Government of Canada Report to the Secretary General of the United Nations on the United Nations General Assembly Special Session on HIV/AIDS Declaration of Commitment on HIV/AIDS

January 2006 - December 2007

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IV Best practices

Political leadership –the Canadian HIV Vaccine Initiative
The $139 million Canadian HIV Vaccine Initiative (CHVI) represents a collaborative Canadian contribution to the Global HIV Vaccine Enterprise that is dedicated to accelerating worldwide efforts towards the development of safe, effective, affordable, and globally accessible HIV vaccines, which are essential to ultimately overcome the HIV/AIDS pandemic. The CHVI is an inclusive, global collaboration involving developed and developing countries, researchers, nongovernmental organizations, the private sector and governments.

The CHVI focuses on five priority areas: discovery and social research; clinical trial capacity building and networks; pilot scale manufacturing capacity for clinical trial lots; policy and regulatory issues, community and social dimensions; and planning, coordination and evaluation.

Political leadership – XVI International AIDS Conference, Toronto 2006
Canada was proud to host, for the third time, the International AIDS Conference which was held in Toronto in August 2006. The City of Toronto, the Government of Ontario and the Government of Canada worked in a coordinated manner, providing extensive political, programme and financial support to the conference organizers and the overall conference program. The event received significant funding from the Government of Canada, providing direct financial support for many initiatives such as satellite sessions, travel entry, the Global Village and the domestic and international scholarship programmes, the latter which allowed for increased event participation and attendance of civil society representatives and people living with HIV/AIDS.

The importance of partnerships was demonstrated through the success of the Canadian Exhibition Space, which visually depicted the relationship amongst Canadians who share responsibility to address HIV/AIDS in Canada. The exhibit was a highly collaborative initiative, involving representatives from the Government of Canada, the provinces and territories, Canadian nongovernmental organizations, and the City of Toronto.

The federal Minister of Health, the federal Minister of International Cooperation, the Ontario Minister of Health and the Mayor of Toronto all contributed to the success of the event providing speeches and presentations throughout the Conference such as at the opening ceremonies, satellite sessions and affiliated events. The Governor General also participated in the opening ceremonies.

The conference received extensive media coverage, bringing increased attention to HIV/AIDS issues across Canada and around the world.

The supportive policy environment – Collaboration to address the epidemic
HIV/AIDS is a priority at all levels of government in Canada. To address the challenges of multi-jurisdictional coordination, a national blueprint for action on HIV/AIDS was developed, which acknowledges the different roles that partners contribute to as part of the Canadian response under a common framework for action.

Leading Together, Canada Takes Action on HIV/AIDS (2005-2010) sets out an ambitious, coordinated nationwide approach to address HIV/AIDS and the underlying health and social issues that contribute to the epidemic. To promote the multi-sectoral approach and vision outlined in this document, a Championing Committee was established in late 2006, comprising of representatives from the voluntary sector, the research sector, and government. The Committee’s mandate is to promote and champion the widespread use of Leading Together throughout Canada so that the document guides all sectors of Canada's response in order to get ahead of the epidemic and to improve the lives of people at risk of and living with HIV/AIDS.

Other advisory and consultative mechanisms exist to facilitate collaboration across and between jurisdictions such as the Federal/Provincial/Territorial Advisory Committee on AIDS, which promotes inter-jurisdictional collaboration and provides public policy development. The Assistant Deputy Minister Committee on HIV/AIDS provides for government-wide, interdepartmental leadership, increased coordination and integration of policy and programs that address HIV/AIDS and its related issues. Different provinces and territories have various mechanisms to support interdepartmental work on HIV/AIDS.

The voluntary sector is also active in coordinating its efforts. For example, the Canadian AIDS Society is a national coalition of over 125 community-based AIDS service organizations dedicated both to strengthening the response to HIV/AIDS across all sectors of society, and to enriching the lives of people and communities living with HIV/AIDS. Another example is the Canadian Aboriginal AIDS Network, a non-profit coalition of individuals and organizations which provides leadership, support, and advocacy for Aboriginal peoples living with and affected by HIV/AIDS, regardless of where they reside (on or off reserve). Several provinces have umbrella groups representing the various community organizations involved in the response to the HIV/AIDS epidemic.

Scale-up of effective prevention programmes
Prevention is fundamental to bringing an end to the epidemic in Canada. Prevention has become a focus of renewed energy, with an emphasis on best practices in reaching at-risk populations, on encouraging partnerships, on knowledge transfer, on scientific evidence, and on specific interventions such as testing and vaccine development.

Prevention: The HIV Prevention Forum
The Public Health Agency of Canada, in partnership with the National Collaborating Centre for Infectious Diseases, held an HIV Prevention Forum in Ottawa on April 12-13, 2007. The forum brought together federal government officials, domestic and international experts, provincial and territorial government and public health delegates, HIV/AIDS national and frontline organization representatives, public health practitioners, people living with HIV/AIDS, researchers, and other stakeholders. Participants discussed and identified strategies for sustaining HIV prevention efforts over the next decade to prevent the acquisition and transmission of new HIV infections.

Outcomes of the forum included an improved awareness of the roles and responsibilities of the partners involved in HIV prevention and identified priorities and multi-stakeholder strategies for sustaining HIV prevention.

Prevention: HIV testing
Emerging issues and policy discussions related to HIV testing include healthcareprovider- initiated testing and counselling, point-of-care rapid testing, the availability of home test kits, as well as issues related to human rights, surveillance, research, training and delivery of testing and counselling programs. These evolving issues, and others, continue to raise several questions regarding who should administer tests as well as the potential impact of insufficient counselling and referral when considering treatment and support initiatives.

The federal government has responded to this changing environment on both the domestic and international front. The Public Health Agency of Canada (PHAC), the Canadian International Development Agency, Health Canada and Foreign Affairs Canada engaged in the WHO/UNAIDS discussion on approaches to provider-initiated testing and counselling in a number of international fora. By bringing forward the Canadian experiences to HIV testing, it reinforced the importance to include pre and post test counselling, confidentiality and informed consent issues in all situations where HIV testing is provided. The PHAC sponsored an international policy dialogue on HIV testing and counselling in 2006, which brought together leading human rights experts, public health ethicists, HIV testing and counselling specialists and public health practitioners to discuss the issues. A research paper prepared for this dialogue – HIV Testing and Counselling: Policies in Transition (2006)³¹ – serves as an important resource on the history of testing and on emerging approaches adopted both domestically and internationally.

Many studies have demonstrated that the use of rapid testing technologies increase the uptake of HIV testing in most vulnerable populations. In support of the introduction of rapid tests, PHAC published revised guidelines: Point of Care HIV Testing Using Rapid HIV Test Kits: Guidance for Health-Care Professionals. These guidelines aim to ensure that health-care professionals, who are approved to perform HIV testing, can appropriately administer rapid HIV testing in points-of-care sites. The guidelines highlight the need for pre- and post-test counselling and the adaptation of post-test counselling in the context of rapid HIV testing.

Prevention: Targeted Research Initiatives
The Canadian Institutes of Health Research (CIHR) identifies prevention as one of six priorities for their HIV/AIDS Research Initiative. To enhance research efforts and to build the capacity of Canadian investigators in the area of HIV prevention, CIHR designed a strategic research funding program, in consultation with a multi-sectoral working group, which was then launched in December 2006. The program supports research projects expected to contribute to the identification of new or improved HIV prevention strategies, ranging from novel technologies to innovative public health interventions.

Scale-up of care/treatment/support
As part of the Federal Initiative, the Public Health Agency of Canada realigned its national HIV/AIDS funding programs to strengthen the federal role in supporting communities to better address the epidemic. In 2006, the Specific Populations HIV/AIDS Initiatives Fund, one of five national funding programs under the Federal Initiative, was launched. This fund program supports national projects that: prevent HIV infection; increase access to appropriate diagnosis, care, treatment, and support; and increase healthy behaviours in populations most affected by HIV/AIDS and most vulnerable to infection.

Capacity building - Developing a national framework for research planning and knowledge exchange
Important components of both Leading Together and the Federal Initiative are initiatives that aim to strengthen research planning and knowledge transfer and exchange in order to increase the uptake and utilization of knowledge to further inform policy and program decisions. The Public Health Agency of Canada plays a lead role in the development of national initiatives. For example, work is underway to develop a national framework for research planning and knowledge exchange in Canada, in collaboration with governments, researchers, funders, community-based and national non-governmental organizations, public health practitioners, front-line service providers and people living with HIV/AIDS. The framework will identify ways in which to harness existing capacities and to strengthen systems so that information needs are identified in a timely manner, and knowledge is developed and transferred to meet these needs, resulting in evidence-informed policy, practice and decision-making.

The Canadian Institutes of Health Research (CIHR), Canada’s leading funding agency for health research, has undertaken several initiatives to complement national research planning and knowledge exchange efforts. In February 2006, CIHR announced six research priorities which will help to guide the agency’s HIV/AIDS research planning and investments to best address the key issues facing the epidemic in Canada. The priorities were identified through a consultative process which engaged researchers, government and community based organizations. The priorities encourage a population-specific approach, targeting high risk populations, and will support initiatives such as those that address the accessibility of essential services for those infected and at risk of HIV. CIHR is also undertaking the development of a strategic plan to better define the HIV/AIDS Research Initiative’s mission and activities over the next five years. Both the strategic plan and priorities will help define the role of the agency in the national framework and will guide the development of a coordinated and collaborative approach with stakeholders.

Capacity building –the National HIV/AIDS Knowledge Exchange Fund
A new National HIV/AIDS Knowledge Exchange Fund was developed in 2006-07 after undertaking the following activities: a literature review of knowledge exchange models; a survey of front-line service providers; and consultations with national HIV/AIDS NGOs, health care providers, public health units, researchers, community-based AIDS service organizations and other federal government departments. In October 2007, the fund process was finalized. The National HIV/AIDS Knowledge Broker will act as the "one stop shop" providing relevant, current, and readily accessible knowledge and information in a timely manner in order to strengthen front-line HIV/AIDS prevention, diagnosis, care, treatment and support programs.

Capacity building – the Development and Pilot of a Common Data Collection and Reporting Tool
The Public Health Agency of Canada (PHAC) has established the Population Health Evaluators Network, whose membership consists of PHAC regional/national evaluators and program consultants from across population health programs. In 2005, the Network launched a pilot monitoring and evaluation initiative which saw the development of a Project Evaluation and Reporting Tool (PERT) and database to enable a more systematic assessment of evidence and improve results-based reporting across the Agency.

Funded organizations complete the PERT data collection questionnaire at various stages throughout their project life-cycle. The PERT can be completed online using an online date entry and analysis web application. A one-year pilot test of the PERT was initiated in October 2006 to assess the validity and reliability of the tool. The tool is currently being validated by external evaluation experts. Revisions will be made to the tool as a result of this process to support monitoring and evaluation activities of the Public Health Agency of Canada. Community organizations whose projects are funded through the AIDS Community Action Program and national HIV/AIDS funding programs, are participating in this pilot.

This initiative will strengthen PHAC’s program monitoring and evaluation processes by supporting a streamlined, integrated, centralized, consistent and comparable approach to reporting.

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³¹ http://www.phac-aspc.gc.ca/aids-sida/publication/hivtest/index-eng.php

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