Programming Connection

Immunodeficiency Clinic (IDC) 

St. Paul's Hospital
Vancouver, British Columbia
2013

Introduction

"We just happened to be in the line of fire”

James comes into the Immunodeficiency Clinic daily. “When he doesn’t, we go looking for him,” says Scott Harrison, the clinic’s director.

The John Ruedy Immunodeficiency Clinic, commonly known as the IDC, doesn’t offer this type of tailored care and support only to James. It offers it to all its patients. While most patients don’t need such intense interaction with clinic staff, for those who do, peer navigators, a mental health team, a complement of primary care providers, nurses, social workers and a dietitian are available to provide comprehensive services to meet the needs of patients whenever they drop in.

The IDC, founded in the 1980s, cared for people living with HIV and AIDS when few treatments were available. “St. Paul’s just happened to be in the line of fire in the early years of the epidemic,” says Mary Petty, a social worker who has worked at the IDC since 2000. At that time, there was very little that providers could do for patients, most of whom were gay men living with and dying of AIDS.

A lot has changed in the landscape of HIV in Vancouver since then: effective treatments became available in the 1990s and British Columbia started to offer them for free to anyone who met treatment guidelines. At the same time, an increasing number of people living in the Downtown Eastside were being diagnosed with HIV/AIDS.

In response to these two developments and the complex needs of people like James, Providence Health Care, the organization that administers the IDC, transformed this clinic from collection of HIV primary care doctors into an interdisciplinary, comprehensive HIV primary care clinic, with a specific mandate to meet the needs of people with the most entrenched and complex barriers to care. Today, patients “have access to a community of care, which takes into account a person’s whole life,” says Harrison.

With funds from the Seek and Treat for Optimal Prevention of HIV/AIDS (STOP) Project, received in 2010, the IDC strengthened its existing support services. In response to patient feedback, the clinic expanded its hours, a critical change that has enabled the clinic to better accommodate the schedules of patients, and it has added nurses and social workers to enhance its specialist services in addictions and mental health. The IDC also hired a dietitian, who provides an important service to patients who need good nutrition to optimize their treatment outcomes but who may not have the skills or resources to determine and maintain an appropriate diet.

The IDC also partnered with Positive Living BC to offer peer navigation services. The navigators provide a peer-based resource that further reduces barriers that patients might face in accessing care at the IDC and elsewhere. According to Petty, having a person living with HIV on staff has also been beneficial for people who have just tested positive and “makes such a difference for people” as they engage in care.

For people like James, the IDC’s comprehensive, patient-centred, low-barrier care has been key to his retention in care and adherence to his medication. “The 20 minutes that he spends with us give him the security he needs to face his day,” says Harrison.