Integrated HIV care and service engagement among people living with HIV who use drugs in a setting with a community-wide treatment as prevention initiative: A qualitative study in Vancouver, Canada

dc.contributor.authorCollins, Alexandra B.
dc.contributor.authorParashar, Surita
dc.contributor.authorHogg, Robert S.
dc.contributor.authorFernando, Saranee
dc.contributor.authorWorthington, Catherine
dc.contributor.authorMcDougall, Patrick
dc.contributor.authorBaltzer Turje, Rosalind
dc.contributor.authorMcNeil, Ryan
dc.date.accessioned2018-08-07T19:56:32Z
dc.date.available2018-08-07T19:56:32Z
dc.date.copyright2017en_US
dc.date.issued2017-03
dc.description.abstractIntroduction: Social-structural inequities impede access to, and retention in, HIV care among structurally vulnerable people living with HIV (PLHIV) who use drugs. The resulting disparities in HIV-related outcomes among PLHIV who use drugs pose barriers to the optimization of HIV treatment as prevention (TasP) initiatives. We undertook this study to examine engagement with, and impacts of, an integrated HIV care services model tailored to the needs of PLHIV who use drugs in Vancouver, Canada - a setting with a community-wide TasP initiative. Methods: We conducted qualitative interviews with 30 PLHIV who use drugs recruited from the Dr. Peter Centre, an HIV care facility operating under an integrated services model and harm reduction approach. We employed novel analytical techniques to analyse participants' service trajectories within this facility to understand how this HIV service environment influences access to, and retention in, HIV care among structurally vulnerable PLHIV who use drugs. Results: Our findings demonstrate that participants' structural vulnerability shaped their engagement with the HIV care facility that provided access to resources that facilitated retention in HIV care and antiretroviral treatment adherence. Additionally, the integrated service environment helped reduce burdens associated with living in extreme poverty by meeting participants' subsistence (e.g. food, shelter) needs. Moreover, access to multiple supports created a structured environment in which participants could develop routine service use patterns and have prolonged engagement with supportive care services. Our findings demonstrate that low-barrier service models can mitigate social and structural barriers to HIV care and complement TasP initiatives for PLHIV who use drugs. Conclusions: These findings highlight the critical role of integrated service models in promoting access to health and support services for structurally vulnerable PLHIV. Complementing structural interventions with integrated service models that are tailored to the needs of structurally vulnerable PLHIV who use drugs will be pursuant to the goals of TasP.en_US
dc.description.reviewstatusRevieweden_US
dc.description.scholarlevelFacultyen_US
dc.description.sponsorshipThe Dr Peter Study is funded by the Canadian Institutes of Health Research (CIHR R-PHE-122186). The DTP receives funding from the provincial government of British Columbia (PharmaCare). Ryan McNeil is supported by the Michael Smith Foundation for Health Research, Canadian Institutes of Health Research, and National Institutes of Health [R01DA033147].en_US
dc.identifier.citationCollins, A.B.; Parashar, S.; Hogg, R.S.; Fernando, S.; Worthington, C.; McDougall, P.; … & McNeil, R. (2017). Integrated HIV care and service engagement among people living with HIV who use drugs in a setting with a community-wide treatment as prevention initiative: A qualitative study in Vancouver, Canada. Journal of the International AIDS Society, 20(1), 21407. https://doi.org/10.7448/IAS.20.1.21407en_US
dc.identifier.urihttps://doi.org/10.7448/IAS.20.1.21407
dc.identifier.urihttp://hdl.handle.net/1828/9870
dc.language.isoenen_US
dc.publisherJournal of the International AIDS Societyen_US
dc.subjectHIV/AIDSen_US
dc.subjectintegrated service modelen_US
dc.subjecttreatment as preventionen_US
dc.subjectstructural vulnerabilityen_US
dc.subjectqualitativeen_US
dc.subjectCanadaen_US
dc.titleIntegrated HIV care and service engagement among people living with HIV who use drugs in a setting with a community-wide treatment as prevention initiative: A qualitative study in Vancouver, Canadaen_US
dc.typeArticleen_US

Files

Original bundle
Now showing 1 - 1 of 1
Loading...
Thumbnail Image
Name:
collins_alexandra_jintaidssoc_2017.pdf
Size:
737.7 KB
Format:
Adobe Portable Document Format
Description:
License bundle
Now showing 1 - 1 of 1
No Thumbnail Available
Name:
license.txt
Size:
1.71 KB
Format:
Item-specific license agreed upon to submission
Description: