HIV in Canada: A primer for service providers

Integrated Approaches to HIV Prevention and Treatment

Key Points

  • Each element of the continuum of HIV care is important to both reduce HIV transmission and improve health outcomes.
  • Services should be designed and delivered in a way that improves the client experience and protects the human rights of people living with and at risk for HIV.

Integrated approaches to HIV prevention and treatment recognize that HIV prevention, testing and diagnosis, treatment, and care and support services (also called the continuum of HIV care) are mutually reinforcing elements of an effective response.

There are two compelling reasons for integration of HIV prevention and treatment. First, biomedical and clinical research shows that each element of the continuum of HIV care is important to both reduce HIV transmission and improve health outcomes. For example, research shows that HIV treatment significantly improves the health of people living with HIV and it significantly reduces the risk of transmission. Research also shows that HIV testing and counselling are important to help prevent HIV transmission and to serve as a gateway to HIV treatment. In light of this research, there is a need to reflect on how better integration of services can maximize both prevention and treatment outcomes.

The second reason for more integrated approaches comes from research and reflection on the experience of clients and their engagement with the continuum of HIV care. Health services are often fragmented. For example, some services, such as HIV treatment, might be clinic based, while other services, such as support, might be community based and still others, such as HIV testing, might be provided through public health units. This fragmentation is artificial from the perspective of the client and may create unnecessary barriers and challenges to accessing services. There may be missed opportunities to provide important health services, and people are often lost to further linkage and/or engagement in care from one service to the next. Integrated approaches can improve health outcomes by improving the client experience with health services as well as improving their engagement and linkage throughout the continuum of HIV care. This approach should result in more holistic, client-centred service delivery.

Integration of HIV prevention and treatment also brings some specific challenges and concerns. Integrated approaches typically involve harmonizing multiple program objectives from the perspectives of public health, communities at risk, clinical practice and people living with HIV. It is crucial that services are designed and delivered in a way that protects the human rights of people living with and at risk for HIV and supports clients to make their own informed health decisions based on the best available information.

Integration often involves bringing HIV-related services to new settings in which providers may not be very familiar with HIV, such as the expansion of HIV testing into routine medical services. Expanding the range of providers involved in HIV work requires dedicated efforts to build their capacity through education, guidelines and informational support. This additional capacity building needs to be factored into program development by planners and funders.

Resource

Integrated approaches to HIV prevention and treatment – Catie webinar

Sources

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