In Canada, approximately 62,790 people have a diagnosis of HIV, with 87% of those currently being treated with medications. In Saskatchewan, HIV numbers remain the highest in the country with transmission rates at more than double the national average. While HIV can affect anyone, marginalized communities carry a disproportionate burden as structural and social factors, such as stable housing, affect a patient’s ability to receive consistent support and care.
Clinical care for patients diagnosed with HIV relies largely on drug therapy, specifically antiretroviral medications. When these medications are taken as prescribed, the benefits include reductions in morbidity, mortality, improved quality of life, prevention of transmission and viral suppression. However, staying adherent to medications can prove to be challenging for many patients. For some at a local clinic in Saskatoon, staying engaged with their healthcare providers and achieving viral suppression was a challenge that needed a solution.
Avg med adherence
Achieved viral suppression
Completed overdue bloodwork
Technology can play a crucial role in bridging the gaps in care. With adherence and engagement being the primary issues for this clinic, patients were provided a medication dispensing device (spencer) and ongoing medication delivery from our pharmacy hub in Saskatoon, while nursing staff at the clinic provided clinical and social support, such as treatment for opportunistic infections and case management. We remote monitored adherence and patient-report outcomes for insights to align and personalize care to each individual. With this interdisciplinary approach, patients achieved high and sustained adherence to their medications which directly attributed to viral suppression.
Not only did we see viral suppression (for one individual within a week!), but we helped to re-kindle relationships among patients with historical factors of mistrust and disengagement.
Kristen Antunes, Director of Clinical Outcomes
Working with this clinic and their dedicated, patient-focused team had a significant impact:
- 93% average adherence over 9 months
- 85%-90% of the patients achieved viral load suppression in 1 to 4 weeks (vs none at the outset)
- 78% completed overdue bloodwork
Not only was adherence high, contributing to viral suppression, but the use of our high-touch tech re-kindled relationships among patients with historical factors of mistrust and disengagement. By establishing regular touch points between patients and providers, our interdisciplinary effort led to better patient outcomes including the opportunity to treat co-morbidities, such as Hepatitis C and Tuberculosis. We were able to go above and beyond HIV to include contraceptive care and Hepatitis C treatment. While we demonstrated a positive impact with this population, it became evident that stable housing was a key factor for success. Of the 16 patients who started with spencer, 10 used it for the full nine months, highlighting the crucial need for stable housing.
We are hopeful that these findings will help with the ongoing advocacy and system change to support meeting this population’s basic needs. As we look to the future, this experience will undoubtedly pave the way for much needed change in the ongoing fight against HIV.