ARCHIVED - Public Health Agency of Canada - Supplementary Tables

Aboriginal Head Start in Urban and Northern Communities

Strategic Outcome: Canada is able to promote health, reduce health inequalities, and mitigate disease and injury.

Name of Transfer Payment Program: Aboriginal Head Start in Urban and Northern Communities (AHSUNC)

Start date: 1995-96

End date: Ongoing

Description: This program supports locally designed and controlled early childhood development intervention strategies for off-reserve Aboriginal children and their families. The program focuses on health promotion, education and school readiness, aboriginal culture and language development, parental involvement, nutrition, and social support.

Expected results: To provide opportunities for the healthy development of Aboriginal pre-school children in urban and northern settings, including the development of positive self-esteem and a desire for learning, and opportunities to develop successfully as young people. The program helps to reduce health disparities experienced by vulnerable children and their families living in conditions of risk by increasing community capacity, helping participants make healthy choices and promoting multi-sectoral partnerships.

Results Achieved: AHSUNC provides comprehensive, culturally-appropriate, early childhood development programming to approximately 4,800 children and their families at 129 sites across Canada. The program mitigates inequalities in health and developmental outcomes for Aboriginal children in urban and northern settings. Improvements have been noted in physical development, health and personal/social development, school readiness, language, literacy and mathematical thinking. Parents have learned about healthy child development and positive parenting skills.

Over the past year, national implementation and training on the Brigance Head Start Screen took place. The Brigance Head Start Screen is a standardized early childhood development screening tool that assesses developmental progress on language development, literacy, mathematics and science, social and emotional development and physical health and development. The 2010 National Administrative Process Survey was completed by 113 sites. The survey showed more than 85% of sites setting aside time every day for physical activity which mitigates the risk of childhood obesity. In addition, sites reported health promotion activities related to injury prevention and oral health: 93% conducted Safety/Fire Drill Training and 83% organized visits from dental health professionals.

The Strategic Fund was also renewed for five years, with regional and national investments to extend the reach of the AHSUNC program focussed on developing a wide range of culturally and linguistically appropriate resources and tools to enhance programming. The AHSUNC Strategic Fund provided support for a well-received Leadership, Administration and Management Training in Yellowknife, NWT for 30 site staff and the development of Inuit specific literacy resources for sites.

Program Activity: Health Promotion
($M)

	Actual Spending 2008-09	Actual Spending 2009-10	Planned Spending 2010-11	Total Authorities 2010-11	Actual Spending 2010-11	Variance(s)
Total Grants
Total Contributions	31.3	31.8	29.1	33.6	33.1	(4.0)
Total Other types of transfer payments
Total Program Activity	$31.3M	$31.8M	$29.1M	$33.6M	$33.1M	$(4.0)M

Comment(s) on Variance(s): Actual spending exceeded planned spending by $4.0M. The variance is due to the program receiving funding for strategic investments of $3.0M in Supplementary Estimates A; a temporary transfer to the regions to support amendments to contribution agreements from the Population Health Fund for $1.3M; and other transfer out of $0.3M to different programs within the Agency.

Audit completed or planned: The program was part of the September 2009 Audit of Health Promotion Programs.

Evaluation completed or planned: A national impact evaluation was completed in 2006. The next evaluation is scheduled to be completed in 2011-12 and will focus on program relevance and performance in accordance with TBS 2009 Policy on Evaluation.

Community Action Program for Children

Strategic Outcome: Canada is able to promote health, reduce health inequalities, and mitigate disease and injury.

Name of Transfer Payment Program: Community Action Program for Children (CAPC)

Start date: 1993-94

End date: Ongoing

Description: CAPC provides funding to community-based groups and coalitions to develop and deliver comprehensive, culturally appropriate prevention and early intervention programs to promote the health and social development of children (0-6 years) and their families facing conditions of risk.

Expected results: To enhance community capacity through a population health approach and to respond to the health and development needs of young children and their families who are facing conditions of risk. To contribute to and improve health and social outcomes for young children and parents/caregivers facing conditions of risk, and to continue partnering with multiple sectors in the community.

Results Achieved: PHAC provided funding and support to 441 community based projects in 2010-11.

An evaluation of CAPC completed in January 2010 provided evidence that the program continues to be relevant to the Canadian context; reaches children and families living in conditions of risk; and contributes to their health and social development. A qualitative analysis of CAPC provided evidence of improved child development outcomes, community capacity and personal parental improvement.

Program Activity: Health Promotion
($M)

	Actual Spending 2008-09	Actual Spending 2009-10	Planned Spending 2010-11	Total Authorities 2010-11	Actual Spending 2010-11	Variance(s)
Total Grants
Total Contributions	56.0	54.4	53.4	54.8	54.7	(1.3)
Total Other types of transfer payments
Total Program Activity	$56.0M	$54.4M	$53.4M	$54.8M	$54.7M	$(1.3)M

Comment(s) on Variance(s): Actual spending exceeded planned spending by $1.3M due to transfer of $0.8M from CPNP and $0.5M from other programs.

Audit completed or planned: The program was included in the September 2009 Audit of Health Promotion Programs.

Evaluation completed or planned: The Summative Evaluation of the Community Action Program for Children: 2004-2009 was completed in January 2010. The program will undergo its next evaluation in 2013-14.

Canada Prenatal Nutrition Program

Strategic Outcome: Canada is able to promote health, reduce health inequalities, and mitigate disease and injury.

Name of Transfer Payment Program: Canada Prenatal Nutrition Program (CPNP)

Start date: 1994-95

End date: Ongoing

Description: This program promotes the health of at-risk pregnant women, infants and their families through leadership and support to community groups. The program focuses on reducing the incidence of unhealthy birth weights, improving the health of both infant and mother, and encouraging breastfeeding.

Expected results: To enhance community capacity through a population health approach to respond to the health and development needs of pregnant women and their infants who are facing conditions of risk. To contribute to and improve health outcomes for pregnant women, infants and their families, and to continue partnering with multiple sectors in the community.

Results Achieved: PHAC provided funding and support to 325 community based projects in 2010-11.

An evaluation of CPNP completed in January 2010 provided evidence that the program continues to be relevant to the Canadian context, reaches vulnerable pregnant women and new mothers, is cost effective, and is effecting positive changes in the health practices of pregnant women/new mothers and promoting positive birth outcomes. CPNP participants were shown to have improved use of vitamin-mineral supplements during pregnancy; to cease or reduce alcohol consumption and/or smoking; to have increased initiation and duration of breastfeeding. Moreover, there was a decreased likelihood of low birth weight infants and preterm births among CPNP participants.

Program Activity: Health Promotion
($M)

	Actual Spending 2008-09	Actual Spending 2009-10	Planned Spending 2010-11	Total Authorities 2010-11	Actual Spending 2010-11	Variance(s)
Total Grants
Total Contributions	27.2	26.4	27.2	27.3	27.0	0.2
Total Other types of transfer payments
Total Program Activity	$27.2M	$26.4M	$27.2M	$27.3M	$27.0M	$0.2M

Comment(s) on Variance(s): n/a

Audit completed or planned: The program was included in the September 2009 Audit of Health Promotion Programs.

Evaluation completed or planned: The Summative Evaluation of the Canada Prenatal Nutrition Program 2004-2009 was completed in January 2010. The program will undergo its next evaluation in 2013-14.

Innovation Strategy

Strategic Outcome: Canada is able to promote health, reduce health inequalities, and mitigate disease and injury.

Name of Transfer Payment Program: Innovation Strategy (IS) previously known as the Population Health Fund

Start date: 1999-2000

End date: Ongoing

Description: The Innovation Strategy is a federal grants and contributions initiative designed to foster and support effective action on and across a broad range of factors that affect the health of Canadians. The IS focuses on innovation and learning in population health to address the determinants of health and to reduce health inequalities. The Strategy supports the development, adaptation, implementation and evaluation of innovative interventions and policy initiatives in various settings and populations in Canada as well as knowledge translation and dissemination based on the systematic collection of results and outcomes of interventions and the promotion of their use across Canada.

Expected results: To increase effective action to reduce health inequalities and their underlying causes. Performance measures include the extent of design and implementation of new promising interventions; the extent of exchange of new knowledge of effective interventions to take action on priority heath issues; and the increase in the number of intersectoral collaborations to address specific determinants of health or combinations of determinants.

Results Achieved: The program has invested more than $27 million over five years to support mental health promotion across Canada. This funding supports the implementation of ten innovative, multi-centre mental health promotion interventions over the period 2010-15. These initiatives will include thousands of children, youth and families in over 50 communities. The program has also invested $7 million over the period 2010-12 in projects to promote healthy weights and prevent obesity. The IS has undertaken capacity building initiatives to ensure effective implementation and evaluation of funded innovative interventions. Initiatives have also strengthened capacity to develop and implement inter-sectoral partnerships. The knowledge being collected and gained from these projects on the impact and effectiveness of interventions will be shared with stakeholders across the country and help shape future projects and programs.

Program Activity: Health Promotion
($M)

	Actual Spending 2008-09	Actual Spending 2009-10	Planned Spending 2010-11	Total Authorities 2010-11	Actual Spending 2010-11	Variance(s)
Total Grants	1.4	2.2	7.5	0.5	0.3	7.2
Total Contributions	6.5	5.5	3.8	8.7	8.2	(4.4)
Total Other types of transfer payments
Total Program Activity	$7.9M	$7.7M	$11.3M	$9.2M	$8.5M	$2.8M

Comment(s) on Variance(s): The variance in grant spending was $7.2M due to transfer of $6.6M from grants to contributions; transfer of $1.0M to the Canadian Institutes of Health Research through Supplementary Estimates C; and other transfers of $0.6M. Actual spending in contributions exceeded planned spending by $4.4M mainly due to transfer from grants, which was offset by transfers out of $1.4M to other programs within PHAC.

Audit completed or planned: The IS was included in the September 2009 Audit of Health Promotion Programs.

Evaluation completed or planned: The Population Health Fund Evaluation 2008 covering the period of 2005-08 was completed in 2009. The next evaluation is planned for completion by 2014-15.

Federal Initiative to Address HIV/AIDS in Canada

Strategic Outcome: Canada is able to promote health, reduce health inequalities, and mitigate disease and injury.

Name of Transfer Payment Program: Federal Initiative to Address HIV/AIDS in Canada (FI)

Start date: January 2005

End date: Ongoing

Description: Contributions towards the Federal Initiative to Address HIV/AIDS in Canada.

Expected results: Projects funded at the national and regional levels will result in increased knowledge and awareness of the nature of HIV and AIDS and ways to address the disease; increased individual and organizational capacity to address HIV and AIDS; and enhanced engagement and collaboration on approaches to address HIV and AIDS.

Results Achieved: In 2010-11, national funding streams supported six projects under the Specific Populations Fund, seven projects under the National Voluntary Sector Response Fund, one under the Knowledge Exchange Fund, and six under the Non-Reserve First Nations, Inuit and Métis Communities HIV/AIDS Project Fund.

A further 21 projects across Canada under the Non-reserve First Nations, Inuit and Métis and Inuit and Métis Communities fund were approved for funding starting in 2011-12. These projects aim to promote the prevention of HIV infection; facilitate access to diagnosis; treatment and social supports for Aboriginal people living with HIV/AIDS and those at risk; and enhance the capacity of service providers to deliver culturally relevant, community-based interventions among Canada's off-reserve First Nations, Inuit and Métis populations.

A total of 20 projects were funded through national funding streams for a total of $7.4 M. PHAC's Regional Transfer Payment Funds, through the AIDS Community Action Program (ACAP), supported 43 time-limited and 84 operational projects across Canada, for a total of $12.4M.

Increased Knowledge and Awareness

Under the AIDS Community Action Program, projects reports from five of the seven regions-representing approximately 85 percent of ACAP funding-reported that 43,264 members of the target populations were reached through a variety of interventions intended to increase knowledge about HIV transmission and risk. Of those reached 19,400 (or 45%) reported that their knowledge about transmission and risk had increased as a result of the intervention and approximately 20% of the target population identified their intention to adopt behaviours that would reduce risk. Currently ACAP projects are involved in an outcome assessment evaluation with the purpose of collecting participant level data to examine increased practice of health behaviours, increased knowledge and awareness of HIV/Acquired immune deficiency syndromeand increased access to programs and services.

Under the Knowledge Transfer and Exchange Fund, project reports indicate that funded activities increased the knowledge of HIV among front-line workers across Canada. A survey of users showed that 92% of respondents indicated that the activities were useful or very useful in providing information, and that they enabled users to respond to the needs of clients and their community. Eighty-six percent of respondents used information provided to change work practices, or establish or adapt programming. As a result, the capacity of community based organizations to develop and deliver programs and services increased. Front line workers reported using funded services frequently-almost 70% used them at least monthly.

In one case, reports indicate that the rate of knowledge of Aboriginal women who are aware of their HIV status increased from 45% to 69% over the course of four years.

Individual and Organizational Capacity

Based on a comparison of total numbers of volunteers and total numbers of volunteer hours reported in 2009-2010, and 2010-11 by nationally funded projects, volunteer engagement increased from 23 to 30 hours per volunteer.

Regional project data from all seven regions reported over 5000 volunteers who donated 159,312 hours (contributing an average of 31 hours per volunteer). There were over 2400 new volunteers. Significant training of over 900 sessions was reported by six of seven regions for both staff and volunteers.

Engagement and collaboration on approaches to address HIV and AIDS

Community-based organizations developed new partnerships with communities and provinces and territories to improve access to prevention and control programs and treatment. Partnerships increased at least 10% per year over the last two years.

Regional projects in six of the seven regions reported over 650 partnerships. Projects in five regions reported a total of 63 partnerships with local and provincial governments across a number of key sectors, and a total of 48 collaborative partnerships with researchers and/or academics (a substantial increase over the last two years). Additionally, in Quebec, 33 projects reported partnerships with government and 11 projects reported partnerships with researchers. Examples of the nature and results of partnerships with researchers include: exploring models of rehabilitation programming for people living with HIV; exploring and documenting innovative models of HIV service delivery; strengthening community-based research skills and knowledge; and greater involvement and access to research expertise. Results of partnerships with the public and voluntary sector include: increased ability to reach populations at risk and provide care, treatment and support to newly diagnosed cases of HIV; increased access to nutritious foods for women and families with HIV; and increased access to medical appointments and to programs and services in general for target populations.

Program Activity: Disease and Injury Prevention and Control
($M)

	Actual Spending 2008-09	Actual Spending 2009-10	Planned Spending 2010-11	Total Authorities 2010-11	Actual Spending 2010-11	Variance(s)
Total Grants	0.4	0.3	6.0	0.2	0.0	0.2
Total Contributions	21.3	21.1	16.7	21.4	19.9	1.5
Total Other types of transfer payments
Total Program Activity	$21.7M	$21.4M	$22.7M	$21.6M	$19.9M	$1.7M

Comment(s) on Variance(s): Funds were transferred from Grants to Contributions. The variance of $1.7M consists of: $0.5M contribution programming deferred under the national funding stream for community-based social marketing because of delays in internal processes; and $1.2M in transfers to other programs for joint action on Federal Initiative outcomes including: 1) $45,000 to Hepatitis C Prevention, Support and Research program for increased knowledge and awareness of Hepatitis C; 2) $0.3M to Canadian HIV Vaccine Initiative for increased capacity, knowledge and awareness on issues of new prevention technologies; and 3)$0.8M to Canadian HIV/AIDS Research Initiative for catalyst research on HIV co-infection, and knowledge dissemination.

Audit completed or planned: The program was part of the September 2009 Audit of Health Promotion Programs.

Evaluation completed or planned: In 2009-10 the Federal Initiative to Address HIV/AIDS in Canada Evaluation Report (2004-07) was approved. An evaluation report summarizing AIDS Community Action Program 2007-09 was finalized in 2010-11. The report will be available online. The next evaluation of the FI to Address HIV/AIDS in Canada is planned for completion by 2013-14.

National Collaborating Centres for Public Health

Strategic Outcome: Canada is able to promote health, reduce health inequalities, and mitigate disease and injury.

Name of Transfer Payment Program: National Collaborating Centres for Public Health (NCCPH)

Start date: 2004-05

End date: Ongoing

Description: Contributions to persons and agencies to support health promotion projects in community health resource development, training/skill development and research. The focus of the NCCPH program is to strengthen public health capacity, translate health knowledge and promote and support the use of knowledge and evidence by public health practitioners in Canada in collaboration with provincial/territorial and local governments, academia, public health practitioners and nongovernmental organizations.

Expected results: Increased opportunities for collaboration and networking between health portfolio partners, NCCs and other external organizations; increased knowledge translation activities-knowledge synthesis, translation and exchange-and the application of scan and research findings by researchers and knowledge users; knowledge gap identification-gaps are identified, acting as catalysts for new research; increased availability of knowledge for evidence-based decision making in public health with consequent increased use of evidence to inform public health programs, policies and practices; and improved public health programs and policies.

Results Achieved: Strategic review of program supported renewal for five years (2010-15). The NCCs are regularly invited to present to the Public Health Network Council and the Council of Chief Medical Officers of Health to inform on the use of evidence in policy and decision making in public health.

Program Activity: Public Health Preparedness and Capacity
($M)

	Actual Spending 2008-09	Actual Spending 2009-10	Planned Spending 2010-11	Total Authorities 2010-11	Actual Spending 2010-11	Variance(s)
Total Grants
Total Contributions	8.8	8.8	8.3	8.6	8.6	(0.3)
Total Other types of transfer payments
Total Program Activity	$8.8M	$8.8M	$8.3M	$8.6M	$8.6M	$(0.3)M

Comment(s) on Variance(s): Additional funding has been provided from other PHAC program areas to support expanded work plan activities.

Audit completed or planned: Recipient audits of NCC centres are planned to occur on a rotating basis.

Evaluation completed or planned: The Formative Evaluation of the National Collaborating Centres for Public Health Program (NCCPH) was completed in 2008-09. An evaluation of Public Health Tools, including the National Collaborating Centres for Public Health, is planned for completion by 2013-14. The evaluation will focus on program relevance and performance in accordance with TBS 2009 Policy on Evaluation.

Healthy Living Fund

Strategic Outcome: Canada is able to promote health, reduce health inequalities, and mitigate disease and injury.

Name of Transfer Payment Program: Healthy Living Fund (HLF)

Start date: June 2005

End date: Ongoing

Description: The HLF supports healthy living activities with community, regional, national and international impacts by funding and engaging the voluntary sector, and by building partnerships between and collaborating with governments, non-governmental organizations and other agencies.

Expected results: Funds will be used to build public health capacity and develop supportive environments for physical activity and healthy eating. Projects will help to strengthen the evidence base, contribute to knowledge development and exchange and help in the formation of health promotion activities.

Results Achieved: Objectives of the HLF are to support effective, sustainable community actions and systems that build community capacity to provide supportive environments for health. Contribution funding targeted Canadian voluntary, not-for-profit organizations to undertake national initiatives that directly support the Agency's mandate, goals and priorities in the area of physical activity and healthy eating and their relationship to healthy weights.

Funding was provided to the Canadian Fitness and Lifestyle Research Institute for data collection and surveillance activities. This work supports the monitoring of physical activity levels of children and youth against targets set by federal and provincial/territorial ministers of Sport, Physical Activity and Recreation. Data will be used to inform stakeholder communities of current physical activity levels and conditions that influence participation.

In partnership with the Canadian Institutes of Health Research, PHAC funded knowledge syntheses to inform future physical activity guideline development with a focus on (a) physical activity among preschool-aged children; and (b) physical activity among people with disabilities.

PHAC also approved funding for a project with Physical and Health Education Canada to undertake the development of an after-school framework to promote physical activity for children and youth. By addressing four key areas-policy development, capacity building, knowledge development and program delivery-the initiative will enable the delivery of quality after-school programs focussed on increased access to physical activity and healthy eating.

Program Activity: Health Promotion
($M)

	Actual Spending 2008-09	Actual Spending 2009-10	Planned Spending 2010-11	Total Authorities 2010-11	Actual Spending 2010-11	Variance(s)
Total Grants
Total Contributions	7.8	7.4	5.2	4.2	4.0	1.2
Total Other types of transfer payments
Total Program Activity	$7.8M	$7.4M	$5.2M	$4.2M	$4.0M	$1.2M

Comment(s) on Variance(s): Actual spending was lower by $1.2M than planned spending due to transfer of $0.3M to CIHR through Supplementary Estimates B to fund projects in Physical Activity; and transfers to other programs with PHAC of $0.9M.

Audit completed or planned: The program was part of the September 2009 Audit of Health Promotion Programs. There were no audits planned for fiscal year 2010-11.

Evaluation completed or planned: The Formative Evaluation of the Integrated Strategy on Healthy Living and Chronic Diseases, of which the Healthy Living Fund is a part, was completed in 2009-10.

Canadian Diabetes Strategy (non-Aboriginal elements)

Strategic Outcome: Canada is able to promote health, reduce health inequalities, and mitigate disease and injury.

Name of Transfer Payment Program: Canadian Diabetes Strategy (non-Aboriginal elements) (CDS)

Start date: 2005-06

End date: Ongoing

Description: The CDS engages provinces, territories and stakeholders at the national and regional levels in order to improve information and services available to Canadians living with or at higher risk of developing diabetes. This is achieved through community-based programming, support for diabetes surveillance systems, and collaboration on knowledge development and exchange related to risk factors and determinants for diabetes and its complications.

Expected results: Improved capacity to apply best practices and clinical practice guidelines to better screen, educate and counsel at-risk Canadians; healthier public policies in organizations across sectors and jurisdictions to address high-risk populations; early detection and management of diabetes; increased organizational capacity for policy, program, services and research development; increased awareness of diabetes risks, complications and prevention strategies for high-risk populations; and, increased knowledge among high-risk populations of skills and behaviours necessary to prevent diabetes and its complications.

Results Achieved: In 2010-11, 40 organizations received funding from the CDS in two streams. National organizations carry out their activities across the country, whereas the regional stream supports local organizations which are able to target the unique needs of their communities. Examples include the following.

The Canadian Pharmaceutical Association developed and disseminated diabetes patient care resources and trained 500 pharmacists across the country through live and online workshops to counsel people with or at risk of developing diabetes that come through their pharmacies. The Canadian Centre for Activity and Aging developed a physical activity program geared for older Canadians with diabetes. Linkages were made with Diabetes Education Centres across the country and diabetes educators and community leaders were trained to deliver the program. The Canadian Association of Wound Care researched best practices to reduce foot complications in people with diabetes (which left unmanaged can lead to limb amputation). Print and Web-based resources were developed, translated into 12 languages, and disseminated to physicians, Diabetes Education Centres and local community organizations in order to raise awareness of the importance of proper foot care for people living with diabetes.

Many of the populations at high risk of developing diabetes face significant challenges in accessing, understanding, and acting upon information that can help them identify their risk and effectively manage their condition. This may be because of language barriers, cultural practices, or living in remote underserved locations. The focus of the regional community-based projects (34 in total) was on the development and implementation of diabetes awareness and self-management initiatives geared to specific populations such as, Nova Scotians of African descent, East Asians living in Alberta, low income populations in Toronto and rural communities in Saskatchewan and British Columbia. As a result, these Canadians were made aware of their risk and provided the support, often from trained peers to whom they could relate, to effectively manage their diabetes or pre-diabetes. In many of these programs emphasis was placed on the prevention of serious cardiovascular complications as well as consideration of the importance of mental health issues, which are prevalent in people living with diabetes.

Program Activity: Disease and Injury Prevention and Mitigation
($M)

	Actual Spending 2008-09	Actual Spending 2009-10	Planned Spending 2010-11	Total Authorities 2010-11	Actual Spending 2010-11	Variance(s)
Total Grants	0.3	0.7	1.2	0.0	0.0	1.2
Total Contributions	2.6	2.3	4.9	4.2	4.1	0.8
Total Other types of transfer payments
Total Program Activity	2.9	3.0	6.1	4.2	4.1	2.0
Program Activity: Surveillance and Population Health Assessment
Total Grants
Total Contributions	0.1	0.1	0.2	0.1	0.1	0.1
Total Other types of transfer payments
Total Program Activity	0.1	0.1	0.2	0.1	0.1	0.1
Total Program Activities	$3.0M	$3.1M	$6.3M	$4.3M	$4.2M	$2.1M

Comment(s) on Variance(s): The grant funding of $1.2M was transferred fully to contributions. However, contribution actual spending was lower than planned spending due to transfer of $0.5M to CIHR through Supplementary Estimates B and other various transfers to different programs within PHAC of $1.6M.

Audit completed or planned: In 2010-11 an audit of the Chronic Disease Prevention and Control Program was completed. The Canadian Diabetes Strategy was part of this audit.

Evaluation completed or planned: An evaluation on the CDS for the period 2004-09 was completed in February 2010 as part of the Promotion of Population Health Grant and Contribution Programs: Summary of Program Evaluations, 2004-09. Evaluations of the grants and contributions components of Chronic Diseases Prevention and Mitigation (including the Integrated Strategy on Healthy Living and Chronic Disease) are planned for 2013-14.

Canadian HIV Vaccine Initiative

Strategic Outcome: Canada is able to promote health, reduce health inequalities, and mitigate disease and injury.

Name of Transfer Payment Program: Canadian HIV Vaccine Initiative (CHVI)

Start date: 2007-08

End date: 2016-17

Description: The CHVI is a collaborative undertaking between the Government of Canada and the Bill & Melinda Gates Foundation to contribute to the global effort to develop a safe, effective, affordable and globally accessible HIV vaccine. This collaboration, formalized by a Memorandum of Understanding signed by both parties in August 2006 and renewed in July 2010, builds on the Government of Canada's commitment to a comprehensive, long-term approach to address HIV/AIDS. Participating federal departments and agencies are the Agency, Health Canada, Industry Canada, the Canadian International Development Agency, and the Canadian Institutes of Health Research.

The CHVI's overall goals are to: advance the basic science of HIV vaccine discovery and social research in Canada and low-and-middle-income countries (LMICs); support the translation of basic science discoveries into clinical research, with a focus on accelerating clinical trials in humans; address the enabling conditions to facilitate regulatory approval and community preparedness; improve the efficacy and effectiveness of HIV Prevention of Mother-to-Child services in LMICs by determining innovative strategies and programmatic solutions related to enhancing the accessibility, quality, and uptake; and ensure horizontal collaboration within the CHVI and with domestic and international stakeholders.

Expected results:

• Increased readiness and capacity in Canada and LMICs
• Increased and improved collaboration and networking
• Strengthened contribution to global efforts to accelerate the development of safe effective, affordable and globally accessible HIV vaccines

Results Achieved:

• Renewal of funding and increase in duration of the partnership between the Government of Canada and the Bill & Melinda Gates Foundation
• Input from stakeholder consultation resulted in the launch of a competitive process to coordinate the CHVI Research and Development Alliance
• CHVI Advisory Board announcement and appointment of co-chairs
• On-going support to domestic and international stakeholders in addressing HIV vaccines policy issues, building capacity and promoting global harmonization of regulatory pathways, and improving preparedness

Program Activity: Disease and Injury Prevention and Mitigation
($M)

Actual Spending 2008-09	Actual Spending 2009-10	Planned Spending 2010-11	Total Authorities 2010-11	Actual Spending 2010-11	Variance(s)
0.0	0.9	9.3	1.1	1.0	8.3
$0.0M	$0.9M	$9.3M	$1.1M	$1.0M	$8.3M

Comment(s) on Variance(s): The Bill & Melinda Gates Foundation and the Government of Canada announced in February 2010 that they would not move forward with the manufacturing facility and in July 2010, announced the renewal of the CHVI, with the establishment of the Research and Development Alliance as its cornerstone.

Audit completed or planned: None.

Evaluation completed or planned: The CHVI Evaluation was completed in 2010-11. The final report will be available on line. A Performance Measurement Strategy is underway and will be implemented in 2011-12.

Hepatitis C Initiative

Strategic Outcome: Canada is able to promote health, reduce health inequalities, and mitigate disease and injury.

Name of Transfer Payment Program: Hepatitis C Initiative (HCI)

Start date: April 2000

End date: March 31, 2020

Description: Payments provided every five years to provinces and territories to improve access to health care and treatment services to persons infected with hepatitis C through the blood system. The final payment will occur in 2014-15.

Expected results: Improved access to current emerging antiviral drug therapies, other relevant drug therapies, immunization and health care services for the treatment of hepatitis C infection and related medical conditions.

Results Achieved: The number of persons infected with hepatitis C in Canada demonstrates the continued need for an initiative of this nature. The Initiative provides $300M in transfer payments over a 20-year period to assist P/Ts in the provision of hepatitis C health care services for persons infected with hepatitis C through the blood system prior to January 1, 1986 and post July 1, 1990. Although the proportion of those infected with hepatitis C through the blood system represents just over one-tenth of estimated cases, the use of the funds to enhance the provision of health services across Canada have made all persons with hepatitis C potential beneficiaries of the HCI. One of the key activities of the Agency is to continue to lead federal programs to address HIV, sexually transmitted and blood borne infections (including viral hepatitis) and tuberculosis; the focus of this work is on effective prevention initiatives, education and awareness activities, diagnosis, care, equitable access to treatments, and support of those persons in Canada infected with, affected by or vulnerable to infectious diseases.

The federal government distributed the required funds according to the agreements. From 2000-01 to 2004-05, $200.6M was transferred to the P/Ts. Another $49.7M payment was made to the provinces in 2009-10 and the final $49.7M payment will be made in 2014-15.

Program Activity: Disease and Injury Prevention and Mitigation
($M)

	Actual Spending 2008-09	Actual Spending 2009-10	Planned Spending 2010-11	Total Authorities 2010-11	Actual Spending Variance(s) 2010-11
Total Grants
Total Contributions
Total Other types of transfer payments		49.7
Total Program Activity	$0.0M	$49.7M	$0.0M	$0.0M	$0.0M $0.0M

Comment(s) on Variance(s): n/a

Audit completed or planned: None.

Evaluation completed or planned: An evaluation of the first five years of the program (2000-05) was completed in 2006. Further evaluation of the program will be incorporated in a larger evaluation of community-associated infections, which is currently scheduled to be completed in 2012-13.

Federal Initiative to Address HIV/AIDS in Canada

Name of Horizontal Initiative: Federal Initiative (FI) to Address HIV/AIDS in Canada

Name of Lead Department(s): Public Health Agency of Canada (PHAC)

Lead Department Program Activities:

• Disease and Injury Prevention and Mitigation
• Surveillance and Population Health Assessment
• Science and Technology for Public Health

Start Date of the Horizontal Initiative: January 13, 2005

End Date of the Horizontal Initiative: Ongoing

Total Federal Funding Allocation (start to end date): Ongoing.

Description of the Horizontal Initiative (Including Funding Agreement): The FI strengthens domestic action on HIV and AIDS, builds a coordinated Government of Canada approach, and supports global health responses to HIV and AIDS. It focuses on prevention and access to diagnosis, care, treatment and support for those populations most affected by HIV and AIDS in Canada-people living with HIV and AIDS, gay men, Aboriginal people, people who use injection drugs, people in prison, youth, women, and people from countries where HIV is endemic. The FI also supports and strengthens multi-sector partnerships to address the determinants of health. It supports collaborative efforts to address factors which can increase the transmission and acquisition of HIV including sexually transmitted infections (STI) and also addresses co-infection issues with other infectious diseases (e.g., Hepatitis C and tuberculosis) from the perspective of disease progression and morbidity in people living with HIV and AIDS. People living with and vulnerable to HIV and AIDS are active partners in FI policies and programs.

Shared Outcome(s):

First level outcomes

• Increased knowledge and awareness of the nature of HIV and AIDS and ways to address the disease;
• Increased individual and organizational capacity;
• Increased Canadian engagement and leadership in the global context; and
• Enhanced engagement and collaboration on approaches to address HIV and AIDS.

Second level outcomes

• Reduced stigma, discrimination, and other barriers;
• Improved access to more effective prevention, care, treatment and support;
• Internationally informed federal response; and
• Increased coherence of the federal response.

Ultimate outcomes

• Prevent the acquisition and transmission of new infections;
• Improved quality of life for those at risk and living with HIV and AIDS;
• Contribute to the global effort to reduce the spread of HIV and AIDS and mitigate its impact; and
• Contribute to the strategic outcomes of partner departments.

*Shared Outcomes have been refined in response to an April 2009 Federal Initiative (FI) to Address HIV/AIDS in Canada Implementation Evaluation Report , which recommended strengthening of the FI's performance measurement framework.

Governance Structure(s): The Responsibility Centre Committee (RCC) is the governance body for the FI. It is comprised of directors from the nine Responsibility Centres which receive funding through the FI. Led by the Agency, the RCC promotes policy and program coherence among the participating departments and agencies, and ensures that evaluation and reporting requirements are met.

The Agency is the federal lead for issues related to HIV and AIDS in Canada responsible for overall coordination, communications, social marketing, reporting, evaluation, national and regional programs, policy development, surveillance and laboratory science.

Health Canada (HC) supports community-based HIV and AIDS education, capacity-building, and prevention for First Nations on-reserve and Inuit communities south of the 60^th degree parallel and provides leadership on international health policy and program issues.

As the Government of Canada's agency for health research, the Canadian Institutes of Health Research (CIHR) sets priorities for and administers the extramural research program.

Correctional Service Canada (CSC), an agency of the Public Safety Portfolio, provides health services (including services related to the prevention, diagnosis, care and treatment of HIV and AIDS) to offenders sentenced to two years or more.

Highlights of performance: Federal partners collaborated to 1) provide guidance and support to key stakeholders on crosscutting priorities, including HIV and AIDS among Aboriginal populations; 2) respond to the outbreak signalled by evidence of increased transmission among a particular subpopulation; and 3) develop a critical Canadian presence at international sectoral events, including AIDS 2010 in Vienna, and Reinvigorating HIV Prevention, an international policy dialogue with Canada and countries with similar resources and prevalence patterns for HIV and AIDS.

In October 2010, the Population Specific HIV/AIDS Status Report: Aboriginal Peoples was published and widely disseminated, twenty-one projects across Canada were approved for funding under the Non-Reserve first Nations, Inuit and Métis Communities HIV/AIDS Project Fund, capacity building activities were hosted for Aboriginal research communities, and federal program activities were coordinated to address the rise of reported HIV infections in Saskatchewan, including work with Saskatchewan to investigate the underlying factors that contributed to the rise, and to develop solutions to help mitigate this trend. Additional project activities at community-based organizations located in the region were also funded.

Federal Partner: The Agency

($M) Federal Partners	Federal Partner Program Activity (PA)	Names of Programs for Federal Partners	Total Allocation (from start to end date)	Planned Spending for 2010-11	Actual Spending for 2010-11	Variance for 2010-11 (from planned to actual expenditure)	Expected Results for 2010-11	Results Achieved in 2010-11
Public Health Agency of Canada	Science and Technology for Public Health	HIV/AIDS Reference Testing	Ongoing	1.7	2.2	(0.5)	ER 1.1	RA 1.1
	Surveillance and Population Health Assessment	Surveillance of Infectious Disease	Ongoing	5.1	5.8	(0.7)	ER 2.1	RA 2.1
	Disease and Injury Prevention and Mitigation	Infectious Disease Prevention and Control & Community Associated Infections	Ongoing	35.6	30.3	5.3	ER 3.1 ER 3.2 ER 3.3	RA 3.1 RA 3.2 RA 3.3
Total				$42.4M	$38.3M	$4.1M

Comments on Variance: The variance of $4.1M consists of: $2.9M of program activities deferred because of delays in internal processes; and $1.2M in transfers to other programs for joint action on Federal Initiative outcomes.

Expected Results (ER)/Results Achieved (RA):

ER 1.1: Public health decisions and interventions by public health officials are supported by timely and reliable and accredited reference service testing.

RA 1.1: The capacity to detect new and emerging subtypes of HIV infection in Canada was increased by evaluating new HIV testing platforms and developing and monitoring the performance of testing algorithms capable of detecting new HIV variant migrating into Canada from other countries.

Provincial HIV testing programs were supported through the provision of ISO accredited testing of specimens which are difficult to correctly diagnose.

Improved quality control standards for diagnosis and patient support were developed to support the standardization of laboratory testing across Canada.

ER 2.1: Establish prevalence of Sexually Transmitted and Bloodborne Infections (STBBI), patterns of risk and health behaviours and monitor trends among men who have sex with men and street youth in Canada through the support of national survey data collection, analysis, interpretation, transfer and exchange for M-Track and E-SYS.

RA 2.1: Specialized laboratory testing on HIV specimens was performed to determine which specimens come from people who are recently infected to better understand the characteristics of the leading edge of the Canadian HIV epidemic.

Laboratory surveillance was conducted for emerging HIV subtypes in order to detect changes in the patterns of the HIV epidemic in Canada. These data also assist in ensuring that commercial diagnostic tests used in the provinces can identify all prevalent strains of HIV and provide the vista of relevant targets to Canadian HIV vaccine researchers.

Key elements for improving HIV prevention strategies targeted to the most vulnerable populations were identified by evaluating the HIV genetic profile of the infections within and between different risk groups and social networks.

On-going HIV/AIDS surveillance and risk assessment activities produced or contributed to several population-based and population-specific reports and publications that monitor trends among men who have sex with men in Canada. They included:

• HIV and AIDS in Canada: Surveillance Report to December 31,2009;
• HIV/AIDS epidemiological Updates (July 2010 edition);
• 2008 HIV estimates and Estimates of the number of prevalent and incident human immunodeficiency virus (HIV) infections in Canada, 2008. (Can J Public Health 2010;101486-90);
• Ethno-racial variable in sexual behaviour and HIV infection among men who have sex with men (MSM): results from the Lambda study;
• An Assessment of the Sexual Health of Asian Gay and Bisexual men in B.C. 2010; and
• HIV/STD testing patterns and associated factors among Asian men who have sex with men in Vancouver, 2010.

Targeted enhanced surveillance studies of street youth (E-SYS) were undertaken in Vancouver, Edmonton, Saskatoon, Winnipeg, Toronto, Ottawa and Halifax which describe the incidence and prevalence of HIV and AIDS and other STBBI in this population. Knowledge transfer activities were undertaken by most sites to disseminate local findings. National E-SYS findings will be published in 2012 along with the implementation of national knowledge transfer activities. Funding supported knowledge transfer activities related to findings from the enhanced surveillance study among gay, bisexual and other men who have sex with men (M-Track).

ER 3.1: Increased knowledge and awareness of the nature of HIV and AIDS and ways to address the disease, as indicated by:

1. the number and type of evidence-based information products, including three population-specific reports, an HIV prevention framework, HIV counselling and testing guidelines, the Canadian Guidelines on Sexually Transmitted Infections, Canadian Sexual Health Education Guidelines information products, interdepartmental pilot projects to address HIV and the determinants of health, augmented HIV case reporting, targeted epidemiological studies, improved knowledge and characterization of HIV strains in Canada, and findings from the study of HIV and AIDS funding programs' structure;
2. ongoing support and guidance provided to partners, including the number and type of knowledge and awareness activities and products, and processes to develop funding proposals aligned with public health priorities;
3. project data on number of presentations and workshops and their reach; and
4. project data on increases in knowledge of HIV transmission and risk factors among target populations.

RA 3.1

1. Knowledge of the factors that contribute to the spread of HIV infection was advanced through augmented HIV and risk behaviour surveillance programs. HIV and AIDS enhanced surveillance programs continue to be established and implemented among at-risk populations, in order to address questions and gaps arising from case-reporting, surveillance, and to provide statistical support for HIV and AIDS modeling efforts to assess the hidden epidemic and produce national HIV estimates.
   
   Enhanced epidemiological studies were developed and/or implemented, including: I-Track (national enhanced surveillance systems that focus on people who inject drugs, e.g., Intravenous Drug Users (IDU)); M-Track (national enhanced surveillance systems that focus on gay, bisexual and other men who have sex with other men); and E-Track (focused on persons who originate from countries where HIV is endemic). Plans were also developed to conduct a pilot study of A-Track (focused on Aboriginal persons) in Regina in collaboration with local public health officials and the Aboriginal community.
   
   The Population Specific HIV/AIDS Status Report: Aboriginal Populations was published, and is being used by governments, researchers and community organizations to guide priorities in policy and program development. It summarizes the current evidence on the state of HIV/AIDS in this population and the factors that affect its vulnerability and resilience to HIV and AIDS. Federal, provincial and national and regional public health partners ensured that over 2100 copies of the report were sent to AIDS service organizations, First Nations, Inuit and Métis communities, and local public health units. The report was presented at knowledge translation and exchange events, nationally, regionally and internationally at AIDS 2010, as well as meetings of key Aboriginal and health research and advisory bodies, including CIHR's HIV/AIDS Research Advisory Committee, and the Canadian Aboriginal AIDS Network.
   
   The Youth Messaging Initiative resulted in three pilot projects using social media to improve knowledge and awareness of healthy sexuality, HIV and other STBBIs among Aboriginal youth. Digital stories were developed for public presentations and have been launched on YouTube. The initiative has been featured as a poster presentation at AIDS 2010 and at the Senate Committee against the Commercial Exploitation of Children and Youth.
   
   Community profiles which provide brief epidemiological and demographic information were completed by regional operations for Ontario communities. An environmental scan documenting the HIV vulnerability of deaf people in Quebec is currently underway. The Ontario region in partnership with the Province of Ontario, Ministry of Health and Quebec is currently underway. The Ontario Region, in partnership with the Province of Ontario, Ministry of Health and Long Term Care (AIDS Bureau), released its annual View from the Front Lines, a summary and analysis report of all data reported by federally and provincially-funded community-based HIV programs through the joint PHAC-AIDS Bureau reporting tool.
   
   Projects funded through the AIDS Community Action Program (ACAP) developed over 680 knowledge products including manuals and training kits geared to populations at risk, as well as train the trainer manuals for professionals and social service providers. Brochures, fact sheets and social media were other forms of products. Six of seven regions reported distributing a toal of over 1 million knowledge products.
   
   Quality practices in provincial / territorial HIV testing programs were promoted and standardized through the implementation of ISO 15189 (Medical Laboratory Requirements) quality management systems and accredited proficiency testing programs.
   
   Standardization and guidelines for HIV testing were promoted and improved as part of an international working group to review and revise interpretative criteria for HIV diagnosis.
   
   
2. Support was provided to Canadian AIDS Treatment Information Exchange (CATIE) to increase dissemination of sexual health and STI resources through CATIE's Ordering Centre, and to promote a broader awareness of co-infection among these infectious diseases. Under the Knowledge Transfer and Exchange Fund, funded activities increased the knowledge of HIV among front-line workers across Canada. A survey of users showed that 92% of respondents indicated that the activities were useful or very useful in providing information, and that they enabled users to respond to the needs of clients and their community. Eighty-six percent of respondents used information provided to change work practices, or establish or adapt programming. As a result, the capacity of community based organizations to develop and deliver programs and services increased. Front line workers reported using funded services frequently-almost 70% used them at least monthly.
   
   Support was provided to two municipal public health efforts to improve public and practitioner awareness about inSPOT, an anonymous on-line partner notification application. The initiative worked to raised awareness about the importance of partner notification for HIV and other STBBIs, and to raise awareness about this new and alternative approach to partner notification.
   
   As part of outbreak support in Saskatchewan, PHAC provided a full-time senior epidemiologist for one year to help Saskatchewan investigate factors associated with recently diagnosed cases of HIV infection to guide prevention and control measures.
   
   PHAC continued to provide epidemiologic and laboratory technical assistance to the Canadian International Development Agency-funded HIV surveillance project in Pakistan. This project, ongoing since 2004, is now recognised as one of the best projects in the world on enhanced HIV surveillance in most-at-risk populations. Under UNAIDS-Health Canada-PHAC Partnership Agreement signed in 2006 and following a request from the Joint United Nations Programme on HIV/AIDS (UNAIDS), PHAC provided technical assistance towards the development and implementation of behavioural and HIV seroprevalence surveys amongst men who have sex with men (MSM) in two Caribbean countries-the Commonwealth of Dominica and in St. Vincent and the Grenadines. These studies were completed in 2010 and are the first successful epidemiologic studies of men who have sex with men in the Eastern Caribbean region.
   
   Modelling and projections activities provided technical support for the estimation of HIV incidence and prevalence in Canada. PHAC began the development of mathematical models to assess the effectiveness of various intervention scenarios.
   
   Mother-to-child pregnancy and breast feeding-related transmission (MTCT) of HIV in resource-limited regions was reduced through the use of HAART (highly active antiretroviral therapy). In collaboration with academic researchers (University of Toronto) and stakeholders in Zambia and Zimbabwe, the use of treatment in late-stage pregnancy and throughout breast feeding was evaluated as a method of improving maternal virological control and reducing MTCT.
   
   Through participation in the WHO HIV Drug Resistance Network Improve, care delivery to persons infected with HIV/AIDS globally was improved. Participation included training of scientist and contributing to international steering committees to improve global HIV drug resistance laboratory testing.
   
   
3. Data from six of the seven regions, representing approximately 90% of ACAP funding, reported that regional projects provided close to 3300 workshops and presentations reaching over 100,000 participants including members of the target populations and professionals and service providers.
4. In one case, reports indicate that the rate of knowledge of Aboriginal women who are aware of their HIV status increased from 45% to 69% over the course of four years.
   
   Data from five of the seven regions, representing approximately 85% of ACAP funding, reported that 43,264 members of the target populations were reached through a variety of interventions intended to increase knowledge about HIV transmission and risk. Of those reached, 19,400 ( 45%) reported that their knowledge about transmission and risk had increased as a result of the intervention and approximately 20% of the target population identified their intentions to change behaviours to reduce risk. Currently ACAP projects are involved in an outcome assessment evaluation with the purpose of collecting participant level data to examine increased practice of health behaviours, increased knowledge and awareness of HIV/Acquired immune deficiency syndromeand increased access to programs and services.
   
   

ER 3.2: Enhanced engagement and collaboration on approaches to address HIV and AIDS, as indicated by:

1. coordinated approaches to data collection and dissemination, enhanced collaboration with key stakeholders in the response to HIV and AIDS, and STI's, including committees, partnerships and collaborative documents;
2. focussed advisory and coordination agendas that link to FI expected results;
3. enhanced engagement of community organisations in the response to HIV and AIDS and the factors that impact those affected and at risk for infection, the number of invitations to submit applications for specific types of activities and the number of funded project proposals;
4. data on number and type of partnerships and their results;
5. project data on improved access to health and social services; and
6. ongoing guidance provided to partners.

RA 3.2

1. Broader representation from organizations, individuals, and communities on the National Aboriginal Council on HIV and AIDS, a key advisory body for federal partners engaged in addressing HIV and AIDS among Aboriginal populations.
   
   A strong international presence for Canada was established at the International AIDS Conference, Vienna, Austria, with the Minister of Health and Chief Public Health Officer and other senior officials leading the 2010 Canadian delegation. PHAC led and/or participated in eleven satellite sessions and four oral and seven poster presentations. PHAC also participated in ten bilateral meetings to strengthen global partnerships. Commitments were made regarding the future sharing of PHAC technical expertise in the areas of surveillance, monitoring, evaluation, capacity building, policy and program approaches. The Canada Booth Exhibition showcased federal, provincial, territorial governmental and non-governmental public health contributions and fostered inter-sectoral engagement and knowledge exchange.
   
   The International Policy Dialogue on Reinvigorating HIV Prevention in March 2011, a partnership between PHAC, Health Canada and UNAIDS, engaged 65 representatives from Canadian and international civil society, government, and research organizations in an international policy dialogue. The aim was to identify and set strategic directions for promising practices and new directions for HIV prevention among countries with similar resource levels and epidemiological trends for HIV.
   
   Federal/Provincial partnership for outbreak response: Collaboration between PHAC and the Saskatchewan Ministry of Health to address the rise of reported HIV infections in that province. PHAC provided enhanced epidemiology and surveillance support through the Agency's Field Surveillance Officer program and additional epidemiologic technical support to investigate the underlying factors contributing to the rise; enhanced funding support to community-based responses to develop specific solutions to help mitigate this trend; and provided funding to support to develop an evaluation framework for Saskatchewan's new HIV/AIDS Strategy. Concurrent enhanced HIV surveillance studies are being conducted to provide further information to guide the response to HIV in Saskatchewan.
   
   The North American Housing and HIV/AIDS Research Summit 2010: PHAC demonstrated public health leadership by co-sponsoring this event to promote the exchange of knowledge to improve service delivery, health outcomes and reduce health inequalities of people living with, or at risk for, HIV/AIDS. Support was provided to the Canadian Treatment Action Council in partnership with other stakeholders, to host the First Canadian HIV/HBV/HCV Co-Infection Research Summit held October 2010 in Toronto. The Summit brought together 100 people from across Canada including researchers, epidemiologists, front-line and community-based workers, and health practitioners to hear about the most current available research on hepatitis and HIV co-infection.
   
   Memoranda of agreement were renewed to continue the province-based work of Field Surveillance Officers and the tracking of HIV strain and drug resistance in Canada.
   
   PHAC works with all 13 provincial/territorial jurisdictions on national HIV/AIDS case-based surveillance. PHAC collaborated with public health officials in Australia and New Zealand on a study comparing rates of new HIV diagnoses between Aboriginal and non-Aboriginal persons.
   
   PHAC regional operations engaged in over25 collaborative partnerships. PHAC contributed to committees and/or networks ranging from small local initiatives to those that are provincial in scope. Results included exchanging and building knowledge and efforts to work with regional and provincial governments to ensure effective use of funds and reduce duplication of efforts. Joint funding arrangements have facilitated support for the OCHART database in Ontario which collects and reports on data from both HIV initiatives funded by the province and PHAC, and had provided for the printing of community resources in Manitoba. PHAC contributed to the Government of Alberta STI and BBP Strategy and Action Report as well as the Alberta HIV Community HIV Policy Funding Consortium. The accessibility, quality and reliability of HIV point of care diagnosis and patient monitoring in remote location was improved by optimizing and evaluating in-house and commercial tests.
   
   Access to care by evaluating novel blood collection and storage techniques that allow easy specimen collection and storage in remote locations was improved. These new collection devices will permit blood-borne pathogen testing and molecular epidemiology analysis in remote regions of Canada.
   
   The quality of HIV testing in resource limited and remote settings by assessing alternative and affordable platforms for CD4 T-cell testing (a measure of immunodeficiency) to assist clinical laboratories with the selection and implementation of appropriate and affordable patient care was improved.
   
   
2. PHAC provides leadership and direction for the national enhanced HIV surveillance studies among most-at-risk populations. The data from these studies is already being used to guide HIV prevention and control programs. PHAC held a national HIV and AIDS surveillance meeting in December 2010 to improve data standardization across jurisdictions and discuss ways to address gaps in the surveillance system.
3. Non-Reserve First Nations, Inuit and Métis Communities HIV/AIDS Project Fund: 21 projects across Canada were approved to start in 2011-12. These projects aim to promote the prevention of HIV infection; facilitate access to diagnosis; treatment and social supports for Aboriginal people living with HIV/AIDS and those at risk; and enhance the capacity of service providers to deliver culturally relevant, community-based interventions among Canada's off-reserve First Nations, Inuit and Métis populations.
4. Community-based organizations developed new partnerships with communities and provinces and territories to improve access to prevention and control programs and treatment. Partnerships increased at least 10% per year over the last two years.
   
   Regional projects in six of the seven regions reported over 650 partnerships. Projects in five regions reported a total of 63 partnerships with local and provincial governments across a number of key sectors. There were 48 collaborative partnerships with researchers and/or academics which is an increase over the last two years. Additionnally in Quebec, 33 projects reported partnerships with government and 11 projects reported partnerships with researchers. Examples of the nature and results of partnerships with researchers include: exploring models of rehabilitation programming for people living with HIV; exploring and documenting innovative models of HIV service delivery; strengthening community-based research skills and knowledge; and greater involvement and access to research expertise. Results of partnerships with the public and voluntary sector include: increased ability to reach populations at risk and provide care, treatment and support to newly diagnosed cases of HIV; increased access to nutritious foods for women and families with HIV; and increased access to medical appointments and to programs and services in general for target populations.
   
   
5. Based on reporting from four of seven regions, there were 31 community projects that reported on improvements to health and social services for target populations.
6. Ongoing guidance provided to partners.

In collaboration with provincial partners, the prevalence of transmitted drug resistance by testing HIV diagnostic specimens from all first-time diagnosed, treatment-naive patients in Canada was determined.

Laboratory testing and analysis for the emergence of drug resistance to newly developed HIV drugs, such as I inhibitors, was conducted in order to inform both clinicians and policy makers in the provinces.

ER 3.3: Increased individual and organizational capacity to address HIV and AIDS, as indicated by:

1. sustained support to community-based organizations, including the number of projects funded and funds provided to community-based funding;
2. number of projects in which target populations contribute to management and delivery of projects;
3. number and type of capacity building activities for non-governmental and community-based organizations;
4. project data on actions to improve access to health and social services; and
5. project data on number of volunteers and volunteer hours.

RA 3.3:

1. In 2010-11, national funding streams supported six projects under the Specific Populations Fund, seven projects under the National Voluntary Sector Response Fund, one under the Knowledge Exchange Fund, and six under the Non-Reserve First Nations, Inuit and Métis Communities HIV/AIDS Project Fund. Under the AIDS Community Action Program, 127 projects were funded for $12.4M. Eighty-four projects were operational, and 43 were time-limited. The majority of projects are delivered in urban and/or urban-rural settings.
2. Based on data from six of the seven regions, 93 ACAP projects (98%) identified that target populations contribute to the delivery and management of projects.
3. PHAC regional operations supported 16 capacity building activities reaching 550 community participants. Capacity building activities included conference presentation on ACAP and Hepatitis C funding to the Northern-Intertribal Health Association (NITHA) annual meeting in Prince Albert, Saskatchewan and training such as evaluation support and peer leadership training development for young gay men. PHAC worked in a consultative way with various stakeholders such as provincial government partners, federal government departments and community-based organizations. PHAC shared resources with internal and external stakeholders to keep them informed about pressing and emerging developments.
4. Based on reporting from four regions there were 31 community projects that reported on improvements to health and social services for target populations.
5. Regional project data from all seven regions reported over 5000 volunteers who donated 159,312 hours (an average of 31 hours per volunteer). There were over 2400 new volunteers. Significant training of over 900 sessions was reported by six of seven regions for both staff and volunteers.

Comment(s) on variance(s): The variance of $ 4.1M consists of: $3.0M of program activities deferred because of delays in internal processes; and $1.1M in transfers to other programs for joint action on Federal Initiative outcomes.

Federal Partner: Health Canada ($M)

Federal Partners	Federal Partner Program Activity (PA)	Names of Programs for Federal Partners	Total Allocation (from start to end date)	Planned Spending for 2010-11	Actual Spending for 2010-11	Variance for 2010-11 (from planned to actual expenditure)	Expected Results for 2010-11	Results Achieved in 2010-11
Health Canada	International Health Affairs	Global Engagement	Ongoing	1.4	1.0	0.4	ER 4.1 ER 4.2	RA 4.1 RA 4.2
	First Nations and Inuit Health Programming and Services	Bloodborne Diseases and Sexually Transmitted Infections-HIV/AIDS	Ongoing	4.0	4.5	(0.5)	ER 4.3 ER 4.4	RA 4.3 RA 4.4
Total HC				$5.4M	$5.5M	$(0.1)M

Expected Results (ER)/Results Achieved (RA):

ER 4.1: Increased Canadian engagement and leadership in the global context through exchanging best practices with global partners to inform global and domestic policies on HIV and AIDS. This will be achieved by supporting the development and dissemination of two documents, and through increased dialogue and engagement with stakeholders and other Government of Canada departments by engaging in three global forums to share expertise and influence policies.

RA 4.1: Outcomes were shared from the October 2009 International Policy Dialogue on HIV/AIDS and Indigenous People and the March 2009 International Policy Dialogue on HIV/AIDS and Disability, at side events of the XVIII International AIDS Conference in Vienna in July 2010. Health Canada also engaged in a number of global fora in order to advance Government of Canada priorities and interests, including the December 2010 UNAIDS Programming Coordinating Board Meeting, the February 2010 International Policy Dialogue on Reinvigorating HIV Prevention, and the XVIII International AIDS Conference in Vienna in July 2010.

ER 4.2: Enhanced engagement and collaboration on approaches to address HIV and AIDS through provision of support to five formal advice documents to inform global collaboration on HIV and AIDS and policy coherence across federal government's global activities on HIV and AIDS.

RA 4.2: Policy advice and support was provided on the negotiation of a number of formal documents that information efforts to address global HIV and AIDS issues, including: 1) The protection of human rights in the context of human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) (HRC16); 2) The Organization of the 2011 comprehensive review of the progress achieved in realizing the Declaration of Commitment on HIV/AIDS and the Political Declaration on HIV/AIDS; 3) Supporting efforts to end obstetric fistula (UNGA65); 4) Women, the girl child and HIV and AIDS (CSW55); and 5) The Outcome Document - High-Level meeting on HIV (UNGASS).

ER 4.3: Increased knowledge and awareness of the nature of HIV and AIDS and ways to address the disease through the production of:

1. A companion reference manual for nursing practice specific to Aboriginal communities on-reserve and Inuit populations to complement the Canadian Guidelines on Sexually Transmitted Infections; and
2. A training tool to upgrade nursing skills on HIV, AIDS and STBBI.

RA 4.3:

1. First Nations and Inuit Health Branch (FNIHB) led the development of an Aboriginal-specific component to accompany the Canadian Guidelines on Sexually Transmitted Infections to enhance the relevance of these guidelines for nurses, physicians, health care providers, outreach workers and community educators working at health facilities on-reserve. This document provides an integrated approach to addressing the management of the Hepatitis C virus, other blood borne pathogens and sexually transmitted infections.
2. FNIHB conducted a mini-survey with input from FNIH Regional BBSTI-HIV Coordinators and the Office of Nursing Services to ascertain what culturally sensitive information is required to complement existing professional resources. Requirements identified through this assessment will be addressed to further meet the practice needs of nurses serving First Nations on-reserve and Inuit populations south of the 60^th degree parallel. The FNIH Saskatchewan Region developed a Sexual Health Teaching Resource Toolkit for parents, teachers, nurses, and other health care providers. The manual includes: age appropriate teaching lessons, manuals and aids; interactive educational games and activities; and CDs and videos. Communication and dissemination of these resources to transferred and non transferred Nurse Managers was completed in June 2010. The aim is to empower Aboriginal youth to make informed sexual health choices and reduce the risk of unplanned pregnancy and sexually transmitted infections (STIs) including HIV/AIDS.

ER 4.4: Increased individual and organizational capacity to address HIV and AIDS, as indicated by:

1. A gap analysis report on HIV and AIDS-STBBI - related services delivered by community nurses at health facilities on reserve;
2. The number of community researchers attending a research proposal writing workshop;
3. The number of First Nations and Inuit health nurses receiving training on HIV and AIDS and related health issues; and;
4. The number of educational workshops for First Nations and Inuit health nurses.

RA 4.4:

1. FNIHB conducted a gap analysis of current HIV/AIDS-BBSTI service delivery in on-reserve First Nations communities to better address service delivery gaps. Information from the gap analysis report was used to develop a Business Case with an increased focus on addressing capacity needs for HIV/AIDS-BBSTI testing, counselling and treatment.
2. Over 30 community-based researchers from across Canada took part in a 2 ½-day skills building event organized by FNIHB, in partnership with CIHR. The goal of the workshop was to enhance the capacity of Aboriginal community-based representatives/researchers to prepare successful research grant proposals specifically applicable to HIV/AIDS-related concerns of on-reserve First Nations communities and Inuit communities south of the 60th degree parallel. The workshop offered an opportunity for participants to engage in open and candid dialogue around the challenges that Aboriginal communities often encounter when seeking research grants. This workshop was timely in equipping participants with the much needed resources to increase their likelihood of success in future grant competitions, and to enhance research capacity in the area of HIV/AIDS to help on-reserve First Nations community and Inuit communities increase their knowledge on how to address the HIV epidemic effectively.
3. More than 635 First Nation and Inuit Health nurses and other health workers received training on HIV and AIDS and related health issues in fiscal year 2010-2011. The training sessions included such topics as: (1) public health challenges in the management of STIs; (2) Nursing Orientation and Skill building sessions, which include epidemiology and basic facts of diseases, teaching resources, and funding processes; and (3) training on pre and post testing counselling. These training sessions contributed to improved knowledge and capacity of health professionals and increased their competency in HIV testing, treatment, contact tracing, and case management identified in their learning objectives from previous educational events.
4. FNIHB and FNIH Regions hosted/supported more than 50 educational workshops on HIV and AIDS and related health issues to nurses working with on-reserve First Nation communities. For example, FNIH Manitoba organized an educational workshop for Public Health Nurses working in First Nations Communities across Manitoba on HIV/AIDS and other related infections. The Saskatchewan Region, in partnership with the Office of Nursing Services, hosted 8 HIV Continuum of Care Workshops. The Ontario region held a Communicable Disease Workshop in May 2010. The Quebec Region supported the First Nations of Quebec and Labrador Health and Social Services Commission (FNQLHSSC) to conduct a two-day training session on pre and post-test counselling on HIV/AIDS. In addition, the Region supported the Quebec Native Women (QNW)/Femmes Autochtones du Quebec (FAQ) to offer several educational workshops on various subjects related to HIV/AIDS. The workshops offered to nurses knowledge and information regarding the demographics of HIV, HIV 101, the importance of HIV testing and early diagnosis, public health challenges in the management of Sexually Transmitted Infections, a First Nations perspective on sexuality, and social networking and contact tracing.

Federal Partner: Canadian Institutes of Health Research
($M)

Federal Partners	Federal Partner Program Activity (PA)	Names of Programs for Federal Partners	Total Allocation (from start to end date)	Planned Spending for 2010-11	Actual Spending for 2010-11	Variance for 2010-11 (from planned to actual expenditure)	Expected Results for 2010-11	Results Achieved in 2010-11
Comments on Variance: $0.8M was transferred to the Canadian HIV/AIDS Research Initiative by partner Agency PHAC in support of applications for catalyst research on HIV/AIDS and comorbidities (CIHR HIV Comorbidity Research Agenda), and knowledge dissemination.
CIHR	HIV and AIDS Research Projects and Personnel Support	HIV and AIDS Research Initiative	Ongoing	21.3	22.1	(0.8)	ER 4.5 ER 4.6	RA 4.5 RA 4.6
Total CIHR				$21.3M	$22.1M	$(0.8)M

Expected Results (ER)/Results Achieved (RA):

ER 4.5: Increased knowledge and awareness of the nature of HIV and AIDS and ways to address the disease through the funding of high quality research and knowledge translation grants in HIV and AIDS. This will be achieved through the ongoing development and administration of strategic research funding programs.

RA 4.5: On behalf of the FI, the Canadian Institutes of Health Research invested a total of $22.1M in HIV/AIDS research and research capacity building in 2010-11. This amount includes $800,000 transferred from PHAC to CIHR in support of HIV comorbidity catalyst grants and overall supports biomedical and clinical research, research on health systems and services and social cultural and environmental determinants of health as well as the CIHR Canadian HIV Trials Network (CTN) and the CIHR HIV/AIDS Community-Based Research (CBR) Program.

In total, including both the Federal Initiative funding and additional CIHR funding, CIHR supported approximately 324 grants, 210 awards and 17 Canada Research Chairs for a total investment of $45.7 M in HIV/AIDS research in 2010-11. This funding level represents CIHR's largest annual investment in HIV/AIDS research to date.

In order to continue to support high quality HIV research and knowledge translation activities, the CIHR HIV/AIDS Research Initiative developed and launched the following research grant funding opportunities: Operating Grants: Priority Announcements (2), Catalyst Grants, Meetings, Planning and Dissemination Grants (5), and partnered on the following: Team Grants - Violence, Gender and Health. In the area of Community-Based Research, (2) Operating and Catalyst Grant funding opportunities were launched in 2010-11. The grants funded through these opportunities will ensure Canadian researchers and their partners are able to advance knowledge about HIV and effective ways to address the disease in the years to come.

CIHR-supported researchers continue to make significant contributions to addressing the HIV/AIDS epidemic both in Canada and globally. In November 2010, Dr. Julio Montaner, B.C. Centre of Excellence in HIV/AIDS, received a prestigious Prix Galien in recognition of his outstanding contribution to the management of people who are HIV-positive and, more recently, to understanding the role of treatment as a tool to reduce the spread of HIV through the population. The award recognizes his ability to bring the results of important research to the political and community environment and encourage the implementation of the findings, both locally and internationally.

Another example of contributions of CIHR funded researchers is the work of Dr. Mona Loutfy and her team at the Women and HIV Research Program of Women's College Research Institute. This team is working on dozens of projects aimed to reduce the stigma and discrimination associated with HIV-positive pregnancies and increase access to pre-conception prevention and fertility services. Dr. Loutfy's program is developing and launching programmatic interventions including the:

• development of National HIV Pregnancy Planning Guidelines;
• creation of four new pamphlets in partnership with CATIE;
• piloting of workshops;
• development of a website; and the
• creation of a multidisciplinary community-based network of informed, supportive experts to assist HIV-positive people with their reproductive issues.

In terms of developing future strategic research programs, the CIHR HIV/AIDS Research Initiative conducted a series of consultations focused on the development of a research agenda to address issues of comorbidities for people living with HIV/AIDS in Canada-a major research priority for both the research community as well as those infected. The HIV Initiative sponsored an independent national consultation to determine what stakeholders viewed as the key issues and priorities for research in HIV/AIDS comorbidities and what research funding programs would be of greatest benefit. The consultation included two components, an electronic survey and targeted key informant interviews. It involved over 400 respondents from a wide range of stakeholder groups including researchers, people living with HIV/AIDS, health service providers, policy makers and others. The Initiative jointly sponsored an overview of systematic reviews of topics related to comorbidity in HIV/AIDS with the Ontario HIV Treatment Network (OHTN). The consultation activities culminated at an invitational Roundtable meeting involving over 30 experts from across Canada and internationally, during which focused discussions were held on the development of the research agenda. During the consultation process, the HIV Initiative launched two developmental funding opportunities related to this agenda in order to help the research community prepare for larger, longer-term opportunities to be launched in 2011-12. Through the consultation process it also built the foundation for strong and diverse partners for the CIHR Comorbidity Research Agenda which will be involved in future funding opportunities under the Agenda.

ER 4.6: Increased individual and organizational capacity for HIV and AIDS research through the funding of high-quality capacity-building grants and awards in HIV and AIDS. This outcome is achieved through the ongoing development and administration of strategic research capacity-building funding programs.

RA 4.6: The CIHR HIV/AIDS Research Initiative continues to build research capacity and foster the next generation of HIV/AIDS researchers by providing a range of capacity-building funding opportunities. The following opportunities were launched in 2010-11: Priority Announcements for New Investigator, Fellowship (2) and Doctoral Research Awards. These awards support trainees and new researchers across all priority areas of HIV/AIDS research. Under the CIHR HIV/AIDS Community-Based Research (CBR) program, Master's and Doctoral Research Awards specifically build new CBR capacity in both the general and Aboriginal streams of the program.

A number of other specific activities were conducted by the HIV Initiative in 2010-11 to build capacity for HIV/AIDS CBR such as a series of CBR grantscrafting presentations at conferences and meetings, several virtual presentations given across Canada, and a partnership developed with the CIHR Centre for REACH in HIV/AIDS (Research Evidence in Action for Community Heath) to provide travel grants for out of province participants to attend an Ontario-led CBR grantscrafting session. In addition, CIHR, in partnership with FNIHB and other organizations, hosted a 2-½-day workshop targeted to Aboriginal community researchers interested in conducting community-based Aboriginal research in the area of HIV/AIDS. This workshop involved over 30 on-reserve community representatives and also included key partner contributions from the Pauktuutit Inuit Women of Canada, the Assembly of First Nations, the Canadian Aboriginal AIDS Network and the Ontario HIV Treatment Network. The cumulative effect of the CBR capacity building activities of CIHR and CIHR funded research teams (i.e., Universities Without Walls and CIHR Centre for REACH in HIV) is a dramatic increase in both the number and quality of CBR applications received by CIHR. Specifically, compared to 2008-09, in 2010-11 there was a 500-% increase in application pressure in the General funding stream and a 900% increase in the Aboriginal funding stream; the number of fundable applications increased by 350% in the General funding stream and by 600% in the Aboriginal funding stream.

Further work was also done in 2010-11 to follow-up on the final component of the CBR program evaluation conducted in 2009. A two part consultation (web-based survey and key informant interviews) was undertaken in summer 2010 to review the current suite of funding mechanisms available in the Program with a specific emphasis on capacity building. Approximately 50 people responded to an online survey and 26 key informants were interviewed, with an excellent cross-section of community, academic, Aboriginal and General stream members participating. A report drafted in December 2010 will be reviewed by CIHR steering and advisory committees and used to guide the implementation of future enhancements of the CBR capacity-building tools.

Federal Partner: Correctional Services Canada
($M)

Federal Partners	Federal Partner Program Activity (PA)	Names of Programs for Federal Partners	Total Allocation (from start to end date)	Planned Spending for 2010-11	Actual Spending for 2010-11	Variance for 2010-11 (from planned to actual expenditure)	Expected Results for 2010-11	Results Achieved in 2010-11
Correction Service Canada	Custody	Institutional Health Services Public Health Services	Ongoing	4.2	4.4	(0.2)	ER 4.7 ER 4.8	RA 4.7 RA 4.8
Total CSC				$4.2M	$4.4M	$(0.2)M

Expected Results (ER)/Results Achieved (RA):

ER 4.7: Increased knowledge and awareness of the nature of HIV and AIDS and ways to address the disease, as indicated by the percentage of federal offenders who indicate improved general knowledge of HIV and AIDS after attending CSC's Peer Education Course.

RA 4.7: Improvement in knowledge of HIV and AIDS after attending CSC's Peer Education Course is assessed by comparison of scores on knowledge tests administered before and after program attendance. To date, analysis has been done on change in scores of participants in the Aboriginal Peer Education Course (APEC) which is offered to Aboriginal offenders. During 2010-11, 87% of APEC participants obtained higher scores following completion of the program, thereby demonstrating improved knowledge. Average score improved from 77.5% (pre-test) to 83% (post-test).

ER 4.8: Enhanced engagement and collaboration on approaches to address HIV and AIDS, as indicated by collaborative partnerships with the Federal/Provincial/Territorial Heads of Corrections Working Group on Health and CSC's Community Consultation on Public Health.

RA 4.8: During 2010-11, CSC continued its engagement and collaboration on approaches to address HIV and AIDS. In-person meetings of the Federal/Provincial/Territorial Heads of Corrections Working Group on Health were held in April and October 2010, as well as a teleconference held in May 2010. A work plan was developed for FY 2010-11 which outlined the priorities of the working group. The Community Consultation Committee met via teleconference in June 2010. In addition, a meeting with representatives of the committee and other CSC Sectors was held in February to explore emergent issues.

Results to be achieved by non-federal partners (if applicable):

Contact information:

Stephanie Mehta
100 Eglantine Drive
Ottawa, ON K1A 0K9
613-954-4502

stephanie.mehta@phac-aspc.gc.ca

Preparedness for Avian and Pandemic Influenza

Name of Horizontal Initiative: Preparedness for Avian and Pandemic Influenza

Name of Lead Department(s): Public Health Agency of Canada (PHAC)

Lead Department Program Activities:

• Public Health Preparedness and Capacity
• Disease and Injury Prevention and Mitigation
• Surveillance and Population Health Assessment
• Science and Technology for Public Health
• Regulatory Enforcement and Emergency Response

Start Date of the Horizontal Initiative: June 21, 2006

End Date of the Horizontal Initiative: Ongoing

Total Federal Funding Allocation (Start to End Date): Ongoing

Description of the Horizontal Initiative (including funding agreement): This initiative is directed at mitigating Canada's risk from two major, inter-related animal and public health threats: the potential spread of avian influenza (AI) virus (i.e., H5N1) to wild birds and domestic fowl in Canada; and, the potential for a human-adapted strain to arise resulting in human-to-human transmission potentially triggering a human influenza pandemic. A coordinated and comprehensive plan to address both avian and pandemic influenza is maintained.

The bulk of the initiative is ongoing. Activities have been launched in the areas of vaccines and antivirals, surge capacity, prevention and early warning, emergency preparedness, critical science and regulation, risk communication, and inter-jurisdictional collaboration. To enhance the federal capacity to address an on-reserve pandemic, efforts have been made to increase surveillance and risk assessment capacity to fill gaps in planning and preparedness.

Shared Outcome(s):

Immediate Outcomes

• Strengthened Canadian capacity to prevent and respond to pandemics; and
• Increased internal and external awareness, knowledge and engagement with stakeholders.

Intermediate Outcomes

• Increased prevention, preparedness and control of challenges and emergencies related to AI/PI; and
• Strengthened public health capacity.

Long-Term and Strategic Outcomes

• Increased/reinforced public confidence in Canada's public health system; and
• Minimization of serious illness, overall deaths, and societal disruption as a result of an influenza pandemic.

Governance Structure(s): In January 2008, the Agency, the Canadian Institutes of Health Research, the Canadian Food Inspection Agency and Health Canada finalized the Avian and Pandemic Influenza Preparedness Interdepartmental/Agency Governance Agreement. The primary scope of the Agreement is the management of specific horizontal issues and/or initiatives relating to avian and pandemic influenza preparedness.

The Agreement is supported by a structure that falls within the auspices of the Deputy Minister's Committee on Avian and Pandemic Influenza Planning. Implementation of the Agreement is led by the Avian and Pandemic Influenza Assistant Deputy Ministers (API ADM) Governance Committee focusing on implementation of the initiatives. The API ADM Governance Committee provides strategic direction and oversight monitoring.

An Avian and Pandemic Influenza Operations Directors General Committee supports the API ADM Governance Committee, makes recommendations to it and oversees the coordination of deliverables.

Federal Partner: The Agency
($M)

Federal Partners	Federal Partner Program Activity (PA)	Names of Programs for Federal Partners	Total Allocation (from Start to End Date)	Planned Spending for 2010-11	Actual Spending for 2010-11	Variance for 2010-11 (from planned to actual expenditure)	Expected Results for 2010-11	Results Achieved in 2010-11
Public Health Agency of Canada	Science and Technology for Public Health	a. Rapid vaccine development and testing	Ongoing	1.6	1.3	0.3	ER 1.1	RA 1.1
		b. Winnipeg lab and space optimization	Ongoing	20.2	6.1	14.1	ER 2.1	RA 2.1
	Surveillance and Population Health Assessment	a. Surveillance	Ongoing	8.3	6.8	1.5	ER 3.1	RA 3.1
	Public Health Preparedness and Capacity	a. Vaccine readiness and clinical trials	Ongoing	14.6	3.3	11.3	ER 4.1 ER 4.2	RA 4.1 RA 4.2
		b. Capacity for pandemic preparedne ss	Ongoing	5.8	7.1	(1.3)	ER 5.1	RA 5.1
		c. Emergency preparedness	Ongoing	5.9	6.0	(0.1)	ER 6.1 ER 6.2 ER 6.3 ER 6.4 ER 6.5 ER 6.6	RA 6.1 RA 6.2 RA 6.3 RA 6.4 RA 6.5 RA 6.6
		d. Emergency human resources	Ongoing	0.4	0.4	0.0	ER .7.1	RA 7.1
		e. Strengtheni ng the public health laboratory network	Ongoing	1.2	1.0	0.2	ER 8.1 ER 8.2 ER 8.3	RA 8.1 RA 8.2 RA 8.3
		f. Influenza research network	Ongoing	1.1	1.9	(0.8)	ER 9.1	RA 9.1
		g. Pandemic influenza risk assessment and modelling	Ongoing	0.8	0.7	0.1	ER 10.1 ER 10.2	RA 10.1 RA 10.2
		h. Performance and evaluation	Ongoing	0.6	0.6	0.0	ER 11.1 ER 11.2 ER 11.3	RA 11.1 RA 11.2 RA 11.3
		i. Pandemic influenza risk communications strategy	Ongoing	1.8	1.1	0.7	ER 12.1 ER 12.2	RA 12.1 RA 12.2
		j. Skilled national public health workforce	Ongoing	5.8	5.8	0.0	ER 13.1 ER 13.2 ER 13.3 ER 13.4	RA 13.1 RA 13.2 RA 13.3 RA 13.4
	Regulatory Enforcement and Emergency Response	a. Contribution to National Antiviral Stockpile	Ongoing	0.1	0.0	0.1	ER 14.1 ER 14.2	RA 14.1 RA 14.2
Total Agency				$68.2M	$42.1M	$26.1M

Comments on Variances:

The Agency's actual spending is $26.1M less than planned. Costs for the construction of the JC Wilt Laboratory for Winnipeg Lab Space Optimization resulted in the reprofiling of $7.0M to future years and an additional $5.2M was internally reallocated within the Agency to offset costs for other program priorities. Lower than anticipated Vaccines Readiness costs gave way to an additional $11.3M of internal reallocations and delays in staffing actions and other minor contract delays created a surplus of $2.4M.

Expected Results (ER)/Results Achieved (RA):

ER 1.1: Progress made on the development of different clinical-grade commercial H5N1 influenza vaccines.

RA 1.1: Pre-pandemic mock vaccine clinical trial is completed and the process to have it licensed in Canada is underway. Pandemic vaccine H1N1 was not funded under this item, but also contributed significantly to the body of knowledge regarding adjuvanted vaccines.

ER 2.1: Renovation of the new lab is completed, thus increasing Canada's research and response capacity.

RA 2.1: The recapitalization of the JC Wilt Infectious Diseases Research Centre is underway. During 2010-11, detailed laboratory design specifications were used to develop construction tender documents. The construction tender process resulted in a contract being awarded in January 2011 on budget, followed by the commencement of the construction in February 2011. The laboratory is expected to be ready for occupancy in spring 2013.

ER 3.1: Capacity to rapidly identify and report human cases of avian flu and health care incidents of potential significance is improved.

RA 3.1: Capacity to rapidly identify and report human cases of avian flu and health care incidents was improved by increasing the number of hospitals reporting under the Canadian Nosocomial Infection Surveillance Program (CNISP), moving from passive to active surveillance and instituting case investigations as part of routine business. In addition, protocols were developed to monitor severe respiratory infections (including avian influenza) through the Critical Care Research Network.

ER 4.1: Clinical trials of a pre-pandemic vaccine are underway, and the relevance of individual trials to Canada's needs is assessed.

RA 4.1: Activity complete. No further activities undertaken or planned.

ER 4.2: Capacity for vaccine-adverse event surveillance and effectiveness monitoring during a pandemic is improved.

RA 4.2: Capacity for vaccine-adverse surveillance was improved through permanent representation of all provinces and territories on the Vaccine Vigilance Working Group (VVWG). For its part, the federal government increased membership to include Department of National Defence, First Nations and Inuit Health Branch at Health Canada, Corrections Services Canada and the Royal Canadian Mounted Police. This group of federal, provincial and territorial experts convenes regularly to monitor vaccine-adverse reactions and ensure the safety of the vaccine supply.

Capacity was also improved through the F/P/T VVWG by increasing the quality and timeliness of vaccine-adverse reaction data the group shares and has access to. In the past, the information regarding potential adverse reactions was provided by vaccine manufactures only to regulators charged with approving the vaccine. Under the new system, the VVWG has direct access to this information and can use it to inform and prepare public health practitioners.

ER 5.1: Capacity for increased use of the regional communication systems is improved.

RA 5.1: The Regional Communications Network capacity has been improved by:

• participation on the PHN Communications Sub-Group;
• sharing Best practises from regional experiences (i.e., British Columbia migrant ship situation);
• maintaining up-to-date Provincial and Territorial contact lists; and
• participating in cross-border committees and regional emergency communications network committees.

ER 6.1: Response mechanisms are established to respond to an avian or pandemic influenza outbreak.

RA 6.1: Rapid response research protocols are under development and will be in place by October 2011. Provided strict safety and ethical precautions have been met, this will enable the safe and rapid vaccine development and testing in the event of a pandemic emergency.

ER 6.2: Laboratories are capable of working with certified influenza strains.

RA 6.2: Each province continues to maintain at least one laboratory capable of working with influenza strains. Labs working with pandemic H1N1 samples must be certified to Containment Level 2 (CL2) which includes specific safety and security measures, labs working with pandemic H1N1 viral cultures must be certified to CL2-plus. Twenty-three labs are currently participating in the National Microbiological Laboratory's (NML) influenza virus proficiency testing program and twenty-one labs are currently participating in the NML's influenza polymerase chain reaction proficiency panel.

ER 6.3: Improved integration of quarantine stations with traditional services at the three major Canadian maritime ports.

RA 6.3: Marine training was provided to quarantine officers to enhance their preparedness and response to marine related incidents. This training was put into effect when the Office of Quarantine Services actively participated in the federal response to the MV SunSea, an illegal immigrant ship, which arrived in Victoria, B.C. This response required the deployment of Quarantine Officers from the Vancouver Quarantine Station to assess the ill travellers on board. There were no actions taken under the Quarantine Act .

ER 6.4: The National Emergency Stockpile System and the Emergency Operations Centres are maintained in a state of readiness.

RA 6.4: The National Emergency Stockpile System (NESS) continues to ensure Canada's ability to respond 24/7 as it maintains an on-call schedule. The NESS will continue to enhance the use of evidence informed decision making processes and the use of risk-based decision support methodologies and tools. The initiatives include the establishment of two task groups (The Pharmaceutical & Therapeutics Committee and The Medical Equipment and Supply Committee) and the development of a risk-based decision support tool to strategically renew and modernize NESS assets.

NESS also finalised the Mini Clinic as its principle deployable asset and completed the acquisition of ten Mini Clinics. The Mini Clinic module comprises the necessary equipment to provide primary assessment and care similar to that of a walk in clinic for surge capacity. It is scalable and meets modern standards of medical care. NESS organised two meetings with health care subject matter expert groups, in April and November 2010 respectively, to review and validate the new Mini Clinic module. The Mini Clinics have been successfully deployed and evaluated at national and international special events (2010 Winter Olympic Games, G8/G20 summits, Canada Winter Games 2011).

ER 6.5: Incident response plans are in place with provincial and territorial departments and non-governmental organizations.

RA 6.5: Forthcoming recommendations from the H1N1 Lessons Learned Report /After Action Review for the implementation of the Canadian Pandemic Influenza Plan during the H1N1 pandemic currently being carried out by PHAC evaluation services will be applied to a review of the plan. Pandemic preparedness and specifically the pandemic plan are on the priority list for being exercised in the coming/following year, based on the revised plan and/or any lessons learned from the H1N1 report. The Agency also, in partnership with Nunavut Health and Social Services, developed and facilitated a Northern Pandemic Table Top Exercise in support of the revision of the Pandemic Influenza Planning and Response Guidelines for the Health Sector.

ER 6.6: Increased efficiency and effectiveness of regional resources placed to facilitate the flow of information between federal, provincial and territorial levels.

RA 6.6: The information flow between federal, provincial and territorial levels was made more efficient and effective by strategically placing regional resources in near proximity to health portfolio partners, other federal departments, the provinces and territories and other stakeholders. This facilitates collaboration by ensuring a common understanding of priorities-both individual and shared, and rapid two-way dissemination of information to health partners and the public in the event of a pandemic-as well as ensuring decision-makers are well informed of regional developments.

ER 7.1: An updated Human Resources (HR) Emergency Response Plan (ERP) is in place.

RA 7.1: A framework to update the HR ERP was developed by March 2011. Under this framework, the following results were achieved:

• Key positions and their back-ups have been identified for the Agency's EPR functions.
• The process for scheduling employees into the Incident Management Structure in support of an event was refined and piloted.
• The need to manage the location of deployed resources during an event was identified during the Trillium-Guardian Exercise in May 2010. A process was developed and piloted during G8/G20.
• On-going participation in task groups has resulted in :
  • Development of a five-year training plan to increase surge capacity and identify EPR (Emergency Preparedness and Response) components for new employees for endorsement by the Joint Emergency Preparedness Committee.
  • Development of a process to mobilise employees for short term (30 days or less) international deployments.
• Completed a Table Top Exercise within HRD in November 2010 to evaluate gaps in preparedness and response.

Going forward, HR will be working with their key clients to validate the balance of the framework, establish priorities and create a multi year action plan to update the HR Emergency Response Plan.

ER 8.1: Federal laboratory liaison technicians in provinces and territories are in place, trained, and equipped.

RA 8.1: Laboratory Liaison Technical Officers (LLTOs) are currently working in six of the ten provincial public health laboratories. The LLTO position in Newfoundland remains vacant, while the LLTO position in Alberta became vacant this fiscal year. Both positions cannot be staffed due to resource constraints. There are no plans to extend LLTO positions to the remaining two provinces.

The LLTOs support communication of information and data between the Public Health Laboratories (PHLs) and the Agency's National Microbiology Laboratory (NML); collaborate with other PHAC field positions within the provinces (e.g., Public Health Officers and HIV Field Surveillance Officers); and facilitate integration of laboratory and epidemiology surveillance data at the provincial and federal level.

ER 8.2: Communications between provincial and territorial labs and the National Microbiology Laboratory is improved thereby strengthening the national lab's capacity.

RA 8.2: Laboratory Liaison Technical Officers (LLTOs) continue to support communication of information and data between the Public Health Laboratories (PHLs) and the Agency's NML, collaborate with other PHAC field positions within the provinces (e.g., Public Health Officers and HIV Field Surveillance Officers), and facilitate integration of laboratory and epidemiology surveillance data at the provincial and federal level. The inability to staff LLTO positions has had negative implications for the linkages between the NML and the provincial labs.

The Canadian Public Health Laboratory Network (CPHLN), funded by the Agency, is the cornerstone for sharing laboratory information between the public health labs. This function continues to strengthen national capacity though a number of initiatives, including:

• Assessing the national public health laboratory system to identify gaps and highlights;
• Supplying a central hub for information exchange on testing protocols, procedures and techniques to identify infectious pathogens; and
• Unified national response through standardization of protocols and testing

The NML, through CPHLN, participates in the development of the Multilateral Information Sharing Agreement (MLISA), a mechanism designed to facilitate the rapid dissemination of information among F/P/T stakeholders (e.g., public health labs) during an outbreak.

ER 8.3: Components of the Canadian Pandemic Influenza Plan's Annex C are in operation.

RA 8.3: The current version of the Canadian Pandemic Influenza Plan, Annex C - Pandemic Influenza Guidelines provides recommendations to Canadian influenza testing facilities on laboratory testing, surveillance and data collection, communication and pandemic preparedness planning. The Agency, through CPHLN, will revise Annex C upon establishment of new planning assumptions by a Public Health network Steering Committee.

ER 9.1: Research resources are optimally allocated to respond to the needs of avian and pandemic influenza preparedness.

RA 9.1: Funding for the projects discussed below was allocated on the basis of priorities and knowledge gaps. The priorities and gaps were identified by Federal, Provincial and Territorial (F/P/T) public health decision makers.

The PHAC/CIHR (Canadian Institutes of Health Research) Influenza Response Network (PCIRN) was created as a result of the partnership between PHAC and CIHR as a means of optimizing and streamlining funding of pandemic related research in accordance with the priorities of Federal, Provincial and Territorial (FPT) public health decision-makers. In its second year of operation, PCIRN continued to deliver valuable relevant research related to: Rapid Vaccine Trials; Rapid Program Implementation; Vaccine Coverage; Vaccine Safety; Vaccine Effectiveness; Laboratory Support; Information Technology Support; and Curriculum and Knowledge Translation. Further information regarding the specific research projects funded can be found online.

The Pandemic Preparedness Strategic Research Initiative (PPSRI), a joint initiative of PHAC and CIHR, funded pandemic research projects related to four research themes: Biology and Diagnostics; Pandemic Planning and Ethics; Transmission, Modeling and Infection Control; and Vaccines. Proceedings of the Canadian Pandemic Preparedness Meeting: Outcomes, Impacts and Lessons Learned are available online. This successful initiative was completed on March 31, 2011.

The Capacity for Pandemic Preparedness Grants and Contributions Program funded the Canadian Critical Care Trials Group to advance PHAC's rapid response research strategy by developing a risk factor database and emergency clinical trial protocols for treatment effectiveness. This grant included FY10/11 and FY11/12 funding and will be completed by October 2011.

ER 10.1: Predictive and assessment models used for pandemic preparedness are developed and established.

RA 10.1: Pandemic influenza models have been developed to support decision-making surrounding the renewal of the National antiviral stockpile, and the impact of demographic variables on the transmission of pandemic influenza in remote and isolated communities. Additional modeling work has focused on examining how diseases spread in various settings and populations of pandemic influenza in rural and urban areas. These decision-support tools will aid in the Agency's initial response to a pandemic and improve the predictive capacity of the Agency.

With respect to quickly identifying emerging pandemics, new statistical models and methods have been developed and applied to assist in the interpretation of surveillance data for seasonal and pandemic influenza and predictive models have been developed to further support decision-making for pandemic planning.

ER 10.2: More potential learners in university and college settings are being trained as mathematical modelers to augment public health capacity in mathematical modeling.

RA 10.2: Significant training of both students and existing public health professionals has occurred over the course of the 2010-11 year. Engaging in semester-long academic course work, students are developing mathematical modelling for public health skills. For example, PHAC scientists have contributed to the design and delivery of the mathematical modelling course offered at the Dalla Lana School of Public Health at the University of Toronto.

In addition, several professional development workshops have been held for public health professionals and students from around the world in conjunction with existing public health organizations (e.g., Ontario Agency for Health Protection and Promotion, American College of Epidemiology, Society for Medical Decision Making, and the North American Congress of Epidemiology).

ER 11.1: Evaluation improvements proposed in the Evaluation Plan for avian and pandemic influenza preparedness are implemented.

RA 11.1: Evaluation Services produced three reviews that provided evidence for future evaluative activities on avian and pandemic influenza preparedness. They are the:

• Lessons Learned Review: Public Health Agency of Canada and Health Canada Response to the 2009 H1N1 Pandemic;
• Evaluation of the National Emergency Stockpile System; and the
• Evaluation of the grant and contribution components of the Avian and Pandemic Influenza Preparedness Initiative.

Progress on Management Response and Action Plans will be monitored by the PHAC Evaluation Committee until all commitments have been addressed. Expected timelines for implementation of specific management responses are specified in the Plans.

ER 11.2: Components of the performance measurement framework are in place at the responsibility-centre level.

RA 11.2: Preparedness for Avian and Pandemic Influenza Responsibility Centres were engaged in collecting, verifying and approving performance measurement information collected for 2006-07 to 2009-10. Results were presented to the Evaluation Committee in August 2010.

Responsibility for maintaining the performance measurement system was transferred from Evaluation Services to the Centre for Immunization and Respiratory Infectious Diseases. The Centre for Immunization and Respiratory Infectious Diseases is currently developing a governance framework for managing this horizontal initiative program on an ongoing basis.

ER 11.3: Performance data and evidence are collected using a Web-based system and are used for management and reporting.

RA 11.3: Performance monitoring and measurement data and evidence for 2006-07 to 2009-10 were analyzed and compared to expected targets. The resulting analysis was provided to each responsibility centre for management, reporting and evaluation use in 2010-11.It has been decided not to use a Web-based data collection system at this time in favour of a more flexible spreadsheet tool.

ER 12.1: Social marketing needs are reviewed and appropriate modifications have been made in light of the H1N1 experience.

RA 12.1: H1N1 communications messaging and information materials were modified for use in the 2010-11 influenza campaign. This modified messaging re-enforced appropriate behaviours for infection prevention of seasonal influenza. Examples include: the FluWatch campaign; posters on busses; GoogleAdWords; print ads targeted to Aboriginal communities; and targeted Facebook advertisements for women 20-45. Through the use of GoogleAdWords, the traffic to the FightFlu website doubled within the week of the launch.

Ongoing collaboration through the Public Health Network Social Marketing Working Group exchanges information and best practices as well as aligning approaches where appropriate. Although no social marketing strategies were revised in 2010-11, this group exchange reinforced the concept of working together across provinces and territories to ensure a collaborative and coordinated approach to seasonal flu campaigns.

ER 12.2: A communications operational plan is developed to support the Canadian Pandemic Influenza Plan.

RA 12.2: Informal consultations with Public Health Network Communications working group on the appropriateness of Annex K of the CPIP-based on H1N1 lessons learned-resulted in changes to the communications operational plan. A revised annex is expected to be prepared by March 31, 2012.

The Communications Directorate identified activities in the H1N1 Management Response and Action Plan to respond to the Health Portfolio Lesson H1N1 Lessons Learned Review. The plan identifies the need to clarify in the CPIP Annex K the roles and responsibilities of communications partners.

ER 13.1: Memoranda of understanding (MOU) with selected placement sites for public health officers across the country are completed.

RA 13.1: Letters of Agreement (LOA) were drafted and signed with 17 placement sites. Four MOUs are already in place and the remaining two LOAs are with sites for signature. Staffing of positions in Canadian Public Health Service is cumulative. To date 23 positions have been staffed and the staffing process for an additional position in Quebec is underway. Due to resource constraints the program is not anticipated to staff to capacity (26 positions) at this time.

ER 13.2: An increased number of public health officers and Canadian Public Health Service regional coordinators are in place across Canada.

RA 13.2: By the end of 2010-11, 23 Public Health Officers (PHO) were hired and placed in public health sites at the P/T, local level or NGOs across Canada. A process to staff a PHO position in Quebec is underway.

ER 13.3: An increased number of training modules are developed and delivered to public health officers in the field.

RA 13.3: 22 Public Health Officers are expected to attend Field Service Training Institute (FSTI) 2011 in Vancouver. Course modules have changed slightly, especially to accommodate attendees with a policy-focus. There has not been an increase in the number of modules.

ER 13.4: Competency profiles for public health officers are developed.

RA 13.4: Work Descriptions and Statements of Merit Criteria have been developed for the 26 PHO positions. These profiles remain current; however, they are subject to revision as needed.

ER 14.1: Improved lead time between the outbreak of a pandemic and the availability of a pandemic vaccine.

RA 14.1: Experience gained in the development of pre-pandemic vaccine, as well as H1N1 vaccines, has yielded improvements in the currently available egg-based vaccine production technology and regulatory processes.

A new pandemic influenza vaccine contract was negotiated with GlaxoSmithKline to replace the contract expiring March 31, 2011. The new contract will provide Canada priority access to a supply of pandemic vaccine manufactured in Canada. A second contract with a back-up supplier of pandemic influenza vaccine was established as a safeguard in the event of delays in domestic vaccine production.

ER 14.2: The National Antiviral Stockpile is maintained and plans are established for the replacement of antiviral stocks as they reach the end of their shelf-life.

RA 14.2: Updated recommendations for national antiviral stockpile size and composition have been developed based on best available science, H1N1 experience and lessons learned, and mathematical modelling research. Further work is underway to develop a long-term strategy for national antiviral stockpile procurement, management and sustainability.

Federal Partner: Health Canada

($M) Federal Partners	Federal Partner Program Activity (PA)	Names of Programs for Federal Partners	Total Allocation (from Start to End Date)	Planned Spending for 2010-11	Actual Spending for 2010-11	Variance for 2010-11 (from planned to actual expenditure)	Expected Results for 2010-11	Results Achieved in 2010-11
Health Canada	Health Products	a. Regulatory activities related to pandemic influenza vaccine	Ongoing	1.1	1.2	(0.1) 1	ER 15.1 ER 15.2 ER 15.3 ER 15.4 ER 15.5 ER 15.6	RA 15.1 RA 15.2 RA 15.3 RA 15.4 RA 15.5 RA 15.6
		b. Resources for review and approval of antiviral drug submissions for treatment of pandemic influenza	Ongoing	0.2	0.2	0.0	ER 16.1 ER 16.2 ER 16.3	RA 16.1 RA 16.2 RA 16.3
		c. Establishment of a crisis risk management unit for monitoring and post-market assessment of therapeutic products	Ongoing	0.3	0.3	0.0	ER 17.1 ER 17.2	RA 17.1 RA 17.2
	First Nations and Inuit health programming and services	a. FN/I surge capacity - FN/I Community Services	$1.5M (2007-08 to 2009-10)	No funding available	No funding available		ER 18.1	RA 18.1
		b. Strengthen federal public health capacity through Governance and Infrastructure	Ongoing	0.7	0.7		ER 19.1 ER 19.2 ER 19.3 ER 19.4 ER 19.5	RA 19.1 RA 19.2 RA 19.3 RA 19.4 RA 19.5
		Support to FN/I Health System
		c. FN/I emergency preparedness, planning, training and integration	Ongoing	0.3	0.3	0.0	ER 20.1	RA 20.1
	Sustainable environmental health	a. Public health emergency preparedness and response (EPR) on conveyances	Ongoing	0.2	0.2	0.0	ER 21.1	RA 21.1
Total Health Canada				$2.8M	$2.9M	$(0.1)M

Expected Results (ER)/Results Achieved (RA):

ER 15.1: World Health Organization (WHO) Guidance on Regulatory Preparedness for Human Pandemic Influenza Vaccines.

RA 15.1: Further to the publication of the guidance and the 2009 pandemic, Health Canada, in collaboration with the WHO, hosted "Confronting the Next Pandemic Workshop" in Ottawa, Ontario, on July 27-29, 2010 to discuss lessons learned from potency testing of pandemic (H1N1) 2009 influenza vaccines and considerations for future potency tests. The report from the workshop will be used to help update the WHO Guidance document in preparation for any future pandemics.

ER 15.2: Finalize Extraordinary Use New Drugs regulations.

RA 15.2: The regulations for Extraordinary Use New Drugs were approved by Treasury Board and came into effect in March 2011.

ER 15.3: Continue links established with international regulatory bodies (WHO, Chinese SFDA) which increase the timeliness and availability of information in the event of a pandemic (i.e., pandemic influenza strain).

RA 15.3: Health Canada continues to link with other regulators as well as the WHO via participation in the International Conference on Drug Regulatory Harmonization, the Pan American Network for Drug Regulatory Harmonization and bilateral agreements. These links facilitate information sharing, which is essential when dealing with a pandemic. For example, China was the first country in the world to initiate a vaccination programme during the 2009 pandemic and their early information on safety was shared with regulators of other countries. Going forward, bilateral agreements with other regulators are in place to allow information sharing in similar situations, even if the information would normally be confidential.

ER 15.4: Review response to the H1N1 events and produce lessons learned.

RA 15.4: Health Canada has been an active participant in numerous H1N1 related reviews and lessons learned such as:

• the Health Portfolio and the Senate Committee H1N1 Lessons Learned reports;
• internal branch lessons learned report (produced and presented to senior management on April 30, 2010);
• the development of a case scenario to assess standard operating procedures for deployment of health human resources during an emergency situation;
• the proposed governance structure for pandemic influenza during response time tabled at Pandemic Preparedness Oversight Committee and Public Health Network Council.

Health Canada is also actively engaged with the Centre for Emergency Preparedness and Response at PHAC to address National Emergency Stockpile System and surge capacity issues. More specifically, Health Canada participated in the discussions around intra- and inter-sharing of health professionals during emergency situations.

ER 15.5: Continue coordinating blood system preparedness through regular teleconferences and regulatory advice/decisions to Canada Blood Services (CBS) and Headquarters (HQ). Our approaches have been shared with WHO Blood Regulator.

RA 15.5: Health Canada continues to meet every three months with both CBS and HQ to discuss risk management issues and continues to play a leading role in the WHO Blood Regulators network.

ER 15.6: Work with the WHO on recommendations for new pneumococcal conjugate vaccine through the WHO Expert Committee on Biologic Standardization (ECBS).

RA 15.6: The new recommendations were adopted by ECBS at its 2009 meeting; therefore no further results for 2010-2011 were anticipated.

ER 16.1: Complete review of any anti-viral submissions that may be received.

RA 16.1: Health Canada received and completed an influenza-antiviral submission review on one Supplemental New Drug Submission (Tamiflu©) and authorized the product for use in the Canadian market. The department also reviewed and approved one Notifiable Change (Relenza©).

ER 16.2: Finalize "Expedited Pandemic Influenza Drug Review" (EPIDR) Protocol.

RA 16.2: The completion of EPIDR protocol is ongoing. The document is currently out for comments and management's review and approval. Founded on existing review principles, the protocol proposes to accept short-term and pre-clinical (animal studies) data. The challenges to finalizing the protocol include competing priorities and meeting the current review deadlines under the new user fee act. Resources will need to be diverted from the regular review stream and legal aspects may need to be sorted out.

ER 16.3: Ongoing on-the-job reviewer training for the "accelerated review." Review procedures for antivirals submissions, before and during pandemic occurrences are established.

RA 16.3: Reviewers were involved in the lesson-learned discussions regarding best ways to achieve antiviral drug review goals under circumstances such as a pandemic (with use of the draft EPIDR protocol). The staff continued to participate in various working groups across the Health Portfolio to provide regulatory/clinical expertise regarding antiviral drug related issues. The review procedures remain the same except that safety conclusions will need to be drawn from limited data and in a short time frame. All decisions made in this area will need to be approved at the executive level.

ER 17.1: Maintenance of the crisis risk management unit.

RA 17.1: The capacity of the crisis management unit to respond in case of an influenza pandemic was maintained in the 2010-11 fiscal year.

ER 17.2: Ongoing post-market assessment of therapeutic products.

RA 17.2: Surveillance of therapeutic products that may be used in the case of an influenza pandemic was ongoing in the 2010-11 fiscal year.

ER 18.1: Implementation of Pandemic and infection control education and training initiatives.

RA 18.1: Using resources received from Branch Public Health Funds, Health Canada leads the development of a National Infection Prevention and Control Strategy. The Strategy aims to align priorities and roles and responsibilities of National and Regional offices for a more coordinated and strategic approach to reducing the incidence of health care-acquired infections in First Nation and Inuit communities within the mandate of the First Nations and Inuit Health Branch (FNIHB). The following partners/stakeholders were involved in the development of the Strategy: Public Health Agency of Canada (PHAC), Assembly of First Nations (AFN), NGOs including CHICA- Canada and Ontario Regional Infection Network.

An environmental scan was conducted in July 2010 with the objective being to capture infection prevention and control structures and activities currently in place in the regions, including strengths, challenges and priorities.

Health Canada also assessed personal protective equipment processes, including related occupational health and safety activities. Results indicated a lack of standardized and formalized respiratory protection activities. To address these respiratory protection issues, Health Canada established a working group including FNIHB partners, FNIH Regional Offices, and Regions and Programs Branch Emergency Preparedness and Occupational Health Directorate.

Health Canada's FNIH Regions were engaged in various infection prevention and control activities depending on regional realities. These activities included fit-testing for N95 masks, infection prevention and control Tool-Kit, infection prevention and control manual and addressing such issues as reprocessing for dental and foot care instruments.

In addition, Health Canada provided feedback on Annex F of the Canadian Pandemic Influenza Plan ( Infection Control and Occupational Health Guidelines During Pandemic Influenza In Traditional and Non-Traditional Health Care Settings) .

ER 19.1: Implement pandemic and infection control education and training initiatives.

RA 19.1: Utilizing Health Canada public health funds, Health Canada also worked closely with PHAC and the Assembly of First Nations to assess the three-year Trilateral Workplan on Pandemic Preparedness. The results of the assessment will guide future collaborative work between the three partners in the area of pandemic preparedness.

ER 19.2: Collaborate with PHAC, Public Safety Canada, and AANDC for planning and response.

RA 19.2: Health Canada participated in several F/P/T task groups and committees. For example, Health Canada is working closely with PHAC, and other provinces and territories, on the F/P/T Office of Emergency Response Services to address intra- and inter-sharing of health professionals during health emergencies. Health Canada also participated as a technical lead at the Canadian Pandemic Influenza Plan (CPIP) for the Health Sector review committee.

Health Canada worked closely with PHAC and the Assembly of First Nations to assess the three-year Trilateral Workplan on Pandemic Preparedness. The results of the assessment will guide future collaborative work between the three partners in the area of pandemic preparedness.

In response to the 2009 H1N1 pandemic, Health Canada has re-established its working relationship with Aboriginal Affairs and Northern Development Canada (AANDC). A working group has been established to ensure that both departments are kept fully informed and each organization provides support in its areas of mandate and expertise to the other, including coordinated advice on issues of common interest related to emergency management and communicable disease emergencies, including pandemics.

ER 19.3: Work on surveillance needs with PHAC.

RA 19.3: In February 2011, Health Canada hosted, in collaboration with PHAC, a meeting between the Communicable Disease Emergencies' Coordinators and the Health Portfolio Emergency Preparedness and Response Coordinators to clarify roles and responsibilities and to discuss how to better integrate to provide emergency preparedness and response to First Nations communities. Health Canada and AANDC are in this process to ensure a comprehensive approach to emergency planning and response.

ER 19.4: Enhance support for First Nations communities.

RA 19.4: Health Canada continues to provide technical expertise and financial support for the communicable disease emergencies' initiative such as the development, testing, and revision of community-level pandemic plans. In collaboration with PHAC, the department developed a pilot version of Annex B (First Nations annex to the Canadian Pandemic Influenza Plan (CPIP) for the Health Sector) that is more user-friendly, interactive and adapted to the Web in language and format, and can be used as a hands-on planning tool.

Health Canada is engaged in the review process of the CPIP to ensure that First Nations considerations are well integrated into the planning activities.

ER 19.5: Increase links with national and regional emergency preparedness and response program staff and with provinces and territories.

RA 19.5: Health Canada participated in several F/P/T committees related to emergency management in general and communicable disease emergency management in particular. The department continues to advocate and to pursue the inclusion of First Nations and Inuit health issues and concerns to the National/Pan-Canadian agenda via the work with the Aboriginal subcommittee of the Senior Officials Responsible for Emergency Management in partnership with AANDC as well as being part of the consultation processes of National and Pan Canadian plans and frameworks such as the Foodborne Illness Outbreak Response Protocol and the Federal Emergency Response Plan.

ER 20.1: Continue to support the testing and revision of community pandemic plans.

RA 20.1: In response to the 2009 H1N1 Pandemic, the level of preparedness in on-reserve First Nations communities has increased. However, important work remains to be done in the area of pandemic preparedness and planning. Currently, 98% of First Nation communities have a community-level pandemic plan, and over 86% of these communities have tested components of their plans such as the mass immunization section.

Additionally, some Health Canada's FNIH Regional Offices updated their pandemic planning template to reflect H1N1 lessons learned. The regions are also working with communities to address the lessons learned through H1N1 activities. These lessons learned will be addressed in revisions of plans.

ER 21.1: Continue ongoing program delivery, training and partnerships, program evaluations and adjustments to address findings.

RA 21.1: Health Canada monitored quarantine calls at points of entry, updated Standard Operating Procedures and environmental health officer training materials, and participated in working groups. Capacity continues at core levels.

Federal Partner: Canadian Institutes of Health Research

($M) Federal Partners	Federal Partner Program Activity (PA)	Names of Programs for Federal Partners	Total Allocation (from start to end date)	Planned Spending for 2010-11	Actual Spending for 2010-11	Variance for 2010-11 (from planned to actual expenditure)	Expected Results for 2010-11	Results Achieved in 2010-11
Canadian Institutes of Health Research		a. Influenza research priorities	$40.9 M (The end date of the PPSRI is March 31, 2011, however, additional partner funds are committed in 2011-12)	11.0	10.6	0.4	ER 22.1 ER 22.2 ER 22.3 ER 22.4	RA 22.1 RA 22.2 RA 22.3 RA 22.4
Total CIHR				$11.0 M	$10.6M	$0.4M

Expected Results (ER)/Results Achieved (RA):

ER 22.1: Research projects are peer reviewed and funded.

RA 22.1: No new requests for application (RFAs) were launched in 2010-11, therefore no projects were peer reviewed or received new funding.

ER 22.2: Requests for research applications are developed and launched as needed.

RA 22.2: With the exception of the PHAC-CIHR Influenza Research Network, funding for activities within the Pandemic Preparedness Strategic Research Initiative (PPSRI) ended in March 2011. Therefore, no new RFAs were launched.

ER 22.3: Progress on funded projects and outcomes of research are reviewed.

RA 22.3: Funded principal investigators were required to submit their annual progress reports in January 2011. The information contained in these reports is currently being synthesized into a report for dissemination to partners and the general public in September, 2011.

ER 22.4: Uptake of research results is facilitated, and consultations on future research needs are completed through reports and meetings of researchers, stakeholders and decision makers.

RA 22.4: In addition to the report described in RA 22.3, the Annual Canadian Pandemic Preparedness Meeting was held in November 2010. This meeting, entitled "Impacts, Outcomes and Lessons Learned," gave researchers an opportunity to disseminate their findings through oral and poster presentations, and to discuss the gaps in the landscape and future needs of pandemic research. A report summarizing this meeting was prepared, and posted on the CIHR website.

Federal Partner: Canadian Food Inspection Agency
($M)

Federal Partners	Federal Partner Program Activity (PA)	Names of Programs for Federal Partners	Total Allocation (from Start to End Date)	Planned Spending for 2010-11	Actual Spending for 2010-11	Variance for 2010-11 (from planned to actual expenditure)	Expected Results for 2010-11	Results Achieved in 2010-11
Canadian Food Inspection Agency	Zoonotic Risk	a. Enhanced enforcement measures	Ongoing	1.5	2.1	(0.6)	ER 23.1	RA 23.1
		b. Avian biosecurity on farms	Ongoing	2.7	2.3	0.4	ER 24.1	RA 24.1
		c. Real property requirements	$4.0M (2006-07 to 2007-08)	0.0	0.0	-	ER 25.1	RA 25.1
		d. Domestic and wildlife surveillance	Ongoing	3.1	1.5	1.6	ER 26.1	RA 26.1
		e. Strengthened economic and regulatory framework	Ongoing	0.9	0.1	0.8	ER 27.1	RA 27.1
		f. Performance and evaluation	Ongoing	1.2	0.9	0.3	ER 28.1	RA 28.1
		g. Risk communications	Ongoing	1.6	1.6	0.0	ER 29.1	RA 29.1
		h. Field training	Ongoing	1.1	0.8	0.3	ER 30.1 ER 30.2	RA 30.1 RA 30.2
		i. AI enhanced managemen t capacity	Ongoing	1.0	1.8	(0.8)	ER 31.1	RA 31.1
		j. Updated emergency response plans	Ongoing	2.0	0.9	1.1	ER 32.1	RA 32.1
		k. Risk assessment and modelling	Ongoing	2.0	0.2	1.8	ER 33.1	RA 33.1
		l. AI Research	Ongoing	1.5	0.1	1.4	ER 34.1	RA 34.1
		m. International collaboration	Ongoing	1.6	0.2	1.4	ER 35.1	RA 35.1
		n. Animal vaccine bank	$0.9M (2006-07 to 2008-09)	0.0	0.0	-	ER 36.1	RA 36.1
		o. Access to antivirals	Ongoing	0.1	0.0	0.1	ER 37.1	RA 37.1
		p. Specialized equipment	$20.7M (2006-07 to 2008-09)	0.0	0.0	-	ER 38.1	RA 38.1
		q. Laboratory surge capacity and capability	Ongoing	3.7	4.2	(0.5)	ER 39.1	RA 39.1
		r. Field surge capacity	Ongoing	1.0	1.7	(0.7)	ER 40.1	RA 40.1
		s. National veterinary reserve	Ongoing	0.9	0.8	0.1	ER 41.1	RA 41.1
Total CFIA				$25.9M	$19.2M	$6.7M

Comments on Variances:

The Agency's 2010-11 Avian Influenza commitments were met. The variance between planned spending and actual spending is related to funding reallocated to expenditures that support this initiative, for example, laboratories operation during the Manitoba Avian Influenza outbreak, Avian Influenza research, and other Agency priorities.

Expected Results (ER)/Results Achieved (RA):

ER 23.1: Increased capacity to support enhanced screening procedures for live birds or poultry products at Canada's ports of entry with a view to mitigating the risk of future avian influenza outbreaks in Canada.

RA 23.1: CFIA maintains its border look-out on Avian Influenza (AI) with the Canada Border Services Agency (CBSA) to target live birds, poultry products and poultry by-products for appropriate action. CBSA reports on the number of birds intercepted on behalf of the CFIA.

ER 24.1: Continuation of stakeholder and general public education, communications and outreach programs in support of the implementation of the National Avian On Farm Biosecurity Standard. Provide stakeholder consultations and develop communication tools to expand education and awareness to the poultry industry service sector.

RA 24.1: The National On Farm Avian Biosecurity Standard outcomes have been incorporated into provincial biosecurity implementation and incentive programming, provincial and federal outreach communication campaigns, and has been disseminated through poultry industry sector magazines and national associations. A producer guidance document has been developed to assist producers in achieving the outcomes in the Standard and is available to stakeholders. A service sector biosecurity guideline for the poultry sector has been drafted and will be released 2011-12 to assist producers with compliance to farm level biosecurity protocols when service personnel are on the farm.

ER 25.1: No planned expenditures as investments were realized in previous fiscal years.

RA 25.1: N/A

ER 26.1: Enhanced/integrated Canadian surveillance system, supported by a robust systems platform and the analysis and interpretation of the data collected to allow more timely identification of potential outbreaks, and more timely response to avian influenza situations. Targeted wild bird surveillance plan is yet to be determined for 2010.

RA 26.1: The CFIA continued with the Canadian Notifiable Avian Influenza Surveillance System (Canadian Notifiable Avian Influenza Surveillance System). Targeted wild bird surveillance plan implemented in collaboration with Canadian Cooperative Wildlife Health Centre. From the results, the National Centre for Foreign Animal Diseases (NCFAD) was able to link the H5N2 turkey outbreak in Manitoba to isolates found in the wild bird survey in ducks from Manitoba, Saskatchewan, and Alberta.

ER 27.1: Initiatives to strengthen regulatory capacity during outbreaks, including a review and analysis of current legislative/regulatory framework continues.

RA 27.1: CFIA continued work on strengthening capacity for analysis of the legislative/regulatory framework.

ER 28.1: Management and evaluation of CFIA's AI activities, including ongoing performance measurement to monitor results.

RA 28.1: CFIA has enhanced its quality management system which supports the compilation and analysis of performance data to ensure consistency and continuous improvement across programs and activities delivered. This system has been incorporated into CFIA's management approach in order to understand the quality of regulatory and service activities delivered by the Agency and to search out opportunities for the continuous improvement of those activities.

ER 29.1: Continued implementation of the "Be Aware and Declare" international border biosecurity outreach campaign. Ongoing media monitoring and training and risk communications related to AI prevention, preparedness and response activities.

RA 29.1: Through the "Be Aware and Declare!" outreach campaign, the CFIA maintained partnerships with 21 international airlines that either broadcast the "Be Aware and Declare!" public service announcement or distributed brochures to passengers on flights to Canada. Under the umbrella of the broader animal health awareness campaign, information was shared with key stakeholders, such as producers and industry associations, via calendars, brochures, posters, public notices and face-to-face interactions.

During the response to the AI outbreak in November, various communications channels, including Twitter, were used to provide information to Canadians. Media monitoring and risk communications related to AI prevention, preparedness and response activities also continued.

ER 30.1: Continued training that will contribute to a skilled and experienced workforce ready to respond to an AI outbreak.

RA 30.1: CFIA maintains a high number of staff trained on Incident Command System (ICS), equipment monitoring and use, venipuncture, Transportation of Dangerous Goods, and First Assessment and Sampling Team training. To augment this training, focus was given to training on biocontainment and Occupational Health and Safety (OSH) procedures. Further, CFIA completed several exercises and drills based on Notifiable Avian Influenza (NAI) scenarios, both in the Western Area, and the Atlantic Area. The objectives of the exercises varied, but included, evaluating initial response procedures, sampling, biocontainment procedures, donning and doffing of protective equipment, and communications.

Annually CFIA holds an internationally recognized disease diagnostic course at the high security virus lab. There the clinical effects of Avian Influenza are demonstrated to CFIA and provincial staff.

ER 30.2: Continued development of training materials (instructor-led and e-learning) in support of emergency response procedures and plans and of trainers in support of end-user training.

RA 30.2: CFIA maintains a high number of staff trained on Incident Command System (ICS), equipment monitoring and use, venipuncture, Transportation of Dangerous Goods and First Assessment and Sampling Team training. To augment this training, focus was given to training on biocontainment and Occupational Health and Safety (OSH) procedures. Further, CFIA completed several exercises and drills based on Notifiable Avian Influenza (NAI) scenarios, both in the Western Area, and the Atlantic Area. The objectives of the exercises varied, but included, evaluating initial response procedures, sampling, biocontainment procedures, donning and doffing of protective equipment, and communications.

Annually CFIA holds an internationally recognized disease diagnostic course at the high security virus lab. There the clinical effects of Avian Influenza are demonstrated to CFIA and provincial staff.

ER 31.1: A multi-disease version for the Canadian Emergency Management Response System (CEMRS) application for national surveillance/outbreak use will be available. Work on the next generation of the application will have begun.

RA 31.1: The CEMRS application continued to be updated to the extent possible in order to enhance its functionality in capturing and querying emergency response data from the field.

Veterinary Biologics products were evaluated with respect to AI virus inclusions and two on-site inspections were conducted on vaccine manufacturing facilities in Guelph and Montreal.

CFIA has engaged personnel with the technical skills necessary to effectively track monitor and respond to outbreaks using geographical information systems and emergency management systems. This information enables informed decisions and rapid interventions.

ER 32.1: Continued development and updating of emergency response procedures and plans.

RA 32.1: CFIA completed after action reports for exercises and responses. The National Disease Control Expert Working Groups continued the development, revision, and updating of disease response protocols for all aspects of the detection, containment and eradication of incursions of Notifiable Avian Influenza (NAI). Validation of updated plans and procedures occurred through field exercises and drills based on NAI scenarios, both in Western Area and Atlantic Area, as well as an actual event in late November 2010, in Manitoba.

The Foreign Animal Disease and Emergency Management (FADEM) section is updating the Notifiable Avian Influenza Hazard Specific Plan (NAIHSP) including the App M that was subject to a large consultation with industry, CVOs, CFIA staff and poultry practitioners.

ER 33.1: Continued development of models to better understand the influence and interaction of various factors on the spread of AI and the effectiveness of the various methods used to control and eradicate the disease.

RA 33.1: Risk assessments were initiated and completed on AI risk issues, including those related to importation of live birds from various AI-infected or exposed countries, and those related to the importation of animal product that might contain the AI virus.

A critical literature review identifying approaches and parameters used for modelling the spread of influenza both within and between animal and human populations was completed in December 2010.

ER 34.1: Investment through research in an improved federal capacity for control, risk assessment, diagnostics and vaccines on avian influenza issues will allow a better understanding of the spread of influenza and the effectiveness of disease control measures. These investments will allow more timely and evidence-based decision making on avian influenza responses, thus helping to reducing the risk of transmission to humans and mitigating economic and production losses.

RA 34.1: The CFIA continued improvement to the rapid diagnostic capability by developing tools and distributing updated tests to the Canadian Animal Health Surveillance Network (CAHSN). Research was also conducted to better understand the biology and evolution of virus pathogenicity and to be able to develop better strategies for AI control.

An initial conceptual framework has been developed to link human and animal disease spread models using the North American Animal Disease Spread Model (NAADSM) and EpiFlex. The final report that identifies the similarities and differences between these two models was provided in December 2010.

ER 35.1: CFIA staff continues to provide assistance to the World Organisation for Animal Health (OIE) Central Bureau in the Communications Department in an effort to promote the development and implementation of science based standards. Furthermore, the CFIA continues to support the OIE's mandate and efforts to assist member countries in the control and eradication of animal diseases, including zoonotics, through its annual contribution to the OIE. In addition, the CFIA continues to support the development of capacity to address emergence of risk at the animal level through the Canadian chapter of Veterinarians without Borders.

RA 35.1: The CFIA continues to be active internationally. For example, the North American Plan for Avian Influenza and Pandemic Influenza (NAPAPI) was revised to become the North American Plan for animal influenza and Pandemic influenza and involved CFIA representatives from TAHD, Sciences and PA. The agreement should be completed in 2011.

The CFIA engaged Australia, the United States, New Zealand, the United Kingdom, and Ireland to exchange best practices for managing activities such as destruction, disposal, decontamination, and surveillance. Incorporation into CFIA plans and procedures was made where such inclusions added value.

ER 36.1: Future AI vaccines will be purchased on an "as needed" basis.

RA 36.1: N/A

ER 37.1: Maintenance of access protocols and bank of antivirals to provide appropriate protection to federal employees, ensuring a more timely and effective response to an avian influenza situation and better protection of Canadians.

RA 37.1: The CFIA continued to maintain access to the antiviral stockpile.

ER 38.1: No planned expenditures as investments realized in previous fiscal years.

RA 38.1: N/A

ER 39.1: Maintaining, coordinating and managing an integrated lab network (federal, provincial and university labs). This network allows for rapid testing, detection and reporting of AI.

RA 39.1: CFIA continued to improve the diagnostic capacity of CAHSN, a network linked to federal, provincial, and university laboratories. As of March 31, 2011, three provincial labs were certified to the foreign Animal Disease biocontainment level, while another four provincial labs were working on certification.

An application to collate influenza test results from swine for all testing methodologies was programmed in response to the pandemic H1N1 virus. This has proven very successful and CFIA has a complete data set for all of 2009 and 2010 from all provincial, academic, and private laboratories.

ER 40.1: Continued development of a viable response plan, including HR capacity and data management tools.

RA 40.1: The Agency increased ability to respond through:

• multiple training initiatives;
• maintenance of the national stockpile inventory giving ready access to necessary equipment and supplies within hours of a declared emergency;
• continued development of a human resources skills inventory database which will provide a centralized information source to identify appropriately trained individuals to respond in an emergency (including retired staff who possess disease response experience and related skills in order to enable broader surge capacity); and
• updates to response plans to ensure the effective use of developed field surge capacity.

ER 41.1: Continued training of a reserve of professional veterinarians to enhance surge capacity, expertise and rapid response capability for animal disease control efforts.

RA 41.1: Continued to work with the Canadian Veterinary Medical Association on the development of the Canadian Veterinary Reserve to maintain and increase specialized capacity in the event of a large scale emergency. The number of reservists trained in 2010-11 was 40, bringing the total trained to 242.

Results to be achieved by non-federal partners (if applicable): N/A

Contact information:

Dr. John Spika
130 Colonnade Road
Ottawa ON K1A 0K9
613-948-7929
john.spika@phac-aspc.gc.ca

Canadian HIV Vaccine Initiative

Name of Horizontal Initiative: Canadian HIV Vaccine Initiative

Name of lead department(s): Public Health Agency of Canada (the Agency)

Lead department program activity: Disease and Injury Prevention and Mitigation

Start date of the Horizontal Initiative: February 20, 2007

End date of the Horizontal Initiative: March 31, 2017

Total federal funding allocation (start to end date): $111M

Description of the Horizontal Initiative (including funding agreement): The Canadian HIV Vaccine Initiative (CHVI) is a collaborative undertaking between the Government of Canada and the Bill & Melinda Gates Foundation (BMGF) to contribute to the global effort to develop a safe, effective, affordable and globally accessible HIV vaccine. This collaboration, formalized by a Memorandum of Understanding signed by both parties in August 2006 and renewed in July 2010, builds on the Government of Canada's commitment to a comprehensive, long-term approach to address HIV/AIDS. Participating federal departments and agencies are the Agency, Health Canada, Industry Canada, the Canadian International Development Agency, and the Canadian Institutes of Health Research.

The CHVI's overall goals are to: advance the basic science of HIV vaccine discovery and social research in Canada and low-and-middle-income countries (LMICs); support the translation of basic science discoveries into clinical research, with a focus on accelerating clinical trials in humans; address the enabling conditions to facilitate regulatory approval and community preparedness; improve the efficacy and effectiveness of HIV Prevention of Mother-to-Child (PMTCT) services in LMICs by determining innovative strategies and programmatic solutions related to enhancing the accessibility, quality, and uptake; and ensure horizontal collaboration within the CHVI and with domestic and international stakeholders.

Shared Outcome(s):

Immediate (1-3 years) Outcomes

• Increased and improved collaboration and networking among researchers working in HIV vaccine discovery and social research in Canada and in LMICs;
• Greater capacity for vaccine research in Canada;
• Enhanced knowledge base;
• Increased readiness and capacity in Canada and LMICs; and
• An Alliance Coordinating Office established.

Intermediate Outcomes

• Strengthened contribution to global efforts to accelerate the development of safe effective, affordable, and globally accessible HIV vaccines;
• An increase in the number of women receiving a complete course of anti-retroviral prophylaxis to reduce the risk of mother to child transmission of HIV; and
• A CHVI Research and Development Alliance established.

Long -Term Outcomes

• The CHVI contributes to the global efforts to reduce the spread of HIV/AIDS particularly in LMICs.

Governance Structure(s): The Minister of Health, in consultation with the Minister of Industry and the Minister of International Cooperation, is the lead Minister for the CHVI. An Advisory Board is being established and be responsible for making recommendations to responsible Ministers regarding projects to be funded and will oversee the implementation of the Memorandum of Understanding between the Government of Canada and the BMGF. The CHVI Secretariat, housed in PHAC will continue to provide a coordinating role to the Government and the BMGF.

Federal Partner: The Agency
($M)

Federal Partners	Federal Partner Program Activity (PA)	Names of Programs for Federal Partners	Total Allocation (from Start to End Date)	Planned Spending for 2010-11	Actual Spending for 2010-11	Variance for 2010-11 (from planned to actual expenditure)	Expected Results for 2010-11	Results Achieved in 2010-11
Comments on Variances: The manufacturing facility did not move forward as planned. None of the applicants were found to be successful in meeting pre-established criteria. Funds have been reprofiled. For ER 1.1, with the new direction for the CHVI, funding allocated for previously defined policy initiatives was transferred to ER 3.1, to support the increased demand in staffing resources required to establish the renewed CHVI.
Public Health Agency of Canada	Disease and Injury Prevention and Mitigation	Infectious Disease Prevention and Control	6.5	1.2	0.9	0.3	ER 1.1	RA 1.1
			17.0	8.7	0.0	8.7	ER 2.1	RA 2.1
			3.5	0.7	1.1	(0.4)	ER 3.1	RA 3.1
Total Agency			$27.0M	$10.7M	$2.0M	$8.6M

Expected Results (ER)/Results Achieved (RA):

ER 1.1: New vaccine policy approaches and increased community involvement (in partnership with Health Canada).

RA 1.1: Results achieved with respect to this expected result are demonstrated by:

• Ongoing and increased support to domestic and international stakeholders addressing HIV vaccines policy issues; building capacity and promoting global harmonization of regulatory pathways; and improving community preparedness for an eventual HIV Vaccine. The CHVI supports community organizations collaborating together and hosts dialogues and satellite sessions at key domestic and international HIV events.
• Increased knowledge about HIV vaccine research and development by supporting activities that promote the exchange of lessons learned and best practices from previous public health interventions in key population groups.
• Enhanced linkages with domestic and international programs related to HIV vaccines, supporting the AIDS Vaccine 2010 Conference attended by international: researchers, funders, policy makers and advocates.

ER 2.1: New areas of investment defined.

RA 2.1: Transferred funds to Canadian Institutes of Health Research and Health Canada to support ER 10.1 and ER 4.1.

ER 3.1: Effective horizontal coordination and communications with stakeholder groups through secretariat support services provided to CHVI committees, CHVI Web site and day-to-day communications.

RA 3.1: Results achieved with respect to this expected result are demonstrated by:

• Coordinated Government-Foundation approach to implementing the CHVI , which included r enewing the funding for an increased duration of the partnership.
• Supporting the establishment of a strong vibrant CHVI Research and Development Alliance through the establishment of the renewed governance structure and the CHVI Advisory Board and undertaking an open and transparent selection process to select an organization to host the Alliance Coordinating Office.
• Strengthening linkages with domestic and international stakeholders.

Federal Partner: Health Canada
($M)

Federal Partners	Federal Partner Program Activity (PA)	Names of Programs for Federal Partners	Total Allocation (from Start to End Date)	Planned Spending for 2010-11	Actual Spending for 2010-11	Variance for 2010-11 (from planned to actual expenditure)	Expected Results for 2010-11	Results Achieved in 2010-11
*This Program was previously listed as the International Health Grants Program; however, Health Canada's engagement in the renewed CHVI was revised.
Health Canada	International Health Affairs	International Health Grants Program*	1.0	0.0	0.05	(0.05)	ER 4.1	RA 4.1
	Health Products	Biologics and Genetic Therapies Directorate	0.0	0.0	0.15	(0.15)	ER 4.2	RA 4.2
Total Health Canada			$1.0M	$0.0M	$0.2M	$(0.2)M

Comments on Variances: Planned spending was $0.0M when RPP 2010-11 was published. Plans were later adjusted to reflect initiatives to be implemented in 2010-11. Additional funds under International Health Affairs in the amount of $0.15M were not spent due to the postponement of an international regulatory capacity building workshop until June 2011, and the unavailability of funds until February 2011 resulting in limited time to implement initiatives such as the Health Canada Mentorship Program. Implementation of the Mentorship Program has commenced as of 2011-12.

Health Canada spending also included $0.15M based on funds transferred from PHAC to Health Canada as outlined in R.A. 2.1 ($0.15M for FY 2010-11 from a total of $4.0M over a 5 year period) towards the implementation of regulatory capacity building activities. Therefore total Health Canada spending for FY 2010-11 was $0.2M.

Expected Results (ER)/Results Achieved (RA):

ER 4.1: New vaccine policy approaches and increased community involvement (in partnership with the Agency).

RA 4.1: Implementation of regulatory capacity building initiatives for developing countries in collaboration with the Biologics and Genetic Therapies Directorate.

ER 4.2: Strengthen the regulatory capacity of developing national regulatory authorities targeted for vaccine and clinical trial submissions, including those related to HIV/AIDS.

RA 4.2: Implementation of capacity building initiatives for developing countries to help strengthen their ability to regulate clinical trials and licensing of HIV/AIDS vaccines.

Federal Partner: Industry Canada
($M)

Federal Partners	Federal Partner Program Activity (PA)	Names of Programs for Federal Partners	Total Allocation (from Start to End Date)	Planned Spending for 2010-11	Actual Spending for 2010-11	Variance for 2010-11 (from planned to actual expenditure)	Expected Results for 2010-11	Results Achieved in 2010-11
Comments on Variances: The manufacturing facility did not move forward as planned. None of the applicants were found to be successful in meeting pre-established criteria. Funds have been reprofiled.
Industry Canada	Industry Sector- Science and Technology and Innovation	Canadian HIV Technology Development	13.0	3.3	0.0	(3.3)	ER 5.1	RA 5.1
Total Industry Canada			$13.0M	$3.3M	$0.0M	$(3.3)M

Expected Results (ER)/Results Achieved (RA):

ER 5.1: New areas of investment defined.

RA 5.1: New areas of investment defined, along with the development, approbation and implementation of a new contribution program to encourage the participation of small and medium enterprises (SMEs) that operate in Canada in the development of an HIV vaccine and other technologies related to the prevention, treatment and diagnosis of HIV.

In 2010-11, Industry Canada received the authorization to create and redirect funding to the new Canadian HIV Technology Development (CHTD) component of the National Research Council's Industrial Research Assistance Program (NRC-IRAP) and to modify NRC-IRAP Terms and Conditions. In February 2011, NRC-IRAP Technology Advisors launched the CHTD and started to promote the program to Canadian SMEs in order to raise awareness and solicit project applications. When NRC-IRAP signs a Contribution Agreement with an SME, money is disbursed only after proposed activities have been undertaken and invoices for admissible expenses submitted. As this could not realistically happen before the end of the 2010-11, funds were reprofiled to 2011-12. As of May 2011, eight projects have been submitted to the CHVI Advisory Board and NRC-IRAP is waiting for a positive recommendation (in writing) before they can sign any contribution agreement.

Federal Partner: Canadian International Development Agency ($M)

Federal Partners	Federal Partner Program Activity (PA)	Names of Programs for Federal Partners	Total Allocation (from Start to End Date)	Planned Spending for 2010-11	Actual Spending for 2010-11	Variance for 2010-11 (from planned to actual expenditure)	Expected Results for 2010-11	Results Achieved in 2010-11
Comments on Variances: The manufacturing facility did not move forward as planned. None of the applicants were found to be successful in meeting pre-established criteria. Funds have been reprofiled.
Canadian International Development Agency	Enhanced capacity and effectiveness of multilateral institutions, Canadian and international organizations in achieving development goals	International Development Assistance Program	16.0	3.5	3.5	0.0	ER 6.1	RA 6.1
			12.0	0.0	0.0	0.0	ER 7.1	RA 7.1
			30.0	12.3	6.0	6.3	ER 8.1	RA 8.1
			2.0	0.5	0.5	0.0	ER 9.1	RA 9.1
Total CIDA			$60.0M	$16.3M	$10.0M	$6.3M

Expected Results (ER)/Results Achieved (RA):

ER 6.1: Increased capacity to conduct high-quality clinical trials of HIV vaccine and other related prevention technologies in LMICs through new teams of Canadian and LMICs researchers and research institutions.

RA 6.1: A six-year, $16.0M project spanning 2008-09 to 2013-14 is in place with the Global Health Research Initiative. This project will strengthen the capacity of researchers and research institutions to conduct high quality clinical trials and build site capacity to conduct HIV vaccine clinical trials in low and middle-income countries. To date, capacity building sub-grants totalling $11.7M have been awarded to seven teams made up of Canadian and African researchers.

ER 7.1: In collaboration with CIHR, increased capacity and greater involvement and collaboration amongst researchers working in HIV vaccine discovery and social research in Canada and in LMICs through the successful completion of the development stage of the Team Grant program to support collaborative teams of Canadian and LMIC researchers.

RA 7.1: A seven-year project in partnership with the CIHR ($17.0M from 2010-11 to 2016-17) is now in place. This project will strengthen the capacity of researchers, promoting greater involvement and collaboration among researchers working in HIV vaccine discovery and social research in Canada and LMICs. The project includes elements such as:

• Ongoing funding provided to five Canadian researchers for operating grants;
• Funding of two teams of Canadian researchers through the Emerging Team Grants - HIV/AIDS Vaccine Discovery and Social Research program; and
• Funding for nine collaborative teams of Canadian and LMIC researchers to support the development of Large Team Grant - HIV/AIDS Vaccine Discovery and Social Research program applications.

ER 8.1: New areas of investment defined.

RA 8.1: An agreement has been put in place with the World Health Organization for $20.0 million over the five years from 2010-11 to 2014-15 to enhance the availability, quality and uptake of prevention of mother to child transmission services. Other projects are being pursued for the remaining funds under this component.

ER 9.1: Increased capacity of regulatory authorities in LMICs especially those where clinical trials are planned or ongoing, through training and networking initiatives.

RA 9.1: The Agency has a project in place with the World Health Initiative in support of capacity-building activities to improve regulatory capacity in LMICs, especially those where clinical trials are planned or ongoing. To date, this four-year project from 2009-10 to 2012-13 has realized the:

• recruitment of full-time professional staff person for the African Vaccine Regulatory Forum;
• assembly of a task team to develop and consult on Terms of Reference for the formalization of the African Vaccine Regulatory Forum;
• delivery of GCP inspection courses in Indonesia (March 2010); and
• delivery of Evaluation of Clinical Data course for participants from seven countries (March 2011)

Federal Partner: Canadian Institutes of Health Research
($M)

Federal Partners	Federal Partner Program Activity (PA)	Names of Programs for Federal Partners	Total Allocation (from Start to End Date)	Planned Spending for 2010-11	Actual Spending for 2010-11	Variance for 2010-11 (from planned to actual expenditure)	Expected Results (ER) for 2010-11	Results Achieved (RA) in 2010-11
Canadian Institutes of Health Research	HIV/AIDS Research Initiative	HIV/AIDS Research Initiative	10.0	1.2	1.2	0.0	ER 10.1	RA 10.1
Total CIHR			$10.0M	$1.2M	$1.2M	$0.0M

Comments on Variances: none

Expected Results (ER)/Results Achieved (RA):

ER 10.1: Increased capacity and greater involvement and collaboration amongst researchers working in HIV vaccine discovery and social research in Canada and in LMICs through:

1. ongoing support for operating and catalyst grants undertaken by Canadian researchers;
2. commencement of funding for two emerging teams of Canadian researchers; and
3. completion of the development stage of the Large Team Grant program to support collaborative teams of Canadian and LMIC researchers in collaboration with CIDA.

RA 10.1: Increased capacity and greater collaboration amongst researchers with new and on-going funding awarded to researchers and teams of researchers working in HIV vaccine and social research in Canada and in LMICs demonstrated by:

1. ongoing funding provided to five Canadian researchers for operating grants;
2. funding of two teams of Canadian researchers through the Emerging Team Grants - HIV/AIDS Vaccine Discovery and Social Research program; and
3. funding for nine collaborative teams of Canadian and LMIC researchers to support the development of Large Team Grant - HIV/AIDS Vaccine Discovery and Social Research program applications.

Results to be achieved by non-federal partners (if applicable):

Contact Information:

Lilja Jónsdóttir
200 Eglantine Driveway
Ottawa, Ontario K1A 0K9
613-957-6592
Lilja.Jonsdottir@phac-aspc.gc.ca