OCHART KTE Day: View from the Front Lines

January 13, 2009

Report to Community-based Programs

Joanne Lush – Ministry of Health and Long-Term Care, The AIDS BureauAnita Fervaha – Public Health Agency of Canada – Ontario Region

Sarah Rubenstein – Ontario HIV Treatment Network

OCHART Development

Need identified in strategies Agency consultation

and review – process included direct agency involvement/feedback

Data capacity survey and IT assessment of agencies

Contracted with the OHTNFocus-tested the

application

Training and implementation

The OHTN hosts the web-based tool, provides administrative, technical and analytical support for the OCHART, including consolidating the data into an annual report

A working group meets regularly

to discuss OCHART

outcomes and necessary refinement

In 2005, AIDS Bureau & PHAC introduced a joint web-based reporting tool in consultation with funded agencies: the

Ontario Community HIV/AIDS Reporting Tool (OCHART)

Purpose of OCHART

The purposes of collecting and reporting data on funded community based HIV/AIDS services are to:

•Improve:• the quality and consistency of information about services

•Provide:• funders with information on use of funds (accountability)

to guide planning• agencies with information to plan and strengthen their

programs/services•Identify:

• research issues/questions• and convey trends in the community

Who Completes OCHART

• 77 agencies funded in 2007/08

Organizations include:

• Funded by either AIDS Bureau or PHAC

• Mainly community-based AIDS service organizations (ASOs)

• Some programs based in community health centres, public health units, & other organizations.

The OCHART

• Agencies submit the OCHART twice each fiscal year: in October (April-September) and April (October-March).

• Agencies provide program-level, not client-level data. It is not possible to identify the exact number of people served or the mix of services used by each individual.

• The agencies may access all their entered data (past and present), as it is maintained and available online/web-based.

• Data quality and consistency are improving over time – enhanced by training, reports and KTE events.

Web-Based OCHART

OCHART Content Overview• Organization Information

• Program/Project Information – Contact listing for all staff

• Governance

• Human Resource Issues

• Organizational Funding

• Catchment Area Characteristics

• Program Planning and Evaluation

• Partnerships

• Education and Community Development

• Outreach Initiatives

• Support Services

• Use of Volunteers and Students

• Injection Drug Use Outreach Programs

Location of AgenciesLHIN Distribution Across Regions

Toronto

Provincial

Central East

EasternSouthwest

Northern

Central West

Ottawa

North Simcoe Muskoka n=1

North Eastn=5

North Westn=3

Hamilton Niagara Haldimand Brant

n=3

Waterloo Wellingtonn=3

Central West / Miss. Halton

n=1

Champlainn=6

South Westn=3

Erie St Clairn=1

South Eastn=2

Provincial

n=11

Central n=3

Central Eastn=4

Toronto Central

n=30

Internal Doughnut = RegionsExternal Doughnut = LHIN

Epidemiology Data

See: Pages 10 - 13

of OCHART Report

Number of HIV Diagnoses (adjusted1) Among Males and Females by Year of Diagnosis, Ontario, 1985 to 2007

0

200

400

600

800

1000

1200

1400

1600

1800

2000

1985

1986

1987

1988

1989

1990

1991

1992

1993

1994

1995

1996

1997

1998

1999

2000

2001

2002

2003

2004

2005

2006

2007

Year

# o

f D

iag

no

ses

Male

Female

1 Unknown sex assigned according to the distribution of cases with known sex (see Technical Notes); thus, totals may differ due to roundingSource of data: HIV Laboratory, Laboratory Branch, Ontario Ministry of Health and Long-Term Care From: http://www.phs.utoronto.ca/ohemu/doc/Table1.pdf - accessed August 8, 2008

• 7% decrease in new HIV diagnoses from 2006 to 2007

• Lowest number of new diagnoses since 2001• Downward trend in infections in women?

• Decrease in new cases among people from HIV-endemic countries

• Decrease among those who reported low- or high-risk heterosexual activity

• Increase among MSM and those who inject drugs.

• New diagnoses up in Northern and Central East regions, but down elsewhere

• Down over 50% in East region• Decrease not due to lack of HIV testing.

• More effective treatments = Higher numbers of people living with HIV in Ontario

• Funded organizations are probably providing services for more people over a longer period.

Overview of Organizations

See: Pages 14 - 30

of OCHART Report

• In 2007-08, 13% drop in funding from charitable foundations and private sector

• One possibility: Increase in funding from AIDS Bureau made it less necessary to spend time fundraising.

• An encouraging general increase in number of organizations involving people with HIV/AIDS or those at risk in organizational activities.

• More organizations involved in community-based research projects each year

• More are measuring the impact of their services

• 50% increase (2005-07) in “Implementing Research Findings” indicates evidence-informed practice.

• In 2007-08, for first time, organizations were asked to indicate proportions of clients in different racial/ethnic groups

• Six of eight regions report most clients are White; two report most clients are Aboriginal.

• In 2007-08, substance abuse and mental health issues affected significantly more clients

• Increase in agencies reporting clients in sex trade/work.

Education & Community Development Data

See: Pages 41 - 49

of OCHART Report

• A steady increase in organizations targeting priority populations

• A decrease in education programs aimed at heterosexual youth or the general public.

• Number of presentations remains constant from 2006-07 to 2007-08, but with 25% fewer participants

• Probably reflects a more targeted approach• Always more presentations in 2nd half of year (fall

and winter) except 2006-07 (International AIDS Conference in July).

• Majority of presentations given to service providers• Marked increase in workplace presentations in 2007-

08, consistent with the finding that employment issues are a priority for people with HIV.

• More community development meetings in 2007-08 than in all years prior to 2006-07

• 2006-07 results due to preparatory meetings for the International AIDS Conference, as well as the Conference itself.

• In 2007-08, # of community development meetings down in all locations except community forums and government

• Reflects increased focus on integration, and on working with other organizations in the community

Outreach Data

See: Pages 50 - 65

of OCHART Report

• This chart shows outreach contacts by funded organizations in all locations

• A clear pattern: while total number of face-to-face outreach contacts dropped steadily from 2005-06 to 2007-08, all other types of contact increased.

• Increase in contacts made at bars (66%), bathhouses (87%) and parks (53%) may be related to concerted effort by Gay Men’s Sexual Health Alliance to reach gay men

• In 2007-08, the trend of using the Internet to raise awareness continued to grow

• Increase in newsletters is a related trend, as many of these were distributed electronically.

• In 2007-08, there was an increase in the number of organizations distributing all but “other” resources

• Just over 80% of all funded organizations now distribute condoms, and 38% distribute needles.

• In 2007-08, organizations were asked (for the first time) whether they distributed other prevention resources not formerly identified.

Support Services Data

See: Pages 66 - 84

of OCHART Report

• 30 organizations reported a higher number of clients receiving support services than in previous year, but overall there was a drop

• Factors for this drop likely include the temporary closure of some services (Ottawa) and more accurate counting (e.g., less double-counting) of clients

• Almost one in five people served in each half of 2007-08 were new clients

• Hamilton Niagara region showed greatest increase in new clients, both in actual number and in percentage.

• Although numbers of clients living with HIV and clients at risk were down in 2007-08, those groups continued to be the main users of support services

• Number of “other” clients increased, partly due to people with Hepatitis C being unable to access support from other services.

• In 2007-08, average number of male clients fell by 20%, while number of female clients fell by only 9% – women now represent about 1/3 of all support clients

• Transgender clients are now being counted more accurately than in previous years.

• A significantly larger number and proportion of women seeking services from ASOs were living with HIV than in the previous year.

• From 2006-07 to 2007-08, the demographics of support service clients shifted significantly – more than can be explained by the passing of one year in age

• Clients aged 25 to 54 increased from 47% to 58% of population; clients over 55 doubled from 3% to 6%.

• Organizations reported more practical assistance sessions than all other types of service combined

• Note: The low number of sessions reported in 2006-07 may be due to it being the first year organizations were asked for this information; tracking mechanisms improved in the second year.

• Possibly, drop in number of support groups caused by mis-reporting in past years (i.e., one support group meeting 15 times over a year might have been reported as 15 groups), before clarification this year

• Some reports indicate some clients increasingly prefer to network rather than hold support group.

• Total financial assistance decreased by 18% from 2006-07 to 2007-08

• Questions were still voluntary. Beginning in 2008-09, questions became mandatory.

• Less variation (between regions) in financial assistance per person than in previous years

• Highest assistance provided in the North, where travel and food costs are high, and in urban areas, where general cost of living is high.

Volunteers & Student Placement Data

See: Pages 85 - 92

of OCHART Report

• Many more volunteers, but slightly fewer total hours• Consistent with a pattern seen across most

organizations that rely on volunteers: people are not able to give as much time as they did in the past.

• Over the past three years, a steady decrease in volunteer hours devoted to fundraising and administration

• A steady increase in hours devoted to practical support, special events and outreach.

• More student volunteers in each half of 2007-08 than in each half of 2006-07, but generating slightly fewer hours of service

• Similar to pattern seen in overall volunteer population.

HIV/IDU Outreach Data

See: Pages 93 - 106

of OCHART Report

• In 2007-08, IDU outreach contacts increased for both men (34%) and women (8%)

• In-service contacts also increased for both men (8%) and women (20%).

• In 2007-08, IDU outreach programs reported distributing more materials and providing more education than in previous two years

• Offset by drops in practical assistance and counselling.

• All IDU outreach programs are required to have strong peer component

• Despite slight declines in active and new peers in 2007-08, the numbers are still significantly higher than in previous years.

• Although IDU programs were involved in fewer community development activities in 2007-08 than in 2006-07, organizations had contact with almost 10% more participants.

Overview of Trends

See: Pages 8 - 9

of OCHART Report

Key Findings and Trends 2007-08

Client Needs

• Mental health and substance use key issues facing clients

• Increase in requests for education from youth, women, and newcomers

• More women using support services

• Support service clients are getting older

Key Findings and Trends 2007-08

Service Delivery• Less face-to-face outreach; more outreach by Internet

and phone• Impact of aggressive policing policies on services• Unemployment key issue but few employment-related

services• Increase in housing services and housing supports -

perhaps due to impact of Positive Spaces Healthy Places study

• More volunteers -- but give fewer hours and want meaningful opportunities

• IDU outreach peers providing more services -- not just distributing information

• Increasing demand for new, more flexible programming approaches

Key Findings and Trends 2007-08

Organizational Issues

• More organizations recruiting and employing people with HIV or at risk

• High rates of staff turnover and vacancies

• More organizations involved in research –commitment to evidence-based practice.

Get More Info

To view the report in full:

https://www.ochart.ca/documents/Resources_Reports.htm