Oasis

1. Oasis Program of Sandy Hill Community Health Centre Hepatitis C Strategy Planning – November 13, 2007 Len Moore, Family Physician

2. Oasis • Oasis opened in 1996, as a result of community pressure on funders to address gaps in service • Target Groups that were to be addressed: Women, aboriginal, gay men, ethno cultural communities, addicts and gender mixed homeless, youth and street involved

3. Oasis • In the beginning (1996) , there were only 4 medications available – by the end of the year there were 12 medications available (era of HAART) • HIV treatments had to be sent from Sunnybrook Hospital in Toronto • Our original location was at 100 Marie Curie – University of Ottawa – Adjacent to Campus Pharmacy • Worked in partnership with the Immunodeficiency Clinic at the Ottawa General Hospital: pharmacist, dietitian, counselor from AIDS Committee of Ottawa • In 1996 - 5 to 10 IV pentamidine treatments per week compared to 0 in 2006 • 1999-present – HCV therapy – monotherapy – RBV+peg interferone

4. Oasis - Today • MANDATE: To provide services to street involved people who have, or who are at risk of HIV • One stop shopping concept: Implement and support Harm Reduction philosophy. • Client guidelines based on mutual respect & overall behaviour. • Conflict resolution based on Non-Violent Crisis Intervention and barring process. • Clients have an official complaint process they can follow to place a grievance.

5. Oasis - Today • Multi-disciplinary team approach – with support from volunteers • Available services include: Medical drop-in, doctor, nurse, nurse practitioner, complimentary therapies, counselors, practical assistance worker, outreach services, Hepatitis C counselor, peer projects, women’s clinic, needle exchange, condoms, safer crack kits, dietitian, arts & crafts, cooking

6. Response to Program • Our clients include individuals with serious mental illness and/or addiction problems, homeless individuals, sex trade workers and anyone concerned about HIV AIDS • 600 active medical clients (half time clinic) • 1100 active clients • 95% past or current substance abuse • 50% diagnosed with mental illness • 21% HIV positive • 42% HCV Antibody positive • 17% co-infected (80% of HIV+ clients Anti HCV +) • Approximately 250 new clients each year (accessing 3+ programs)

7. Particular Program Innovations • Client complaint process • Re-entry Interviews • Harm Reduction Primary Care • Positive Men’s Harm Reduction Support Group • Peer Projects • Annual Street Angels Memorial • Choices Newsletter (peer driven) • HHH funded programs: • Cheque Day Assistance Program • Life Skills Worker • Addiction Worker

8. Oasis - Today • The success of this “one stop shopping” model is largely due to the commitment of the numerous community partners, dedicated staff and volunteers. • Oasis volunteers contribute approximately 3200 hours yearly.

9. Oasis – Today - Challenges • Changes in drug use patterns in Ottawa • Project Funding changes (both ours and the partners) • Family physician shortage • Working with people not in our initial mandate (at risk for HIV – but now HCV) • Relocation of program • Current political environment – regional and provincial

10. Hepatitis C • Engagement • Ready-ness / Preparedness • Support (Rarely linear and more likely relapsing)

11. Hepatitis C - Engagement • Meeting clients’ stated needs – responding to expressed concerns – which do not always include concerns for Hepatitis C or HIV • Usually addressing immediate needs – including: financial (forms), abscess, housing and other health concerns – Establishing trust • Vitamins / Needle exchange / condoms / Testing (anonymous/POC)/”Oasis Special”

12. Hepatitis C Preparedness • Addressing issues of housing / addiction – harm reduction / OHIP / OW- ODSP • Importance of Partner agencies / services • Motivational Interviewing – consideration for Hepatitis C or HIV treatments – Referral to specialist / or initiation at Oasis with specialist support • Lab work / Investigations – monitoring and ongoing discussion / Immunizations – Ability to attend community lab/Oasis appointments can reflect ability to attend specialist appointment – offers an “out” if not prepared to start)

13. Hepatitis C Preparedness • Client reasons for refusal of treatment: • Fear of side-effects – Fear of biopsy • Fear of psychiatric side-effects • Fear of failure • “I’m feeling fine – It ain’t broke - don’t fix it” • Fear of relapse (HCV following HIV infection) • Fear of needing to be abstinent • “My CD4 is too low now”

14. Hepatitis C - Support • Transportation – Accompaniment – Review • Accessible central location – Outreach • Addressing concerns: mental health, addiction – triggers, financial, psychosocial • Injections / Medication Storage / Blood work / Side-effect Management

15. Hepatitis C Support • Monitoring if decide against treatment or feel unprepared – “how to remain healthy” • Open communication with consultants / nursing / other supports • Support post HCV treatment • Harm reduction / Mental Health monitoring • Addressing health issues not specific to HCV/HIV • End of life issues – Respect – Dignity - Being remembered