Social determinants of health and retention in HIV care in a clinical cohort in Ontario, Canada

Rachlis, Beth; Burchell, Ann; Gardner, Sandra; Light, Lucia; Raboud, Janet; Antoniou, Tony; Bacon, Jean; Benoit, Anita C.; Cooper, Curtis; Kendall, Claire; Loutfy, Mona; Wobeser, Wendy; McGee, Frank; Rachlis, Anita; Rourke, Sean B.

doi:10.1080/09540121.2016.1271389

Cited by 34 publications

(34 citation statements)

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“…In addition to offering chronic disease management, primary care settings had a greater range of mental health and addictions services. These services are critical to closing the gaps in mental health care among people living with HIV in Canada,[ 35 ] reducing barriers associated with the social determinants of health,[ 36 ] and supporting priority populations such as people who use drugs[ 37 ] or experience homelessness. [ 38 ]…”

Section: Discussionmentioning

confidence: 99%

The organizational attributes of HIV care delivery models in Canada: A cross-sectional study

et al. 2018

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HIV treatment in Canada has rapidly progressed with the advent of new drug therapies and approaches to care. With this evolution, there is increasing interest in Canada in understanding the current delivery of HIV care, specifically where care is delivered, how, and by whom, to inform the design of care models required to meet the evolving needs of the population. We conducted a cross-sectional survey of Canadian care settings identified as delivering HIV care between June 2015 and January 2016. Given known potential differences in delivery approaches, we stratified settings as primary care or specialist settings, and described their structure, geographic location, populations served, health human resources, technological resources, and available clinical services. We received responses from 22 of 43 contacted care settings located in seven Canadian provinces (51.2% response rate). The total number of patients and HIV patients served by the participating settings was 38,060 and 17,678, respectively (mean number of HIV patients in primary care settings = 1,005, mean number of HIV patients in specialist care settings = 562). Settings were urban for 20 of the 22 (90.9%) clinics and 14 (63.6%) were entirely HIV focused. Primary care settings were more likely to offer preventative services (e.g., cervical smear, needle exchange, IUD insertion, chronic disease self-management program) than specialist settings. The study illustrates diversity in Canadian HIV care settings. All settings were team based, but primary care settings offered a broader range of preventative services and comprehensive access to mental health services, including addictions and peer support.

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Section: Discussionmentioning

confidence: 99%

The organizational attributes of HIV care delivery models in Canada: A cross-sectional study

et al. 2018

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“… 20 In addition, low self-efficacy, comorbid psychiatric conditions and female gender are also linked to lower rates of adherence, 21 22 as are younger age (<40 years), drug use, indigenous ethnicity and hazardous drinking or smoking status. 19 23 These findings indicate that adherence to ART and retention in care in Canada are profoundly shaped by the social contexts of patients’ lives.…”

Section: Introductionmentioning

confidence: 99%

“…With regard to HIV, retention has been defined as ‘patients known to be alive and receiving treatment,’ or based on the frequency of clinic visits (varying from 2 weeks to 1 year), 18 or the number of viral load tests conducted each year. 19 …”

Section: Introductionmentioning

confidence: 99%

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Strategies to improve adherence to antiretroviral therapy and retention in care for people living with HIV in high-income countries: a protocol for an overview of systematic reviews

et al. 2018

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IntroductionWhile access to antiretroviral therapy (ART) for people living with HIV has expanded in recent years, additional efforts are required to support adherence to medication and retention in care. Interventions should be applicable in real-world settings and amenable to widespread use. The objectives of this overview are to identify effective pragmatic interventions that increase adherence to ART and retention in care for people living with HIV at high risk for suboptimal adherence and retention in high-income countries.Methods and analysisWe will conduct an overview of systematic reviews of studies on interventions which target improved adherence to medication and retention in care among high-risk people living with HIV in high-income countries (men who have sex with men, African, Caribbean and black people, sex workers, people who inject drugs, indigenous people and other socially marginalised groups). We will search the following databases: PubMed, EMBASE (Exerpta Medica Database), CINAHL (Cumulative Index to Nursing and Allied Health Literature), PsycINFO, Web of Science and the Cochrane Library. We will conduct screening, data extraction and assessment of methodological quality of the systematic reviews. Analysis will be narrative. Our findings will be interpreted in light of the certainty of the evidence, level of pragmatism, setting and population of interest.Ethics and disseminationOnly published secondary data will be used in this study, and therefore ethics approval is not required. Our findings will be disseminated as peer-reviewed manuscripts, conference abstracts and through community activities. The findings from this overview will inform a mixed-methods study among people living with HIV and health workers in Ontario, Canada.

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“…The cascade of care (ie, HIV treatment cascade or the HIV care continuum) is a framework recommended by UNAIDS for member countries to measure their progress in ending the AIDS epidemic 2. Individual countries, and individual states and provinces within those countries, have adapted this continuum to fit their local contexts12 13 and consulted patients in its local implementation 14 15. However, a common end point is universal among these frameworks: retention in care (ie, attending regular medical appointments and accessing community supports) and maintaining viral suppression (<50 copies of HIV per millilitre of blood, meaning that people living with HIV cannot sexually transmit the virus) 16 17.…”

Section: Introductionmentioning

confidence: 99%

The ART of conversation: feasibility and acceptability of a pilot peer intervention to help transition complex HIV-positive people from hospital to community

et al. 2019

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ObjectivesTo pilot a peer-based intervention for people living with HIV who used substances, had challenges with antiretroviral adherence and would be discharged from hospital to community.Study designA community-based, quasi-experimental pilot intervention study designed to assess feasibility, acceptability and connection to a community-based HIV organisation.SettingThis study was conducted in Toronto, Canada, at Casey House (CH; hospital for people living with HIV) in collaboration with the AIDS Committee of Toronto (ACT; community-based HIV organisation).ParticipantsPeople living with HIV who were CH inpatient between 1 April 2017 and 31 March 2018, struggled with antiretroviral adherence, actively used substances and would be discharged to community were eligible. Forty people met criteria, 19 were approached by an inpatient nurse and 17 consented. Average age was 48.8 years (SD=11.4), 58.8% were male and participants averaged 7.8 physical and mental health comorbidities (SD=3.1).InterventionTitled ’The ART of Conversation', the three-pronged personalised intervention was developed through input from CH clients and ACT volunteers, all living with HIV. Intervention components were (a) predischarge goal-setting (adherence, substance use and self-identified goal) with the study nurse; (b) predischarge meeting with an HIV+ peer volunteer (PV) and (c) nine postdischarge phone calls between PV and participant, once per day for 3 days, then once per week for 6 weeks.Primary outcomesFeasibility was measured through proportion of eligible participants recruited and PV availability. Acceptability was assessed through participant interviews at three times (preintervention, post-intervention and 6 weeks follow-up) and through PV call logs. Client records determined connection to ACT within the study timeframe.ResultsTwelve participants completed the intervention and nine connected with ACT. Predischarge goal-setting and PV meeting were both feasible and acceptable. Postdischarge phone calls were a challenge as half of completers missed at least one call.ConclusionsAlthough predischarge goal-setting and PV meeting were feasible, methods to maintain connection following discharge require further investigation.

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Social determinants of health and retention in HIV care in a clinical cohort in Ontario, Canada

Cited by 34 publications

References 34 publications

The organizational attributes of HIV care delivery models in Canada: A cross-sectional study

The organizational attributes of HIV care delivery models in Canada: A cross-sectional study

Strategies to improve adherence to antiretroviral therapy and retention in care for people living with HIV in high-income countries: a protocol for an overview of systematic reviews

The ART of conversation: feasibility and acceptability of a pilot peer intervention to help transition complex HIV-positive people from hospital to community

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