Access to crucial HIV/AIDS treatment has dramatically improved for marginalized individuals in London’s inner city through a partnership between St. Josephs’ Health Care London and the London InterCommunity Health Centre (LIHC).
Recognizing that many individuals with HIV and hepatitis C have difficulty accessing care or are reluctant to seek treatment at a hospital, St. Joseph’s and LIHC collaborate to provide a clinic twice a month at LIHC where St. Joseph’s specialists, along with the LIHC nursing and social work staff, see patients with HIV.
“Our partnership with LIHC staff has been an example of how well collaboration between organizations can enhance patient care,” says Dr. Michael Silverman, Chair/Chief, Infectious Diseases and Medical Director of the Infectious Diseases Care Program at St. Joseph’s Hospital. “We have been able to get many people on life-sustaining treatment who would otherwise not be followed for their HIV. By treating people you make their virus undetectable, helping the patient and also helping prevent transmission in the community.”
Earlier this year Middlesex London Health Unit officials reported about staggering increases in HIV and hepatitis C in the city in the last 10 years. The partnership between St. Joseph’s and LIHC, called the MyCare program, began two years ago as LIHC frontline staff began to recognize and track increasing rates in new diagnoses of HIV among clients of LIHC’s Health Outreach Program. By working together, St. Joseph’s specialized HIV care is integrated with the case management and primary care provided by LIHC staff , who have a long-term relationship and rapport with the city’s vulnerable HIV patients.
“Our staff are specialized in providing primary care and outreach services to individuals experiencing addiction and homelessness, which created a unique opportunity to provide HIV care where clients are already accessing supports and resources, “ explains Susan Hocking, Director, Client Services at LIHC.
While HIV treatment now allows people to live long, healthy lives, it's difficult to treat HIV when the individual is also battling addiction, poverty and homelessness, says Dr. Silverman. “Many people with HIV have difficulty with transportation, have chaotic lifestyles and are challenged to keep appointments for long-term follow up. Many of the patients we see at LIHC were referred to St. Joseph’s but never came for their appointments. It’s clear having them travel to us is not going to work. As the only HIV care providers in the city, we have to make it available, which means bringing care to individuals where they are.”
The partnership has also strengthened LIHC’s ability to coordinate care for those clients who transition between the community and acute care settings, says Hocking.
“Our clients often experience extreme challenges as they cross the systems of health care. Working with St. Joseph’s Infectious Diseases Care Program allows us to follow the client, provide support and advocate for life changing interventions that can lead to sustainable changes such as substance use management, establishing housing on discharge from hospital, following up on HIV treatment started while in hospital or jail, etc."
St. Joseph’s and LIHC also partner to provide a weekly hepatitis C clinic at LIHC. Many patients with HIV also have hepatitis C and face the same barriers to care. And Like HIV care, hepatitis C treatment also transforms lives.
For Dr. Kaveri Gupta, an infectious diseases specialist with St. Joseph’s, the opportunity to care for HIV patients at LIHC is gratifying.
“There is a perception that these individuals are not eligible for HIV treatment,” says Dr. Gupta. “Many feel neglected so it is tremendously rewarding to provide care. As well, HIV treatment has had a ripple effect. When an individual feels better, they feel more confident and may seek support for other challenges in their lives.”
Treating HIV/AIDS from the very beginning
St. Joseph’s has been treating people with HIV/AIDS since the disease appeared in the mid-1980s. The Infectious Diseases Care Program meets the outpatient needs of HIV-infected and affected populations across the region, providing medical, nursing, social work, pharmacy, and nutrition services. The focus is on both medical and psycho-social aspects of HIV/AIDS.
In total, St. Joseph’s currently cares for about 600 patients with HIV/AIDS, from infants to patients in their 80s, and about 350 patients with hepatitis C. Care is provided at St. Joseph’s Hospital or through a partnership with the London InterCommunity Health Centre.
To help manage rising rates of both HIV and hepatitis C, a new infectious disease specialist, Dr. Lise Bondy, recently joined the St. Joseph’s team.
The Infectious Diseases Care Program also provides care for patients with a broad range of other acute and chronic infectious diseases.