Grant: Team Grant: HIV Implementation Science - Component 2 - Indigenous Populations

First Nations people living on-reserve in Saskatchewan have the highest rates of HIV infection in Canada, with an incidence approximately 7.3-times higher than the national average. They also have the least access to care and to life saving antiretroviral therapy. To address this need, a comprehensive on-reserve HIV testing and treatment initiative called "Know Your Status" (KYS) was launched in 2011. KYS is a community-designed and community-managed program based on partnerships and collaborations between First Nations communities and care providers. Key components of KYS include: community involvement and leadership, education, prevention, specialized nursing support, support for mental health and addictions, lab testing and accessible and culturally-safe clinical management that meets clients where they are located. Culturally supportive services, such as mentorship from Elders and traditional teachings, are also integrated within the program. Thus far, KYS has been primarily implemented to care for HIV and sexually transmitted infections on a few on-reserve communities. However, there is a need to expand the program to include hepatitis C testing, linkage and treatment, as a result of similarly high on-reserve rates. The research team, in close partnership with First Nation communities, intends to refine, adapt, and expand the KYS intervention to communities with the greatest need. Traditional experimental designs to evaluate the KYS initiative cannot be used for various reasons. Instead, the team will use practical, though rigorous, methods to evaluate the effectiveness, acceptability and sustainability of the expanded KYS program, while ensuring that community needs are met. First Nations leaders and communities, policy makers and other physicians will be engaged throughout the project to build community and provincial capacity to treat on-reserve HIV and hepatitis C, and to ensure program sustainability for years to come.