Filling Gaps to Provide HIV Care in Rural Regions

posted on February 20, 2017

Colleen Maloney, Health Outreach Nurse with South Okanagan on right and Denelle Bonneau, a new graduate from Athabasca University’s Post Licensed Practical Nurse (LPN) Program.

This post follows a previous article profiling the STOP Outreach Team in Vancouver (under Vancouver Coastal Health). A series of posts this month looks at the contributions provided by teams and team members working across the province to achieve the goals of the STOP HIV/AIDS program, implemented in BC with support from the provincial government.

Working together to stop HIV and AIDS

The STOP HIV/AIDS Program, based on the concept of Treatment as Prevention (or TasP) pioneered by BC-CfE Director Dr. Julio Montaner, aims to engage vulnerable populations in earlier HIV testing, treatment and care. What does it mean to conduct this work in the 215,000-square-kilometre region covered by the Interior Health Authority? Colleen Maloney was a public health nurse for many years before she became a Health Outreach Nurse in the South Okanagan (part of the Interior Health region). The BC-CfE spoke with her about this experience, and the triumphs and setbacks she sees in her role.

Within the framework and philosophy of the STOP HIV/AIDS program, factors like housing, access to income and employment, and care for mental health and addiction are interwoven with one’s ability to reach and maintain HIV treatment. Clients in the South Okanagan face shortages of resources to address these social determinants of health, according to Maloney. When addressed, these factors can lead to encouraging and notable improvements in clients’ overall wellbeing.

“Stable housing is key,” said Maloney. “Once I get a client housed, things settle down in their lives. For example, they may use fewer [illicit] drugs, keep appointments and take their medications on a more regular basis.”

Finding success in the face of challenges

Maloney works out of the Martin Street Outreach Centre, opened in 2015, where mental health, addiction, general practitioner (GP) and HIV care are all under one roof. Maloney sees the team approach leading to big gains.

One particularly striking success story is of an individual who was living with both hepatitis C and HIV, and is a user of injection drugs. He didn’t fit the criteria some in the health care community might associate with likely success in achieving curative treatment for hepatitis C. Still, with support from the outreach team and a move into stable housing, he completed a six-month hepatitis C treatment course. He also significantly reduced his drug use and has improved his consistency in taking other medications including his HIV antiretrovirals.

There have been similar stories in Vancouver’s Downtown Eastside where the achievement of high rates of HIV treatment and significant declines in HIV transmission, mainly among a hard-to-reach population of people who use drugs, are credited as the main drivers of the decreasing rates of HIV in the province of BC. In the 1980s to mid-1990s, Vancouver was the epicentre and ground zero of HIV. It has since turned itself around to become a model in sustainable HIV care and treatment—through TasP and Dr. Montaner’s tireless advocacy for expansion of earlier HIV testing and treatment.

Stigma is another challenge that can hit rural communities especially hard. People living with HIV in some parts of the Interior, like the South Okanagan, have not had any peer support or opportunities to talk to others living with HIV. New and expanding programs and peer network supports (like retreats funded by Positive Women’s Network, leadership training and support groups) can play a positive role. “For one woman who [recently attended] a Positive Women’s Network retreat, it was the first time she was able to talk about her HIV and she found it very empowering,” said Maloney.

Expanding capacity to reach the goals of the STOP HIV/AIDS program

Fortunately, Maloney said her region is seeing a growing network of specially trained physicians and health care providers, who have shadowed infectious disease physicians at Vancouver’s St. Paul’s Hospital as part of the BC-CfE’s Preceptorship postgraduate program. Designed for physicians, family practice residents and nurse practitioners, the program consists of rotations at the St. Paul’s Immunodeficiency Clinic (IDC) and other related clinics. Health care providers return home with skills to provide more specific and targeted HIV care, in line with HIV treatment guidelines.

“These physicians provide a high level of HIV care and have access to infectious disease specialists in Kelowna and Kamloops,” said Maloney. “It’s really satisfying to see people get the care they need. HIV care is much more than just prescribing antiretrovirals.”

An outreach nurse in a smaller community wears many hats. In rural regions, like the ones covered by Interior Health, many miles can separate outreach team members. They meet regularly via phone conference and twice-yearly in-person to share crucial updates and maintain a collaborative relationship. Despite big obstacles, the results of working as part of an outreach team can be multifold. “Helping people navigate the system so clients can take care of themselves, take their antiretrovirals and follow up with their referrals—it takes time, but it is so rewarding,” said Maloney.

“You’ve got to get their trust before clients solidly engage in care. You have to work with the client’s priorities and celebrate each successful step that they take,” added Maloney. “The goal of the outreach program is to get people to manage their needs independently and eventually to transition them off of my caseload.”

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STOP HIV/AIDS

Treatment as Prevention®

BC Centre for Excellence in HIV/AIDS

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Filling Gaps to Provide HIV Care in Rural Regions

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