This past weekend, I attended the annual meeting of the American Association of the Advancement of Science (AAAS). Every few years, the AAAS overlooks the first "A" in its name and holds the meeting outside of the US. This year was Vancouver's turn to hold the spotlight, with 8,000 attendees from all over the world sharing their research and ideas, and debating complex issues ' both technical and ethical.
I attended sessions on a dizzying range of topics, but the one that really stood out for me was a presentation by Dr. Julio Montaner, Director of the British Columbia Centre for Excellence in HIV/AIDS. Montaner is also Chair in AIDS Research and Head of Division of AIDS in the Faculty of Medicine at UBC, and Past-President of the International AIDS Society (IAS). He is clearly well-qualified to speak to this topic.
Montaner described both an amazing scientific success story and a distressing social failure. Through the introduction of Highly Active Antiretroviral Therapy (HAART), HIV/AIDS has become a well-managed disease in many areas of the world. Thanks to this treatment, women who are HIV-positive are being told that they can, with reasonable safety, have babies and expect them to be healthy, with the added bonus that the mother too can expect to live long enough to see those babies grow up and graduate from college. What a difference to the state of affairs of just ten years ago! Montaner showed graphs of HIV infection rates in BC, which peaked in 2005 before dropping precipitously as the new HAART program took effect. He said we are well on our way to having no new cases in BC.
So, what is the down side to all this?
For BC there isn't one; it's good news all the way. The problem comes when we look at infection rates in other provinces, most notably Saskatchewan. During the same time that BC rates were plummeting, a full-blown epidemic was taking place in Saskatchewan, with rates going up by a factor of five. This increase appears to be happening almost exclusively within First Nations communities. In a dramatic conclusion to his speech, Montaner (wearing an Order of Canada pin on his lapel) attributed this failure to the Canadian government and its attitude that First Nations peoples were "somehow less than other citizens"! In Canada? Really?
Speaking with him afterwards, I was keen to know more about this issue, and what might be done to help. He told me that the lack of a proper health records for First Nations peoples, who fall between the cracks of provincial versus federal healthcare systems, is a big problem in administering and tracking HAART.
I couldn't help but draw comparisons between this problem and a similar one being addressed by Alberta's Stoney and Siksika First Nations, relating to their vaccinations records. Recognizing the faults in their paper-based immunization recording system, these communities began working with Edmonton-based OKAKI Health Intelligence at the end of 2011 to create the Community Health Immunization Program (CHIP). This program, developed with support from Cybera, is a simple system for electronically managing and sharing immunization records.
It certainly seems like there are many common elements between this initiative and what is required in Saskatchewan, and it raises the question of whether a cloud-based medical record system targeted at a particular healthcare problem could be applied to HIV/AIDS tracking as well as to vaccination programs.
CHIP has been astonishingly successful. In less than six months, 50,000 immunization records have been entered into the system. Analyzing these records has actually shown that immunization rates in Alberta's First Nations communities are significantly lower than previously reported. Now, public health providers can seamlessly communicate patient information as they move between CHIP health centres; they also have the tools to easily find the children overdue for vaccination, as well as monitor the program's performance.
Why has CHIP been so successful? Certainly, the technical aspects are well done and the system is easy to use, but it's also because the demand for it came from within. Visionary leaders on the Siksika reserve, like Tyler White, CEO of Siksika Health Services, and physicians working with First Nations, like Dr. Salim Samanani of OKAKI, saw what was needed and developed an appropriate solution. Without a mandate from Ottawa or Edmonton, the system took off, and is now making a real difference in peoples' lives.
Let's see if there is similar will to try a custom-fit solution for knocking down the appalling HIV infection rate in other Canadian communities.