Financing Integrated Models of Care and Support The Vancouver STOP HIV Experience

Transcription

1 Financing Integrated Models of Care and Support The Vancouver STOP HIV Experience Presenter: Miranda Compton Manager, Regional HIV Program, Vancouver Coastal Health September 15, 2015

2 STOP HIV Pilot Initiative 2010: Through Dr. Julio Montaner (BC CFE) advocating for the opportunity of Treatment as Prevention approach, the British Columbia Minister of Health announced funding for 3 year Pilot Project ( ) : The STOP HIV Project STOP = Seek and Treat to Optimally Prevent HIV/AIDS 2 Pilot sites: Vancouver and Prince George (Northern BC) Focus on1) increasing testing and diagnosis and 2) ensuring timely connection treatment and long-term treatment engagement. Project built on the existing continuum of services including: 1) a robust harm reduction program 2) A provincially funded HIV Drug Treatment Program offers universal access to medication for all BC residents. 2

3 HIV Epidemic in British Columbia 3

4 STOP HIV Pilot Initiative 3 main approaches to investment of resources (approx. $20 million over 3 years): Expand capacity within existing system Try new approaches gather ideas from clinicians, researchers, community Develop new partnerships across continuum of care Assertive approach to evaluation funding for initiatives was renewed on a 6 month basis to ensure continual dialogue with project partners, and on-going assessment of the efficacy of the individual projects. 4

5 Year 1 & 2 STOP HIV initiatives New care and treatment resources were geared toward individuals who had a detectable pvl, not engaged in services pvl data was collected across all programs as a key indicator of increased health stability Programs implemented: - Expanded clinical capacity - Expanded access to POC Testing - Peer Navigator Program - Treatment adherence programs within community drop-ins - Housing Programs (outreach workers, stabilization, supported housing, rental subsidies) 5

6 STOP HIV Outreach Team New Clinical Outreach Team: RNs, Social Workers, Outreach Workers, to work with individuals who were: Newly diagnosed Disengaged from care Not successfully adhering to ARV treatment 6

7 Impact of new resources After 1 year+ implementation, most projects had promising results but - Long-standing clinical and community service providers reported increased caseload, and increased client complexity as a result of the new clients who were being engaged in care. - Demand on newly implemented services growing at unsustainable rate New resources were not magic bullet: Services were still working in relative silos Recognized need to utilize STOP resources to revision entire system of HIV care to increase integration. 7

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9 Transition to Hope to Health Integrated Service Delivery System Early 2013: Minister of Health announces on-going funding for initiative: Hope to Health - Expanded scope to include prevention - Expanded to Province-wide program New service delivery models informed revisionning across direct clinical programs and community contracts 9

10 Model for HIV Care and Treatment

11 Model for HIV Care and Treatment Street-based outreach Maximally assisted therapy Pharmacy Daily dispense Residential medication programs Specialized housing /residential care Intensive care coordination Interdisciplinary support RH Pharmacy ad hoc Housing Outreach/ supported housing Care planning System navigation support Healthcare, income support, food/nutrition, affordable housing, etc Wellness and Treatment Information resources Counselling, Support groups Resource information ( health services, housing, income, education, employment) Peer support HIV-knowledgeable Family Physician\ Specialists Treatment access

12 Care & Treatment Pods

13 Care and Treatment Results STOP Outreach Team random sample of 135/481 discharged clients: 39% had suppressed intake Median # days with CM % had pvl<200at discharge 79% had pvl <200 at most recent measure (>6 months post discharge) Housing Programs N= 134 clients 30% pvl <200@ intake 70% pvl <200@ most recent measure (Jan 2015) 13

14 Source: Public Health Surveillance Unit (HIV Surveillance Data) & BCCfE Drug Treatment Program Data. Prepared by: Vancouver Coastal Health, Public Health Surveillance Unit. April 21,

15 Next steps Focus on individuals who continue to face challenges in maintaining engagement in care (approx. 20% of HIV+ population) Housing endures as a primary, pivotal factor in health outcomes Need for greater integration with Mental Health/addictions sectors to address on-going barriers to stable housing and treatment engagement among complex, high need clients. 15

16 Special Thanks to: My many colleagues on the Vancouver Hope to Health Team Chris Buchner, Scott Harrison, Dr. Reka Gustafson, Julie Kille,Ellen Demlow, Jill Pringle, Elizabeth Holliday, Glenn Doupe, Logan Chinski, Nancy Chow, Sarah Levine, Troy Shannon, The STOP Clinical Outreach Team, VCH Contracted HIV Services Questions? Miranda Compton Regional Manager, HIV Services VCH/PHC Hope to Health Initiative