HIV in Canada: A primer for service providers

Framework for Integrated Approaches to HIV Prevention and Treatment

Key Points

  • The core elements of an integrated HIV framework are prevention, testing and diagnosis, treatment, and care and support.
  • These different elements, which form the continuum of HIV care, need to be combined or linked so that people can move seamlessly through the continuum of services depending on their needs and circumstances.
  • Interventions may involve one or more of the following levels or aspects: biomedical, behavioural, community and structural.

A framework for integration provides a way of conceptualizing frontline services that allows people involved in the frontline response to situate themselves within the broader landscape of HIV work. The purpose of a framework is to articulate the elements of an integrated program in such a way that the experience of the client is central and the linkages between different program elements are explicit. The framework can be used to assess access to services, to identify new services and/or to increase engagement and linkages across different services with the overall goal of improving client-centred care.

The core elements of an integrated HIV framework:

  • prevention
  • testing and diagnosis
  • treatment
  • care and support

The different elements that form the continuum of HIV care need to be combined or linked so that people—whether they are HIV positive, HIV negative or don’t know their status—can move seamlessly through the continuum of services depending on their needs and circumstances. The elements may be combined in a single intervention, such as voluntary testing and counselling that include both prevention and testing services. The elements may also be combined and linked between different organizations, such as partnerships between clinics and community organizations that link treatment services with support services. People may enter the continuum of care through any of the elements, so it becomes important that clients are fully engaged, informed and linked to other relevant elements.

In addition to the core elements of service delivery, it is important to recognize that interventions need to work on different levels to be effective—from the individual to the community to the social world in which we all live. Typically, interventions may involve one or more of the following aspects:

  • Biomedical – distributing/using a “technology” or “device” such as a condom, an HIV drug or a testing technology
  • Behavioural – promoting/supporting changes in behaviour, including changes needed in order for a biomedical technology to be effective such as consistent condom use, adherence to drug treatments or voluntary testing
  • Community – understanding/influencing the social and cultural context for an intervention, including community norms and acceptability of an intervention
  • Structural (institutional and systems-level) – identifying/changing policies, procedures and other institutional or system-related issues that may increase HIV risk, limit access to health services or adversely affect health outcomes, such as criminalization of HIV nondisclosure or institutional policies regarding needle exchange

The framework can be used as a tool for addressing some key questions regarding the integration of HIV prevention and treatment, such as:

  • What “package” of services should be provided to a specific community?
    Who should be engaged in and offered these services? When? How?
  • What is the best setting or context for specific services?
  • How should services be linked or combined?

Sources

  1. CATIE. National deliberative dialogue on integrated approaches to HIV treatment and prevention: meeting report. 2013. Available from: http://www.catie.ca/sites/default/files/National-Deliberative-Dialogue-on-Integrated-Approaches-to-HIV-Treatment-and-Prevention_05312012.pdf.
  2. Rogers T. Integrated approaches to HIV prevention and treatment [video]. CATIE, 2013. Available from: http://www.catie.ca/en/resources/integrated-approaches-hiv-prevention-and-treatment.
  3. Government of British Columbia. From hope to health: Towards an AIDS-free generation. 2012. Available from: http://www.health.gov.bc.ca/library/publications/year/2012/from-hope-to-health-aids-free.pdf
  4. UNAIDS. 90-90-90: An ambitious treatment target to help end the AIDS epidemic. 2014. Available from: http://www.unaids.org/sites/default/files/media_asset/90-90-90_en_0.pdf
  5. Ontario Advisory Committee on HIV/AIDS. HIV/AIDS Strategy to 2026: Focusing Our Efforts – Changing the Course of the HIV Prevention, Engagement and Care Cascade in Ontario. 2016. Available from: http://www.health.gov.on.ca/en/pro/programs/hivaids/docs/oach_strategy_2026.pdf
  6. International Advisory Panel on HIV Care Continuum Optimization. IAPAC Guidelines for Optimizing the HIV Care Continuum for Adults and Adolescents. Journal of the International Association of Providers of AIDS Care. 2015;14 Suppl 1:S3–S34. Available from: http://www.iapac.org/uploads/JIAPAC-IAPAC-Guidelines-for-Optimizing-the-HIV-Care-Continuum-Supplement-Nov-Dec-2015.pdf