CMEonHIV.com is dedicated to providing online CME presentations (slides with voiceover) on HIV/AIDS for healthcare professionals given by local and international experts to keep you up-to-date on the ongoing developments in the field.
Conference
"Hard to Reach Populations" Dr. Mark Tyndall (biography) English - 2003-03-30 - 29 minutes
Summary : Providing HIV Care to Hard-to-Reach Populations
Antiretroviral therapy has led to a significant reduction in morbidity and mortality as well as an enhanced quality of life for many HIV-positive individuals. Injection drug users (IDUs), however, have a lower uptake of antiretroviral (ARV) therapy compared to other HIV-positive persons. There are many obstacles to the provision of HIV care and treatment that must be considered in this population if sustainable benefits are to be realized. These include substandard housing, inadequate drug and alcohol treatment, poor coordination with the criminal justice system, lack of coherent harm reduction strategies, and concurrent infections such as Hepatitis C and tuberculosis. Physicians are also reluctant to initiate therapy if they cannot be reasonably certain of adherence as the efficacy and durability of therapy is closely linked to consistent ingestion of the medications. Public health concerns are also arising due to multi-drug resistant virus that is promoted in populations who do not adhere to therapy.
Vancouver’s Downtown Eastside (DTES) is one of Canada’s poorest urban neighborhoods and is characterized by unemployment, crime, mental illness, prostitution and inadequate housing. The community’s harsh social environment and crippling poverty perpetuate the serious health consequences facing its residents. These include pervasive drug addiction and epidemics of blood-borne infections and overdose deaths. Accurate estimates on the burden of HIV infection and the number individuals who are eligible for ARV treatment in the DTES are not available. For argument sake, it is estimated that there are 4000 to 5000 active injection drug users in the DTES. Of these, between 30% and 40% or about 2000 people are HIV positive. If half of these individuals quality for treatment than it can be estimated that approximately 1000 people should be on ARVs. The Drug Treatment Program at the BC Centre for Excellence currently distributes ARV medications to about 250 people with postal codes in the DTES indicating a significant under-utilization of ARVs in this community.
There are currently several community-based models to enhance the delivery of ARVs in Vancouver based on simplified treatment regimes and social support systems. There have been some excellent therapeutic results for the people in these programs and further expansion, refinement, and evaluation are ongoing.
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