The organizational attributes of HIV care delivery models in Canada: A cross-sectional study.

Claire E Kendall,Philip Lundrigan,Esther Susanna Shoemaker,Sean B Rourke,Ron Rosenes,Lois Crowe,Shabnam Asghari,Christine Bibeau,Danielle E Rolfe,Lisa Boucher,Clare Liddy,Marissa Becker,Viviane D Lima

doi:10.1371/journal.pone.0199395

Abstract

HIV treatment in Canada has rapidly progressed with the advent of new drug therapies and approaches to care. With this evolution, there is increasing interest in Canada in understanding the current delivery of HIV care, specifically where care is delivered, how, and by whom, to inform the design of care models required to meet the evolving needs of the population. We conducted a cross-sectional survey of Canadian care settings identified as delivering HIV care between June 2015 and January 2016. Given known potential differences in delivery approaches, we stratified settings as primary care or specialist settings, and described their structure, geographic location, populations served, health human resources, technological resources, and available clinical services. We received responses from 22 of 43 contacted care settings located in seven Canadian provinces (51.2% response rate). The total number of patients and HIV patients served by the participating settings was 38,060 and 17,678, respectively (mean number of HIV patients in primary care settings = 1,005, mean number of HIV patients in specialist care settings = 562). Settings were urban for 20 of the 22 (90.9%) clinics and 14 (63.6%) were entirely HIV focused. Primary care settings were more likely to offer preventative services (e.g., cervical smear, needle exchange, IUD insertion, chronic disease self-management program) than specialist settings. The study illustrates diversity in Canadian HIV care settings. All settings were team based, but primary care settings offered a broader range of preventative services and comprehensive access to mental health services, including addictions and peer support.

Highlights

With improvements in treatment and acute care, people living with HIV are living longer.[1]
We developed the Canadian HIV Clinic Survey based on adaptations of validated primary health care surveys; the Patient-Centered Medical Home Assessment (PCMH-A) [24,25], the Canadian Institute for Health Information’s (CIHI) Measuring Organizational Attributes of Primary Health Care Survey,[26] and the Primary Health Care Indicator Framework developed previously by our team.[27]
Contact was made with clinicians and/or organizations in Prince Edward Island, the Northwest Territories, and Nunavut, but sites within these jurisdictions reported that they did not identify as HIV care settings and that patients from these areas travel to other provinces for HIV care

Summary

Introduction

With improvements in treatment and acute care, people living with HIV are living longer.[1]. Previous work has attempted to address findings that HIV specialists have the expertise to treat HIV as a specific condition, but that their care alone might not be sufficient to deliver the expanding comprehensiveness of services required for people aging with HIV.[11,12,13] Primary care is best equipped to deliver care to people with chronic diseases,[14] but not all primary care providers have the expertise to effectively manage the complexities of HIV treatment.[15,16,17] In addition, the number of clinicians providing HIV specialist care [18] and enrollment in infectious disease training programs is declining in North America.[19,20] The way HIV care has been organized in Canada may no longer be sustainable, nor meet the needs of the population,[21] with many people with HIV not accessing comprehensive care, despite our universal healthcare system.[22,23]

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Results

Conclusion