The HIV Cascade of Care

 

The HIV Cascade Of Care


 

Within the HIV realm, the Cascade of Care has been used as a way to monitor people living with HIV (PLWH) through each stage of care (from infection and diagnosis through to ART initiation and viral suppression).

 

The HIV Care Cascade shows the essential services and interventions that must take place along the continuum for an individual to ultimately reach the point of viral suppression. It is used to present summary statistics on the number of PLWH within a population who are infected, diagnosed, linked to HIV-specific care, retained in care, on antiretroviral treatment (ART), and with viral suppression.

CTAC’s Project: Gaps and Policy Barriers to Engagement with the HIV Cascade of Care


 

This project explores the issues that impact the engagement of people living with HIV in healthcare within Ontario. The goal of this project was to, a) identify some of the policy issues that impact treatment access for PLWH, and b) identify some opportunities to make the healthcare system more accessible for PLWH .

 

This project consisted of two parts:

 

Part one was made up of two comprehensive reviews of the research literature regarding the HIV Cascade of Care in Canada. These two reviews primarily focused on two steps within the HIV Cascade of Care:

 

a) The step from testing/knowing one’s status to being linked to care

b) The step from being retained in care to reaching viral suppression

 

Part two consisted of qualitative interviews with service providers and PLWH in Ontario.

 

In order to have a sample representative of PLWH in Ontario, we worked with PLWH from each of Ontario’s priority populations (gay, bi and other men who have sex with men (MSM); African, Caribbean and Black people; Indigenous people; people who use injection drugs; and women from the above groups). We also worked with community partners to gather a geographically diverse sample including hosting 11 focus groups in total (5 in Toronto, 4 in suburban and rural communities in the GTA, 1 in northern Ontario, and 1 in Ottawa).

 

Research has shown people drop out of the HIV Cascade of Care – e.g. a person starting treatment doesn’t stay on it. By seeking out those policy barriers that may lead individuals to drop out of care, and developing solutions to address these barriers, we can reveal opportunities for community-based agencies to organize and promote policy change that will enhance access and retention in care. This will enable people to live long, healthy, and happy lives.

 

Although this project was focused on access to services within Ontario, many of the treatment access issues that were brought to light during this project can be found across Canada.

 

Read the full project paper here: Identifying and Plugging the Leaks: Gaps And Policy Barriers To Engagement With The HIV Cascade Of Care.

 

The paper is available in French here.

Policy Issues and Recommendations


 

From this project, we have gained valuable insight into the challenges in the HIV Cascade of Care for frontline service providers and policy makers.

 

The project has five recommendations around barriers to engagement in the HIV Cascade of Care. 

 

  1. Mandatory training around Human Rights Code for physicians, training for AIDS Service Organizations (ASOs) about how to make complaints to the Human Rights Tribunal.
  2. Revision to Ontario standards for doctor and other healthcare provider training related to HIV, as well as the expansion of HIV care in non-urban areas.
  3. Reduce the deductible for Trillium, and the co-payments for the Ontario Disability Benefit (ODB).
  4. Provide compassionate access to care and treatment for people without status in Canada.
  5. Implement policies and practices that will ensure successful linkage to care, and standardized access to treatment, for all individuals that experience incarceration in Ontario.

 

Read the full project paper here: Identifying and Plugging the Leaks: Gaps And Policy Barriers To Engagement With The HIV Cascade Of Care.

 

Read two comprehensive reviews of the research literature regarding the HIV Cascade of Care in Canada, primarily focused on two steps within the HIV Cascade of Care:

 

a) The step from testing/knowing one’s status to being linked to care

b) The step from being retained in care to reaching viral suppression

 

Dissemination Events and Next Steps


 

The project’s next steps include:

 

  1. The dissemination of the valuable insights and knowledge gathered throughout the course of this project in order to help service providers and service utilizers more effectively advocate for their needs.
  2. Identifying further areas of policy work with communities most affected by HIV and HIV/hepatitis C co-infection including but not limited to the following groups: youth, the trans community, First Nations, Indigenous populations, people who use injection drugs, and incarcerated individuals.

So far, the project has been disseminated at the following events:

The Ontario HIV Treatment Network (OHTN) 2018 HIV Endgame Conference, December 2018.

Findings of the project and recommendations going forward were presented as part of the Improving Engagement, Retention, and Adherence session.

Dissemination and Community Appreciation Event, December 2018.

This half-day event honored those in the community without which the project wouldn’t have been successful. Project findings were disseminated and the process of highlighting best practices among programs and services in the community was begun.  

 

If you have any thoughts, comments, or would like to know more, please get in touch with CTAC’s Director of Policy, Research, and Development Amanda Fletcher at amanda@ctac.ca.