Prevention in Focus

Fall 2020 

From the front lines: Adapting programs in response to COVID-19

The COVID-19 pandemic has led to many service providers adapting the way that their HIV, hepatitis C and harm reduction programs are delivered due to measures such as physical distancing. This has impacts on both the way that staff are providing services and the way that clients are accessing services.

We asked service providers about how they have adapted their services during the COVID-19 pandemic, what they have learned as a result of this rapid adaptation and what learnings they will take forward as measures are relaxed:

  • Bruce Rankin, Director of Client Services & Lila Desjardine, Manager of Resident Care, John Gordon Home, Regional HIV/AIDS Connection
  • Sonja Burke, Director of Harm Reduction, Carepoint Consumption and Treatment Service, Regional HIV/AIDS Connection
  • Gerard Yetman, Executive Director & Alexe Morgan, Harm Reduction Project Coordinator, AIDS Committee of Newfoundland and Labrador

Bruce Rankin & Lila Desjardine

John Gordon Home (JGH) provides support to people with HIV/AIDS and hepatitis C who have immediate healthcare needs to help them realize positive health and wellness outcomes, through the provision of transitional care, respite care and end-of-life care.

How have you adapted your client programs and services due to COVID-19?

The introduction of new guidelines for congregate settings increased the workload for everyone. There is more frequent cleaning/disinfecting, more frequent monitoring of people’s status (taking vitals, etc.) and more documentation required. Properly putting on and taking off personal protective equipment (PPE) and the need for constant handwashing and sanitizing have introduced additional tasks that can slow things down.

Most of our client programs went virtual, so clients are now accessing their medical appointments and HIV support services through phone, text, Zoom or other online applications.

Physical distancing measures have affected the home-like environment of JGH, for example:

  • Only two people can sit at a large table to eat.
  • There is no more “family style” serving (e.g., no communal fruit bowl, no platters of baked goods or candy dishes).
  • Staff wear PPE (e.g., face masks, goggles or shields, gloves) for all interactions with residents, which feels “clinical” or “institutional.”
  • A “no visitors” policy has increased social isolation for some, and staff are “checking in” more often to see how people are doing.

We have provided new resources to residents on how to adapt harm reduction practices to help prevent COVID-19; however, these can be difficult to implement out in the community. For example, many people do not practise physical distancing while using drugs, and drug purchasing/trading is a high-risk activity in the context of COVID-19. We’ve also seen an increase in dealing/sharing drugs within the building, as some residents who relied on panhandling to purchase drugs experienced a sudden loss of income.

How has this impacted the clients that you serve or how have clients responded to these changes?

We have had some very positive feedback from residents, expressing gratitude for the steps taken early on in the pandemic to prevent COVID-19 infection and keep everyone safe.

The transition to virtual programs and appointments can pose challenges for many who do not have experience with and/or the technical skills needed to use electronic devices. Most residents do not have their own phones, tablets or computers, and they need technical assistance from staff to participate in their appointments. This means that staff are often attending appointments, and as a result the appointments are less private for the resident.

Most of our residents live with comorbidities (e.g., HIV, hepatitis C, respiratory conditions) that make them more susceptible to COVID-19, and staff are frequently reminding them to take precautions against COVID-19. Over time, this is perceived as nagging and has affected staff/client relations.

What have you learned from this experience that will inform your work moving forward, once restrictions are relaxed?

We have learned that residents continue to be resilient regardless of the circumstances. We have seen our staff demonstrate courage and dedication to their professions in the face of uncertainty, and organizational leadership that has recognized and rewarded this. While it is cliché to say “adversity makes us stronger,” the experience of this pandemic has made our team stronger and more resilient.

We’ve also learned that there are cost savings and efficiencies to be had in moving to virtual appointments and programs. For example, the need for transportation to appointments and all the resources that requires has decreased.

Inequities in healthcare are laid bare in a pandemic. Some people can afford to stay home and have everything they need delivered to their front door. This is not the case for people living in poverty and precarious housing or homelessness. One of the single most important tools to gain access to healthcare is now a mobile phone, and many people we work with do not have one.

Lastly, service providers in London came together and collaborated in new ways to solve problems and share resources. Under the leadership of the City of London Homeless Prevention department, a number of service providers have been meeting weekly. Collectively, they have created and staffed new “isolation spaces” for people who are underhoused and need to self-isolate, redeployed staff to support this space, and shared PPE across organizations when supplies were low. Working relationships in the community are stronger and we are better prepared for the next crisis.   

Sonja Burke

Carepoint Consumption and Treatment Service (CTS) offers a space for people to use drugs safely and seek services for recovery.

How have you adapted your client programs and services due to COVID-19?

We have significantly adjusted our services in a number of ways, including practical changes to better protect staff and clients from COVID-19 and changes in service delivery related to better supporting clients.

Some practical changes include:

  • implementing a COVID-19 screening tool for all clients who come in contact with staff
  • reducing seating in the waiting room and in the injection and after-care areas
  • supporting physical distancing in the waiting room and in the needle/syringe distribution and intake areas using taped-off areas
  • stopping the use of oxygen as a first response in overdose because of increased transmission risk for COVID-19
  • having staff at all points of interaction wear face masks and face shields
  • having staff wear gowns and gloves (in addition to face covering) when responding to an overdose or providing wound assessment
  • setting up personal protective equipment (PPE) stations for staff near client service areas and washrooms
  • training staff in properly putting on and taking off PPE
  • providing clients with cloth masks to take with them and/or wear when accessing services
  • adapting harm reduction outreach to maintain physical distancing and continue providing services during COVID-19
  • providing premade supply kits instead of letting clients help themselves
  • having designated space for kit-making stations where staff can be physically distanced

Additional changes related to client supports:

  • supporting a warm transfer process with London InterCommunity Health Centre for COVID-19 testing and providing a direct referral to “isolation spaces” if a client is screened positive for COVID-19
  • providing clients with updated information on local services that remain open (e.g., shelters, food programs) or new services available
  • delivering harm reduction supplies to people in “isolation spaces” that were newly developed under the leadership of the City of London Homeless Prevention department
  • modifying food bank services to a delivery service format
  • moving in-person support groups and educational and one-on-one support services to a virtual format
  • partnering with other service providers to distribute harm reduction equipment more widely
  • increasing the volume of supplies given to partner service providers who distribute harm reduction supplies
  • partnering with other organizations to distribute premade lunches

How has this impacted the clients that you serve or how have clients responded to these changes?

We have seen a reduced number of clients accessing Carepoint CTS. Many clients are in isolation spaces and can’t visit the service. People who are in city-run self-monitoring locations or isolation spaces are located farther away from Carepoint and transportation to the site can be a challenge.

Clients who are visiting the space are experiencing increased frustration because of longer than usual wait times. They report that services are experienced as more “clinical” or “cold” and have expressed disconnection from staff, who are all wearing face coverings.

However, clients have also expressed appreciation for our quick response in making the necessary changes to prevent COVID-19 infection and for ensuring that our service stays open.

What have you learned from this experience that will inform your work moving forward, once restrictions are relaxed?

Moving forward, we will continue to provide hand sanitization stations at Carepoint CTS and to remind clients about the importance of handwashing. We will also have an increased supply of PPE on hand.

From this experience, we have learned what procedures work well in a pandemic situation and in the future we will apply our learning in a more streamlined approach. In future site design planning we would plan for increased floor space when possible to minimize service disruption in a pandemic situation.

Overall, we have been reminded of the importance of human connection and the critical role that it plays in our service delivery and we have tried to maintain it as much as possible through these challenging times.

Gerard Yetman & Alexe Morgan

AIDS Committee of Newfoundland and Labrador (ACNL) is a provincial organization committed to preventing the spread of HIV, hepatitis C and other sexually transmitted and blood-borne infections. ACNL supports people living with, affected by, and/or at risk for these illnesses and advocates for change via provincial, regional, national and international networking.

How have you adapted your client programs and services due to COVID-19?

During the COVID-19 pandemic, the ACNL office is closed to the public. The HIV/HCV Provincial Services Coordinator works from home and conducts counselling with clients and takes inquiries via telephone.  The Safe Works Access Program (SWAP, our needle distribution service) remains open, with services now being conducted over intercom.  Materials are ordered over intercom, packaged up and placed outside for the client to retrieve.

Throughout the COVID-19 pandemic, ACNL has continued to offer curbside deliveries of safer drug use supplies, with physical distancing protocols in place, for people who can’t get to the office for whatever reason. We also mail supplies via Canada Post to ensure all people who use drugs throughout the province have access to supplies for safer substance use. Our satellite sites that provide safer supplies in the community have also continued to provide access to those services.

Our Supportive Housing Program and emergency shelter are both filled to capacity. ACNL has six on-site supportive housing units and runs the four-bedroom Tommy Sexton Centre shelter. Both are available to individuals living with, affected by, or considered at risk of HIV and/or hepatitis C. Housing and shelter staff are maintaining an operational work environment by following COVID-19 public health guidelines such as physical distancing, increased sanitization and frequent handwashing. They are also conducting regular check-ins with residents of both programs to monitor their health status and provide support by phone when necessary.

How has this impacted the clients that you serve or how have clients responded to these changes?

The province responded fairly rapidly to implement COVID-19 guidelines, and organizations adapted quickly to continue providing services as safely as possible.

Feedback on the operation of our services during the COVID-19 pandemic has been good, and as an organization we are thankful we have been able to continue to offer our day-to-day services with minor changes. Clients have responded well and many are pleased with the changes we have implemented because it allows them to continue accessing our services while practising physical distancing or isolating because of COVID-19.

Initially, the SWAP program saw fewer clients and demand for our mail-out and delivery service was much greater than usual. However, demand for these programs seems to be returning to normal as time goes on.

What have you learned from this experience that will inform your work moving forward, once restrictions are relaxed?

A lesson that has been reinforced is that much of our work requires one-on-one interaction and group work to be most successful and supportive.

At ACNL our services provide individuals with a safe and non-judgmental space to talk about their drug use, their sexual health and their overall well-being, with staff and peers. We have learned over the years that sometimes the casual conversations and check-ins can mean the most to our service users. Right now, because of COVID-19 guidelines, one-on-one interactions mainly happen at the door. They are very brief and the lack of privacy makes it difficult to have personal conversations.

The lack of one-on-one interaction with our clients also means that staff have limited opportunities to learn from people with lived and living experience about what is happening in the community; this is information that we may not otherwise get to hear about but that is important to our work.

We continue to learn as we move through the COVID-19 pandemic. Once restrictions are lifted and staff are no longer working from home, together we will review the impact of COVID-19 on both the staff and the clients.