First-of-its-kind initiative aims to engage more individuals living with HIV in care and treatment

posted on June 15, 2018

Outreach workers persistent in helping support the needs of their most hard-to-reach clients

Re-engagement and Engagement in Treatment for Antiretroviral Interrupted and Naïve Populations (RETAIN) is BC-CfE initiative that aims to reach patients who have stopped accessing HIV treatment and care by linking these individuals to outreach teams across the province. RETAIN is the first initiative of its kind in North America, linking clinical and public health services to address HIV.

RETAIN is implemented by teams within the five B.C. regional Health Authorities who are a part of STOP HIV/AIDS, a province-wide initiative to better engage individuals living with HIV in testing, care and treatment. STOP teams include outreach nurses, social workers, counsellors, and other outreach workers collaborating to support the needs of people living with HIV in their communities. They are tireless in their efforts to engage or reengage clients into care and RETAIN is a component of their strategy.

Kassie Junek (centre), Outreach Nurse with other members of the VCH STOP HIV/AIDS Team

The results from the RETAIN program are encouraging so far. In the past five years, the BC-CfE Drug Treatment Program (DTP) has sent approximately 6,000 treatment interruption alerts to physicians across the province – the clarion call to indicate that an individual has been out of touch with their HIV treatment program for 60 days or longer.

Out of the close to 6,000 alerts, 1,152 individuals were referred to the STOP Teams. Some of the clients referred to STOP teams were removed from the referral list for reasons such living out-of-jurisdiction, being on HIV treatment from other sources or being previously known to public health offices at the time of their HIV diagnosis. This resulted in 634 active referrals to the Health Authorities. At the provincial level, of those actively referred, 45% were linked to care and 43% were engaged in ART.

In May, members of STOP teams convened to share about their experiences, challenges and triumphs in working towards the goals of the STOP HIV/AIDS® and RETAIN initiatives. “We are grateful for the work that you are doing,” says Dr. Julio Montaner, Director of the BC-CfE. “This is a critical aspect of our strategy to stop the spread of HIV.

A BC-CfE analysis of RETAIN found the initiative is contributing to a reduction in the length of time clients are lost to care. “I feel like RETAIN is really helpful to Vancouver Coastal Health [VCH] because no one is slipping through the cracks,” said Kassie Junek, Outreach Nurse with the VCH STOP HIV/AIDS Team.

Karien Lanenga, the Regional Nursing Lead for Communicable Diseases with Northern Health

According to STOP team members, RETAIN has been a boost in reaching individuals lost to care, as well as in raising awareness among the health care community and among physicians. “For some of the clients [referred by RETAIN], we otherwise wouldn’t be aware that they have disengaged or stopped treatment for one reason or another. Receiving those referrals is an access point for that person. It’s had a really positive impact,” said Karien Lanenga, the Regional Nursing Lead for Communicable Diseases with Northern Health.

By sharing best practices and case studies, unique and differing challenges and common experiences emerged among STOP team members. For example, the Northern Health Authority serves a very large geographic area equivalent to roughly two-thirds of British Columbia, with a population equivalent to about half of downtown Vancouver. Some places can only be accessed by snowmobile in the winter, and by airplane in the summer. In contrast, nurses on the Fraser Health team serve an area spanning several large municipalities and encounter difficulties in managing travel to clients amid high traffic.

Persistence, flexibility and honesty are resounding themes. STOP team members sometimes use Skype or Facebook to reach individuals. Lanenga has found that in-person visits have been key to re-engagement, which can entail coordination with other organizations to bridge the connection. Consistent, persistent outreach can engender success in bringing the most reticent clients into care. One hard-to-reach client of the Interior Health team was impressed the STOP team hadn’t given up on finding him.

Nurse Sheila Murphy with other members of the Fraser Health STOP HIV/AIDS Team

An important concept shared by team members is meeting clients “where they are” and addressing complex issues that may be hindering clients’ access to care. “Some clients may need intensive case management while others may only need to be connected to one or two services. For those that decline our services, it allows us to reach out to them, let them know about our program and how they may connect with us if they choose in the future,” said Sheila Murphy, a nurse on the Fraser Health STOP Team.

Outreach workers are often focused on critical needs and social determinants of health such as access to housing or employment, immigration barriers and substance use issues. This, in turn, helps build a trusting relationship between STOP teams and their clients, who may be more open to receiving care and treatment. Program results have shown very few clients have declined to receive ART.

“I hope to see that RETAIN will become an unnecessary program when all of our clients are connected with the services and health care they need,” said Murphy.

For more information about RETAIN, please visit: http://www.cfenet.ubc.ca/stop-hivaids/retain

RETAIN is a component of the Treatment as Prevention (TasP®) strategy, based on the concept that an individual living with HIV who is engaged in effective, consistent treatment will achieve improved quality of life, reach undetectable viral load and be unable to transmit the virus to others. There is resounding scientific consensus that when an individual reaches a viral load that is undetectable by standard blood tests, the chances they can transmit the HIV virus to others drop to zero.
The Drug Treatment Program is one of the foundational programs of the BC-CfE, funded by PharmaCare and tasked with distributing HIV antiretrovirals (ART) to individuals diagnosed with HIV. Information from all participants is entered into a database, which acts as a registry of HIV-treating physicians in the province, as well as an early warning system about the trajectory of the disease.

BC Centre for Excellence in HIV/AIDS

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First-of-its-kind initiative aims to engage more individuals living with HIV in care and treatment

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