| Summary: | BACKGROUND: Vancouver's Downtown Eastside (DTES) neighborhood is infamous for its high rates of HIV infection and related morbidity and mortality. The Vancouver Native Health Society cares for over 350 DTES residents living with HIV, of which 53% are Aboriginal (inclusive of First Nations, Inuit or Métis). In 2007 our centre initiated a HIV quality improvement project (entitled CHCNUP -- Complete HIV Care for Native Urban People) based upon the Chronic Care model. OBJECTIVE: To evaluate the impact of CHCNUP by measuring improvements in HIV care engagement and treatment success. METHODS: Among 306 HIV positive participants enrolled in CHCNUP between October 2007 and October 2008, the rates of syphilis screening, pneumococcal immunization, TB screening, antiretroviral uptake (proxies for HIV care engagement) and viral load suppression (proxy for HIV care success) were measured. We then compared these baseline measures with quarterly follow-up rates up to and including January 2009. RESULTS: The study group consisted of 67% male and 53% Aboriginal participants. The median age was 46 and the majority was thought to have contracted HIV through injection drug use. Compared to their baseline status, those enrolled in the program showed increases in rates of pneumovax immunization (48% vs. 69%), syphilis screening (50% vs. 66%), tuberculosis screening (14 vs. 20%), antiretroviral uptake (51% vs. 68%), and viral load suppression (71% vs. 90%).CONCLUSIONS: This preliminary analysis indicates that a chronic disease management approach to HIV care in an inner-city population leads to improved rates of HIV care engagement, antiretroviral treatment uptake, and antiretroviral treatment success. Further follow-up and analysis is required to establish the magnitude of these improvements, the durability of these improvements over time and whether they translate into reductions in mortality and morbidity.
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