Programming Connection

Maximally Assisted Therapy (MAT) Program 

Downtown Community Health Centre
Vancouver, British Columbia
2013

Introduction

It’s a community of caring

MAT is far too small for the personalities it welcomes every day. Since 1999, the Maximally Assisted Therapy Program, known all over Vancouver simply as MAT, has cared for people living with HIV who face significant barriers to daily adherence to antiretroviral therapy. Since 2001, MAT has cared for its members in a crowded, busy, friendly and supportive section of the Downtown Community Health Centre.

MAT is not just a clinical response to the need to improve ART adherence: it’s “a community of caring,” according to Suzy Coulter, MAT’s previous clinical coordinator and now a casual nurse at the program, where any barrier—biomedical or psychosocial—to adherence is addressed by members of a committed and compassionate interdisciplinary team.

Some members have been coming to MAT for years. They come because there’s breakfast, because the nurses on staff know their veins and it makes their blood work easier, and because for many it has become a vital part of their routine. Mostly, members continue to come to MAT “because it’s a safe place, [where] they feel like they have a home away from home,” according to Fleur Sussman, a clinical pharmacist at MAT since 2000. Over the years, MAT’s waiting room has developed into an informal space where members can socialize and share their treatment successes and challenges.

It’s not always easy at MAT; tensions can flare, especially in fall and winter when it’s standing room only and people want to get out of the rain. “There are lots of things that can go sideways, in a…small waiting area,” says Sussman. A community agreement, which all members sign, outlines rights and responsibilities and offers some order in the chaos. Bans are rare at MAT, where the emphasis is on providing “vulnerable people a safe environment” while ensuring that all in need can access the program’s services.

The program is open seven days a week, with access to registered nurses, community liaison workers, a social worker and, uniquely for a program of this type, an onsite clinical pharmacist. As Christine Gillespie, the outgoing clinical coordinator, notes, “it’s a crucial point to the program” to have a pharmacist on staff and available to members who want to discuss drug interactions, side effects and optimal adherence. The pharmacists also keep the antiretrovirals moving with the member wherever they go—to hospital, drug treatment centre or jail—without interruption.

Although MAT has always sent out a daily outreach team in the afternoons, funding from the Seek and Treat for Optimal Prevention of HIV/AIDS (STOP) Project has allowed the program to take its services to the wider inner city of Vancouver. A full-time outreach team is tasked with reaching those with the most significant barriers to care and, through respectful support, helping them to reduce those barriers and re-engaging them in healthcare. Gillespie credits the work of this team with allowing MAT to more fully accomplish its mandate to reach those who experience significant barriers to care and treatment adherence.

This has meant that MAT’s demographic has shifted, with a significant increase in the number of members who are commercial sex workers, members who have co-infections and dual diagnoses and members who are extremely isolated and disconnected from the healthcare system, and as both Coulter and Gillespie noted, in members with severe and persistent mental health challenges.

As Sussman says, “It’s a family here.” MAT staff know that offering low-barrier, interdisciplinary, sometimes creative, always non-judgemental care and support can result in positive outcomes for a person’s health, and they apply this knowledge as they care for MAT’s members every day of the year.