Abstract
OBJECTIVES: The objective of the Immediate Staging Pilot Project (ISPP) was to improve linkage to human immunodeficiency virus (HIV) care by increasing the number of referrals made to HIV care, and to decrease the time between diagnosis and linkage to care for newly diagnosed HIV clients. This pilot had the potential to decrease HIV transmission at a population level by engaging clients in treatment earlier.
SETTING: The Bute Street Clinic and Health Initiative for Men Clinic on Davie in Vancouver, British Columbia are low-threshold public health facilities providing HIV/STI testing primarily to men who have sex with men (MSM).
INTERVENTION: To improve engagement of MSM in the cascade of HIV care, the BC Centre for Disease Control implemented a 12-month ISPP in 2012 for clients newly diagnosed with HIV. The pilot offered CD4 and viral load testing at the time of diagnosis, implemented improved referral procedures and enhanced nursing support for clients.
OUTCOMES: Comparing linkage to care outcomes between a group that received the standard of care (SOC) and an intervention group that received immediate staging, the median linkage to care time decreased from 21.5 to 14.0 days respectively (p = 0.053). The referral rates to HIV care were 56.1% in the SOC group and 94.1% in the intervention group (p < 0.001).
CONCLUSION:Creating best practices that include offering CD4 and viral load testing at the time of diagnosis, enhanced nursing support and standardized referral processes has facilitated an improvement in the quality of HIV services provided to MSM clients attending low-threshold clinics.
Key Words: Linkage to care, continuum of care, HIV, men who have sex with men, low-threshold sites, outcome assessment (health care)
Résumé
OBJECTIFS: Le projet pilote ISPP (Immediate Staging Pilot Project ou projet pilote de mise en place immédiate) visait à améliorer le lien vers les soins du virus de l’immunodéficience humaine (VIH) en augmentant le nombre d’orientations vers les soins du VIH, et à réduire le délai entre le diagnostic et le lien vers les soins pour les patients ayant reçu un diagnostic récent de VIH. Le projet pilote pouvait potentiellement réduire la transmission du VIH dans l’ensemble de la population en amorçant le traitement des patients plus tôt.
LIEU: Les cliniques Bute Street Clinic et Health Initiative for Men on Davie de Vancouver (Colombie-Britannique) sont des établissements de santé publique à seuil bas qui offrent le dépistage du VIH et des ITS principalement aux hommes ayant des relations sexuelles avec des hommes (HARSAH).
INTERVENTION: Pour améliorer l’intégration des HARSAH dans le flot des soins du VIH, le BC Centre for Disease Control a mis en œuvre ce projet pilote de 12 mois pour les patients ayant reçu un diagnostic récent de VIH. Le projet pilote offrait la numération des lymphocytes CD4 et la mesure de la charge virale au moment du diagnostic, appliquait une procédure d’orientation améliorée et rehaussait le soutien infirmier des patients.
RÉSULTATS: En comparant les résultats du lien vers les soins entre un groupe ayant reçu la norme de soins (NDS) et un groupe d’intervention ayant reçu la mise en place immédiate des soins, la durée médiane du lien vers les soins a diminué, passant de 21,5 à 14 jours, respectivement (p = 0,053). Les taux d’orientation vers les soins du VIH étaient de 56,1% dans le groupe de la NDS et de 94,1% dans le groupe d’intervention (p < 0,001).
CONCLUSION: La création de pratiques exemplaires incluant la numération des lymphocytes CD4 et la mesure de la charge virale au moment du diagnostic, un soutien infirmier renforcé et des processus d’orientation standardisés a favorisé une amélioration de la qualité des services VIH offerts aux patients HARSAH fréquentant des cliniques à seuil bas.
Mots Clés: lien vers les soins, chaîne des soins, VIH, hommes ayant des relations sexuelles avec des hommes, établissements à seuil bas, évaluation de résultat (soins)
Footnotes
Acknowledgements: The authors acknowledge the nurses at the Bute Street and HIM on Davie Clinics, Annelies Becu, Teddy Consolacion and Heather Pedersen, whose contributions made this program possible. This project was operationally supported by the BC Centre for Disease Control.
Conflict of Interest: None to declare.
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