Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada - Meeting of October 23 - 24, 2008 - Ottawa, Ontario
Public Record of Meeting

Present:

Ministerial Advisory Council: Brian Conway and John Charles Plater (Co-Chairs); Jonathan B. Angel, Monique Doolittle-Romas, Jacqueline Gahagan, Faye Katzman, Ken Monteith, Gerry Mugford, David M. Nelson, Anita Rachlis, Sheena Sargeant, Jacobet Edith Wambayi. Ex officio: Frank McGee

Regrets: Michelle George, Frank McGee.

Public Health Agency of Canada (PHAC): Marsha Hay-Snyder, Manager, Accountability and Evaluation Section, HIV/AIDS Policy, Coordination and Programs Division.

Secretariat: Fardosa Loyan, Susan Maves.

Facilitation and Recording Services: Wylie Thomas and Hajo Versteeg

Guests: Chris Archibald, Surveillance and Risk Assessment Division (SRAD), PHAC; Jacqueline Arthur, HIV/AIDS Division, PHAC; Marc-André Gaudreau, HIV/AIDS Division, PHAC; Michael Grant, CHARAC (CIHR HIV/AIDS Research Advisory Committee); Paula Kirton, Institute of Infection and Immunity, Canadian Institutes for Health Research (CIHR); Andrew Matejcic, Institute of Infection and Immunity, CIHR; Susanna Ogunnaike-Cooke, SRAD, PHAC; Jeff Potts, Community Acquired Infections Division, PHAC; Chris Power, University of Alberta; Kim Thomas, Canadian AIDS Society.

Welcome

The Co-Chairs of the Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada opened the meeting with a few words of welcome. The meeting facilitator reviewed the agenda, which was accepted with modifications.

Update on Pan-Canadian HIV/AIDS Research Plan

The Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada received an update from the Canadian Institutes of Health Research (CIHR), the Canadian Association for HIV Research (CAHR) and the Public Health Agency of Canada (PHAC) on their respective activities in HIV research.

Andrew Matejcic, Team Lead for HIV/AIDS at the CIHR Institute of Infection and Immunity (III), presented an overview of CIHR’s HIV/AIDS Research Initiative Strategic Plan (2008-2013), which was approved by the III Advisory Board in the summer of 2008. He noted that the HIV/AIDS Strategic Plan is considered a “living” document against which the activities of CIHR and the Federal Initiative in support of HIV/AIDS research in Canada can be assessed.  It will undergo review and revision at regular five-year intervals in parallel with the review and renewal of the CIHR III strategic plan within which it is nested.

Jacqueline Arthur of the HIV/AIDS Policy, Coordination and Programs Division of PHAC provided an update on her agency’s work to develop a knowledge exchange and translation framework. Two aspects of this work are: 1) the establishment of a central “knowledge broker” which will act as a clearing house that links creators of knowledge and users of knowledge; 2) implementation of a survey of community-based and frontline workers to determine their knowledge translation needs. Ms. Arthur noted that plans for developing a pan-Canadian research plan were deferred to allow the Agency to first focus on developing its knowledge exchange and translation framework.

Brian Conway, President, CAHR, provided an update on his organization’s work to develop an inventory of Canadian HIV research which will include all research regardless of funding source. He noted that the inventory would allow for the development of a broad picture of research in Canada to help identify gaps in a systematic manner and design ways for addressing the gaps.
Following the departure of the presenters, the Ministerial Advisory Council held a debriefing on the information it received. Generally, Ministerial Advisory Council members were in favour of continuing to monitor this area to ensure that the various stakeholders involved in HIV research communicate with each other as they develop the components of what could one day feed into the development of a pan-Canadian research plan. However, the Ministerial Advisory Council agreed that no immediate follow-up actions were required and asked its Research Committee to take the day’s proceedings under advisement and report back with recommended follow up actions, if any.

Update on HIV Testing and Counselling Policy Framework

Marc-André Gaudreau, Manager, Program Development and Evidence-Based Interventions, HIV/AIDS Division, PHAC, joined the meeting to provide the Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada with a status update on the development of the HIV Testing Policy Framework. He last presented to the Ministerial Advisory Council in March 2008, and noted that, since that time, an Ad Hoc Experts Working Group had been established with membership drawn from a broad spectrum of stakeholders. He advised that the Working Group held its first meeting on September 9 and 10, where it was able to: 1) agree to a mandate and work plan; 2) identify strengths and weaknesses of various HIV testing and counselling approaches; and 3) advise on the public consultation process to guide the development of the framework and component guidance documents. Mr. Gaudreau described the main points of advice of the Working Group and presented the proposed timeline for completing the framework and supporting documents, which will involve a public consultation in early 2009.

Following the presentation, the Ministerial Advisory Council provided Mr. Gaudreau with feedback and suggestions on the consultation process, including additional groups to consult and the potential limitations of an online approach to consultation.

Following the presenter’s departure, the Ministerial Advisory Council held a debriefing, where it noted the importance of increasing the availability of testing to tackle the hidden epidemic of HIV-positive Canadians who are unaware of their infections (approximately 27 %). In terms of follow-up actions, it asked its members to respond to Mr. Gaudreau’s request for information on names of individuals and organizations to consult, topics or questions to include in the consultation as well as their suggestions for research they deem critical to improving the framework. It also agreed to write to Mr. Gaudreau thanking him for his presentation and offering Council’s continued support as the framework is developed.

Update from the Leading Together Championing Committee

Kim Thomas, Director of Programs, Canadian AIDS Society, joined the meeting to provide the Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada with an update on the activities of the Leading Together Championing Committee, which she co-chairs. The Championing Committee was established two years ago to promote the widespread use of Leading Together: Canada Takes Action on HIV/AIDS. Currently, there are ten members of the committee representing governments and communities, including people living with HIV/AIDS. Ms. Thomas stressed that the committee’s mandate is to promote and champion the widespread use of Leading Together throughout Canada and not to enforce or evaluate its implementation. She described a number of activities undertaken by the committee to encourage people and organizations to use Leading Together. Among these, she described the development of a toolkit that provides case studies of the different ways that Leading Together has been used. The toolkit will be launched shortly.

Following the presentation, the floor was opened up for feedback and comments from the Ministerial Advisory Council. Several members expressed disappointment that the mandate of the committee did not include a role for assessing how well the goals of Leading Together are being met and providing recommendations for improvements. They noted the value of examining the Federal Initiative in light of how it is contributing to the goals of Leading Together.

Following the departure of the presenter, the Ministerial Advisory Council debriefed on the information it received. Generally, the Ministerial Advisory Council agreed that an assessment of the Federal Initiative and the goals of Leading Together would generate useful information to ensure that it is properly prepared to advise the Minister of Health when the time comes to take stock of the first five years of the Federal Initiative. It asked its Partnerships Committee to take the presentation and discussion under advisement and report back at a later time. It also agreed to write a letter to Ms. Thomas to thank her for her presentation and ask for additional information on the activities of the Championing Committee.

Work Plan Review

The Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada reviewed the final draft of its work plan for 2008-2009. It identified a number of minor changes and agreed to fund two projects to be completed between now and the end of the fiscal year: 1) a paper on the use of evidence in policy decision making; and, 2) comparative analysis of HIV/AIDS strategies internationally. It asked its Strategies Committee and International Committee to work with the Secretariat to develop statements of work for the projects.

Committee Reports to Council

Report from the Strategies Committee

The Strategies Committee provided its report to the Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada, noting that it last met on September 18 via teleconference. It briefly reviewed the main issues it is working on: Council’s role in the review of the Federal Initiative post-2009; financial accountability; co-infection and the hepatitis C strategy; and, follow-up on the 2008 International AIDS Conference.  The committee noted that it would be seeking Council’s approval to commission a paper on “evidence-based” decision making.

Report from the Partnerships Committee

The Partnerships Committee provided its report to the Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada, noting that it had met by teleconference on October 8th. It described the main issues it is working on, including: the determinants of health in light of recent pronouncements on the subject by the Chief Public Health Office and the World Health Organisation; follow-up with Correctional Service Canada in light of the presentation received at the June meeting; building relations with the National Aboriginal Council on HIV/AIDS; the Canadian HIV Vaccine Initiative; the Council website; World AIDS Day; and, follow-up to the 2008 International AIDS Conference.

Report from the Research Committee

The Research Committee provided its report to the Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada, noting that it last met on October 2nd. It reviewed its main activities, which included:  preparations for this meeting’s session on the pan-Canadian research plan; the “Tracks Program” of second generation surveillance among populations vulnerable to HIV/AIDS; research in prisons, including the results of the 2007 Inmates Survey; debrief on the 2008 International AIDS Conference; and, the research ethics board for community-based researchers.

Report form the International Committee

The International Committee provided its report to the Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada, noting that it had last met on October 8th. It recommended that the Council continue to participate in the Consultative Group on Global HIV/AIDS Issues and advised that it would be seeking Council’s approval to commission a comparative analysis of national HIV/AIDS strategies internationally. The Ministerial Advisory Council agreed with this recommendation and asked the committee to identify a representative to the Consultative Group.

Report from the Prevention, Care, Treatment and Support Committee

The Prevention, Care, Treatment and Support (PCTS) Committee provided its report to the Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada, highlighting its work in the following areas: Status Reports for Vulnerable Populations; stigma and discrimination; criminalization of HIV; and, treatment as prevention. 

Debrief on 2008 International AIDS Conference

The Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada debriefed on the 2008 International AIDS Conference in August. Council members who attended the Conference were given an opportunity to share their observations, and some gave presentations summarizing the results of the different tracks of the Conference. Following the presentations, the Ministerial Advisory Council discussed its engagement in the next International AIDS Conference and agreed in principle to make preliminary inquiries about possibly holding a panel session on national HIV/AIDS advisory bodies and their roles and influence in national responses to HIV/AIDS. It also identified other ideas for engaging in the Conference which it asked the International Committee to take under advisement.

Executive Committee Report to Council

The Executive Committee provided its report to the Ministerial Advisory Committee on the Federal Initiative to Address HIV/AIDS in Canada, noting that its main activities had revolved around the work plan and preparations for this meeting.

June 2008 Meeting Reports

The Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada approved the Record of Decision and Public Record of Meeting from its meeting in Vancouver on June 19 -21, 2008.

Canada’s Public Health Response to Hepatitis C—Jeff Potts

Jeff Potts, Manager of the Hepatitis C Program, PHAC, joined the meeting to provide the Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada with an update on the Hepatitis C Prevention, Support and Research Program. He noted that the original Hepatitis C Program was established in 1999 with annual funding of $10.65 million. It was set to end in 2003/2004, but was kept going until the end of 2006/2007 through a series of one-year extensions. The current renewed program was announced in May 2008 and follows a formal evaluation of the program from 1999 to 2006. The current program is being funded at the same level as the former program. Its three funding streams are:  Research and Surveillance ($3.23 million); Care and Awareness ($518 thousand); and Prevention and Community-Based Support ($5.9 million).

Mr. Potts stayed on following his presentation to answer questions from the Ministerial Advisory Council. Following his departure, the Ministerial Advisory Council held a debriefing to identify actions in follow up. In the discussion that ensued, it agreed to write to Mr. Potts to thank him for his presentation. It also asked its Partnership Committee to look at opportunities for working with the Hepatitis C Program to raise awareness of hepatitis C and co-infection with HIV in Canada and report back at a later date with recommendations.

Second Generation HIV Surveillance in Canada

Chris Archibald, Director of the Surveillance and Risk Assessment Division (SRAD) and Susanna Ogunnaike-Cooke, Manager of the Tracks Program, PHAC, joined the meeting to present the Ministerial Advisory Council on the Federal Initiative to Address HIV in Canada with an update on the Tracks Program of second generation HIV surveillance among populations at risk or vulnerable to HIV infection. The Tracks Program is being implemented as repeated cross-sectional surveys at centres across Canada and is at various stages of development for the following populations: persons who inject drugs (I-Track); men who have sex with men (M-Track); persons from ethnocultural populations (E-Track); Aboriginal Canadians (A-Track); and, persons living with HIV/AIDS (P-Track). Participants complete a questionnaire comprised of a core set of questions to which may be added site-specific questions of interest to the local partner. Participants are normally also asked to provide a dried blood spot for HIV and other testing, although this is optional at some sites. Dr. Archibald and Ms. Ogunnaike-Cooke reviewed results from I-Track and M-Track which are furthest along in implementation, and described next steps in terms of data analysis and distribution. An important task will be to tailor the information to different audience so that it can be used at all levels to inform policy and programming.

Following their presentations, Dr. Archibald and Ms. Ogunnaike-Cooke stayed on to answer questions and hear comments from the Ministerial Advisory Council. Following the departure of the presenters, the Ministerial Council agreed to write to Ms. Ogunnaike-Cooke and Dr. Archibald to thank them for their presentation and to highlight the importance of ensuring that knowledge translation and exchange processes are in place so that the data generated by the Tracks studies help inform and improve programs and policies at all levels.

Review of Business Arising Since the June Meeting

The Secretariat reviewed the status of action items identified at the June meeting and identified a number for further follow up.

Letter to the Minister of Health

The Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada discussed sending a letter to the Minister of Health, with a focus on preparing the Ministerial Advisory Council’s advice to the Minister on World AIDS Day and preparations for a possible new Minister. The Ministerial Advisory Council agreed to the structure and content of the letter, which it asked its Secretariat to draft. It also asked its Partnerships Committee to prepare a bulleted list of possible World AIDS Day messages for the Minister and to circulate the draft list to the full Council for comment.

Closing Remarks 

The Co-Chairs thanked members of the Ministerial Advisory Council on the Federal Initiative to Address HIV/AIDS in Canada and the Secretariat for their hard work and dedication.