.

Health Canada (HC) supports HIV and AIDS prevention, education, awareness building and community capacity building in First Nation communities south of the 60th parallel, as well as facilitating access to quality HIV/AIDS diagnosis, care, treatment, and social support services in these communities.

As the Government of Canada’s agency for health research, the Canadian Institutes of Health Research (CIHR) sets priorities for and administers the extramural research program.
Correctional Service of Canada (CSC), an agency in the Public Safety Portfolio, provides health services (including services related to the prevention, diagnosis, care and treatment of HIV and AIDS) to offenders sentenced to two years or more.

Performance highlights:

In 2013–14, federal partners engaged stakeholders in the development of integrated approaches to HIV and Hepatitis C community funding to address related health factors such as co-morbidities, mental health, aging, chronic diseases, and other determinants of health. Programs identified additional areas of collaboration with provinces and territories to prevent STBBIs, and amended agreements with the governments of the Northwest Territories and Nunavut to address HIV and related infections on the basis of local community wellness plans. Updated guidance, and information on surveillance and interventions, were shared more widely and in a timely manner through webinars to help health professionals and public health officials prevent the spread of HIV and other related infections. The results of program evaluations led to new research funding opportunities and partnerships to help solve current and emerging challenges with ongoing transmission of HIV.

Federal partner: The Agency
PAA Programs Contributing activities / programs Total allocation (from start date to end date)
($M)
2013–14 ($M)
Planned spending Actual spending Expected results Results achieved
Public Health Infrastructure Public Health Laboratory Systems Ongoing 4.9 6.6 ER 1.1
ER 1.2
RA 1.1
RA 1.2
Health Promotion and Disease Prevention Infectious and Communicable Diseases Ongoing 3.6 3.3 ER 2.1 RA 2.1
Healthy Communities Ongoing 33.3 31.9 ER 3.1
ER 3.2
ER 3.3
RA 3.1
RA 3.2
RA 3.3
Total Agency

 

41.8 41.8

 

 

Comments on variances: N/A

Expected results and results achieved for 2013–14:

ER 1.1: Public health decisions and interventions are supported by timely, reliable and accredited reference service testing that accurately captures all the circulating HIV strains in Canada and directs attention to new outbreaks of HIV. This ensures effective identification and testing for emerging strains of HIV and enhanced quality, reliability and comparability of HIV testing.
RA 1.1: During the relocation of its National HIV Retrovirology Laboratories to Winnipeg, the Agency conducted concurrent testing in both its Ottawa and Winnipeg laboratories to meet ISO quality requirements for timeliness of reference test reporting, and maintain its accreditation.

ER 1.2: Use of laboratory-generated knowledge is increased to: develop diagnostic, prognostic and drug resistance testing standards; provide quality assurance and performance standardization services for regional laboratories; determine changes in the patterns of HIV transmission; and reduce transmission of HIV from mothers to their infants through the identification of optimal and affordable antiviral therapies. Laboratory research expertise and knowledge platforms are consolidated to develop a hub for global leadership in HIV research and viral diagnostics, outbreak response, and genetic linkages to risk of disease.
RA 1.2: The Agency contributed laboratory-based testing and analysis to inform studies of best practices in breastfeeding and reduce mother-to-child HIV transmission, an important World Health Organization (WHO) goal in HIV prevention. The studies included the evaluation of the role of host factors, such as maternal health and breastfeeding practices, in preventing the HIV transmission through breast milk.

The Agency developed the next generation of sequencing technology for HIV drug resistance testing as a best practice and has begun promoting new technology to domestic and international partners. Additionally, the Agency provided technical expertise and assistance by assessing previously undetectable HIV levels in the blood of HIV-infected infants as part of the Paediatric HIV Cure Initiative. This initiative seeks to provide a functional cureFootnote 7  for children born with HIV.

As well, the Agency provided external quality assurance services to over 900 laboratories worldwide, positively affecting care and treatment in thousands of HIV- infected persons. With the opening of the JC Wilt Infectious Diseases Research Centre in February 2014, the Agency has consolidated national HIV laboratory services to better serve clinical stakeholders and the HIV research community.

ER 2.1: Engage and collaborate with provinces and territories through the Public Health Network, develop greater awareness of trends and a better understanding of factors associated with HIV and related sexually transmitted and blood-borne infections (STBBIs) through targeted behavioral epidemiological surveys, and promote and integrate best practices to inform prevention and control efforts in HIV and related STBBI surveillance and guidance.
RA 2.1: The Agency actively engaged with provinces and territories through the Public Health Network's Communicable and Infectious Disease Steering Committee, which convened a time-limited task group to identify potential areas for F/P/T collaboration to prevent and control STBBIs. In collaboration with provinces and territories, the Agency continued its surveillance activities which included enhanced data collection in Quebec City (of people who inject drugs) and Montreal (of people from countries where HIV is endemic); and promoting the results of its pilot enhanced surveillance system among Aboriginal peoples, people who inject drugs, and youth. The Agency used webinars to promote key surveillance and public health guidance reports such as the 2012 HIV/AIDS Surveillance Reportand the HIV Screening and Testing Guide. Findings from its enhanced surveillance activities were disseminated to approximately 1,300 front-line public health professionals, medical experts, community-based workers, and P/T partners, who indicated their intention to apply this evidence or guidance to their work. The Agency reviewed evidence on the risk of HIV transmission and developed drug resistant gonorrhea knowledge translation tools. The objective of this effort was to promote awareness and uptake of new treatment recommendations for gonococcal infections to limit development and spread of antimicrobial resistance. The Agency also disseminated the revised chapter on gonococcal infections of the Canadian Guidelines on Sexually Transmitted Infections and initiated the development of a mobile application for the prevention and control of multi-drug resistant gonorrhea and other sexually transmitted infections.

ER 3.1: Enhance public health and community capacity to prevent and control HIV and related STBBIs, through strategic partnerships among stakeholders.
RA 3.1: The Agency and the World Bank developed educational materials and disseminated 140 Canadian stakeholders involved in the HIV/AIDS response, including community leaders, policy makers, and research academics. Outreach resulted in the identification of mechanisms and methods to assess interventions along with best and promising practices.

The Agency, the Ontario Ministry of Health and Long-term Care and the Ontario HIV Treatment Network held their annual Knowledge Translation and Exchange day with community-based organizations. This event enhanced the capacity of community organizations to prevent and control HIV through the sharing of successful practices, the identification of regional trends, networking opportunities, and the strengthening of regional partnerships. One of the identified trends is the “greying of HIV” (affecting people over the age of 40) as an emerging challenge for community-based organizations.

The Agency supported Manitoba Health, Healthy Living and Seniors through its participation on the advisory committee for the province’s Sexually Transmitted Infection and Blood-Borne Pathogen Strategy.

The Agency continued to co-chair the Alberta Community HIV Policy and Funding Consortium with Alberta Health. It supported the active participation of community representatives, helped build capacity on infectious disease epidemiology and develop a community-based Aboriginal HIV/AIDS Strategy for Alberta.

The Agency provided funding to support the development of the Saskatchewan Indigenous Council on HIV/AIDS to facilitate the development of the Saskatchewan Indigenous Strategy on HIV/AIDS.

ER 3.2: Develop integrated approaches to HIV and related STBBIs and factors such as co-morbidities, mental health, aging, chronic diseases, and other determinants of health, including an integrated community funding model and a renewed stakeholder engagement strategy which expands the mandate of existing disease-specific engagement mechanisms.
RA 3.2: The Agency engaged stakeholders to develop the guiding principles and high-level priorities for the development of a new HIV/AIDS and Hepatitis C Action Fund by April 1, 2017. The Agency also reviewed existing external, civil society governance structures such as community-based organizations to address HIV/AIDS, hepatitis C, sexually transmitted infections, and related health factors and actively engaged with members.

ER 3.3: Improve information available to public health stakeholders by providing updated knowledge for effective interventions among vulnerable populations including HIV/AIDS population-specific status reports, Questions and Answers: Inclusive Practice in Sexual Health Education with Racial and Ethnic Minorities, Questions and Answers: STBBIs in Middle-aged and Older Adults, and other targeted information products.
RA 3.3: The Agency published a revised version of the Sexually Transmitted Infections booklet for youth. Over 100,000 copies are distributed to the public annually. The Agency also released Questions and Answers: Inclusive Practice in Prevention of STBBI Among Ethnocultural Minorities and the Population Specific Report on HIV and other STBBI among youth in Canada (PDF Document). Together with other populations status reports, these resources were promoted through webinars to over 500 public health stakeholders, including front-line community-based workers and P/T officials, and were downloaded 7,245 times.

Community-based organizations funded through the Agency’s grants and contributions, such as Positive Women’s Network, provided education on HIV, hepatitis C virus and sexual health to health care and service providers. Winnipeg’s Klinic Community Health Centre, with funding from the Agency, produced the Teen Talk Service Provider Manual to assist northern service providers working in the areas of sexual health, healthy relationships, and mental health with vulnerable populations.

With financial support from the Agency, the Action Santé Travesti(e)s et Transsexuel(le)s du Québec (ASTTQ) provided sensitivity workshops to 100 health and social service professionals, students and AIDS service organizations on the health needs of transgendered individuals. The ASTTQ also updated its guide for service providers which was distributed in both official languages across the province of Quebec.

Federal partner: HC
PAA Programs Contributing activities / programs Total allocation (from start date to end date)
($M)
2013–14 ($M)
Planned spending Actual spending Expected results Results achieved
Internal Services Governance and Management Support Services Ongoing 1.1 0.0 ER 4.1 RA 4.1
First Nations and Inuit Primary Health Care Bloodborne Diseases and Sexually Transmitted Infections – HIV/AIDS Ongoing 4.5 4.5 ER 5.1 RA 5.1
Total HC

 

5.6 4.5

 

 

Comments on variances: No spending on internal services has occurred due to streamlining of operations and administrative functions. While this is a permanent reduction, the FI will continue to meet its global engagement and international leadership objectives by integrating this component into ongoing activities conducted by FI partners.

Expected results and results achieved for 2013–14:

ER 4.1: In collaboration with other Government of Canada partners, the Health Portfolio will support Canada’s engagement in the global response to HIV/AIDS to ensure Canada’s international engagement is coherent and effective.
RA 4.1: As a result of Health Portfolio realignment, the Agency assumed responsibility from HC for the coordination of the FI’s engagement in the global response to HIV/AIDS. Collaboration with other government departments supported Canada’s participation at the UNAIDS Programme Coordinating Board and enabled HIV/AIDS prevention activities to be addressed at various international fora.

ER 5.1: Work will be initiated with First Nations leadership and other stakeholders to develop enhanced approaches to address HIV/AIDS in First Nation communities south of the 60th parallel. The expected result is a report setting forth directions for an enhanced national approach, ultimately leading to improved health outcomes.
RA 5.1: HC and the Assembly of First Nations engaged partners in the development of a national framework to reduce the incidence and prevalence of STBBIs in First Nations on-reserve. An initial planning meeting took place in October 2013 to identify a strategic direction and a process for engaging partners and stakeholders. A governance structure was established and environmental scans were completed, culminating in a discussion paper on STBBIs in First Nations on-reserve. Currently, a comprehensive process is being developed to solicit the participation of a broad range of partners and stakeholders, including but not limited to First Nations organizations and communities, federal and provincial partners, and experts.

Federal partner: CIHR
PAA Programs Contributing activities / programs Total allocation (from start date to end date)
($M)
2013–14 ($M)
Planned spending Actual spending Expected results Results achieved
Health and Health Services Advances HIV and AIDS Research Initiative Ongoing 20.7 22.3 ER 6.1
ER 6.2
ER 6.3
RA 6.1
RA 6.2
RA 6.3
Total CIHR

 

20.7 22.3

 

 

Comments on variances: The variance reflects additional investments in HIV/AIDS grants and awards. Funding was provided through two sources: 1) $0.4M was provided by the Agency via Supplementary Estimates C in support of additional HIV/AIDS research projects; and 2) CIHR contributed $1.2M from its base budget to strategic HIV programs for a total variance of $1.6M.

Expected results and results achieved for 2013–14:

ER 6.1: Increased knowledge and awareness of the nature of HIV and ways to address the disease through the development and administration of diverse HIV research funding programs. In 2013–14, new funding and funding programs will focus on finding a cure for HIV, strengthening Canada’s network of clinical investigators and addressing social determinants of health and health services.
RA 6.1: In 2013–14, CIHR invested in the following research areas: biomedical and clinical aspects of HIV, efforts to improve health systems and service responses to HIV/AIDS; enhancing the understanding of the social, cultural and environmental determinants of HIV; and community-partnered investigations.

CIHR developed and launched a range of new funding opportunities and continued support for multi-year projects previously approved through CIHR competitions. Research and knowledge translation programs launched in 2013–14 to support new HIV/AIDS research included:

  • Operating Grants (2);
  • Community-based Research Operating (1) and Catalyst Grants (1);
  • Planning and Dissemination Grants (3);
  • Team Grants: Boys’ and Men’s Health; and
  • Centres for HIV/AIDS Population Health and Health Services Research (1).

Additionally:

  • Two new teams were funded via the $10M Team Grant: HIV Cure Research program, launched in 2012–13 in partnership with the Canadian Foundation for AIDS Research and International AIDS Society:
    • The Institut de recherches cliniques de Montréal leads the Canadian HIV Cure Enterprise, a collaboration of leading Canadian HIV researchers aimed at finding new approaches to curing HIV infection; and
    • The Centre hospitalier universitaire Sainte-Justine leads a project focused on curing babies and children who acquire HIV from their mothers during pregnancy;
  • Guided by a 2012–13 program evaluation, the CIHR Clinical Trials Network in HIV/AIDS program was re-launched in 2013–14. Following international peer review, the long-standing CIHR Canadian HIV Trials Network (CTN) was approved for an additional five years, an investment worth nearly $23M;
  • The Centres for HIV/AIDS Population Health and Health Services Research funding opportunity was developed and launched in 2013–14 based on a mid-term program evaluation conducted in 2012–13. The program was designed to support Centres that will help solve current and emerging challenges with the ongoing transmission of HIV and for people living with HIV in Canada; and
  • A CTN initiative, led by the University of Ottawa, McGill University, and the British Columbia Centre for Excellence in HIV/ AIDS, developed treatment guidelines for the management of HIV-hepatitis C co-infection. Published in the Canadian Journal of Infectious Disease and Medical Microbiology, these guidelines are intended to influence clinical practice and policy development.

ER 6.2: A strong and diverse HIV research community with the capacity to advance HIV research from biomedical science to community-based projects through support for training and multi-disciplinary research teams.
RA 6.2: CIHR continued to build a strong and diverse HIV/AIDS research community through a number of initiatives including the following capacity-building funding opportunities launched in 2013–14.

  • Fellowship Awards Priority Announcement;
  • Doctoral Research Awards Priority Announcement; and
  • Travel Awards (2).

CIHR continued to support several large-scale, capacity-building initiatives including:

  • two community-based research (CBR) Collaborative Centres focused on establishing national networks that will enhance capacity and address health issues through a community-centered research approach; and
  • the International Infectious Disease and Global Health Training Program which focuses on advanced trainees (i.e., PhD students, postdoctoral fellows, and clinical fellows) from all four of CIHR’s pillars of research (i.e., biomedical, clinical, health services, and population health).

In addition, other large CIHR-supported networks embeded training and mentoring into research programs including the CTN , the Centres for HIV/AIDS Population Health and Health Services Research, and the CanCURE team.

CIHR partnered with the Canadian Association for HIV Research (CAHR) and other collaborating organizations to support several training workshops such as:

  • A mid-career HIV and hepatitis C researcher workshop; and
  • A workshop focused on community-based research in the North, to help address the rising incidence of HIV (and other STBBI) through increased research capacity.

CIHR also partnered with the CAHR and the Ontario HIV Treatment Network to support the development of an online platform for building CBR capacity entitled The CBR Learning Place. This online practicum guides viewers through the many facets of CBR using high-quality, interactive educational modules.

ER 6.3: Enhanced coordination and strategic alignment of HIV research with national and international health research priorities and initiatives through the leadership and involvement of CIHR and Canadian researchers. Better coordination and strengthened partnerships will enhance resources for priority topicsand help ensure effective application of new knowledge.
RA 6.3: Hosted a meeting of grantees and partners in the CIHR HIV Comorbidity Research Agenda in March 2014. The meeting focused on enhancing collaboration between research teams, and between the teams and the partners, with an emphasis on research, capacity building and knowledge translation. Eleven new areas of collaboration were initiated at the meeting among the 33 participants.

A project was completed in collaboration with other Canadian HIV research funders that assessed the current HIV/AIDS research funding landscape and the outcomes of capacity building investments. The project will be used to help coordinate investments across research funders and design future capacity building strategies.

A Café Scientifique, held in Saskatoon, Saskatchewan in September 2013, invited the public to engage in a discussion with researchers and community leaders on how Saskatchewan can get to zero new HIV infections. The event was designed and held in partnership with the Government of Saskatchewan, the Canadian Aboriginal AIDS Network, and other partners to ensure alignment with the local context and needs.

CIHR continued to participate in the Towards an HIV Cure Stakeholder Advisory Committee led by the International AIDS Society. This international committee provides a mechanism for increasing awareness and aligning efforts to find a cure for HIV.

Federal partner: CSC
PAA Programs Contributing activities / programs Total allocation (from start date to end date)
($M)
2013–14 ($M)
Planned spending Actual spending Expected results Results achieved
Custody Institutional Health Services Public Health Services Ongoing 4.2 4.4 ER 7.1
ER 7.2
RA 7.1
RA 7.2
Total CSC

 

4.2 4.4

 

 

Comments on variances: N/A

Expected results and results achieved for 2013–14:

ER 7.1: Increased knowledge and awareness of the nature of HIV/AIDS and ways to address the disease achieved through health surveillance activities, knowledge transfer to service providers, educational program delivery, and distribution of disease prevention materials to federal offenders.
RA 7.1: During 2013–14, health surveillance activities were used to monitor testing uptake, to determine HIV prevalence, and to guide policy and program development. A key indicator of HIV prevention in CSC, including knowledge and awareness, is the increased uptake of voluntary HIV testing on admission and throughout incarceration. In 2013–14, over 7,000 inmates were tested for HIV. A variety of educational programs and disease prevention materials were delivered to federal offenders. This included the development and distribution of eight issues of newsletters focusing on disease prevention, multi-media presentations, and educational programs. The Reception Awareness Program, offered to newly-admitted inmates, was attended by 2,174 offenders. In addition, the Peer Education Course trains inmates as peer education coordinators who provide support and health information to other offenders. During 2013–14, 85% of CSC institutions had a peer education coordinator in place to provide these services to other offenders.

ER 7.2: Enhanced engagement and collaboration on approaches to address HIV/AIDS through the development and strengthening of partnerships with provincial/territorial governments, federal departments, and community partners. Results will be achieved through meetings and ongoing communication with the Federal/Provincial/Territorial Heads of Corrections Working Group on Health, Community Consultation Committee on Public Health, and meetings and presentations with other federal departments and community partners.
RA 7.2: CSC enhanced engagement and collaboration on approaches to address HIV/AIDS and STBBI. Meetings of the F/P/T Heads of Corrections Working Group on Health were held to address common issues, including prevention and management of HIV. As a member of the F/P/T Council of the Chief Medical Officers of Health, CSC continued to participate in monthly meetings to address public health issues, including HIV.

Results to be achieved by non-federal partners: N/A

Contact information:
Marsha Hay-Snyder
Director, Centre for Communicable Diseases and Infection Control
100 Eglantine Drive
Ottawa, ON K1A 0K9
613-957-1345
marsha.hay-snyder@phac-aspc.gc.ca


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