High quality, consistent and accessible care is essential for people living with HIV. With effective treatment and care, people with HIV can live a near-normal lifespan. Life expectancy for a 20 year-old individual in the U.S. or Canada on combination antiretroviral therapy (cART) may approach that of the general population.1 Fully effective suppression of plasma HIV-1 RNA or viral load (VL) through the use of cART can profoundly reduce mortality and morbidity.
Some Ontarians with HIV who are on treatment are doing well, but disparities persist. Life expectancy and mortality for individuals accessing cART in Canada differ by sex, injection drug use (IDU) history, Indigenous ancestry, CD4 count before initiating ART, and by time of ART initiation. In general, the life expectancy of people with HIV in Canada remains lower than that of the general population.
The use of comprehensive HIV care guidelines can improve health outcomes. Focusing Our Efforts – Changing the Course of the HIV Prevention, Engagement and Care Cascade in Ontario, the HIV/AIDS Strategy to 2026 released in February 2017, recommended the following to improve the health, longevity and quality of life for all people with HIV:
“… the Ministry of Health and Long Term Care (MOHLTC) will work with HIV providers to:
- Establish standards of care for people with HIV, including the use of care pathways that help people navigate the system and stay engaged in care
- Strengthen HIV care delivery by building needed capacity and better care coordination.”
The guidelines are intended to:
- Optimize clinical management of HIV infection
- Empower patients to be engaged in their care, act as their own best advocates and make informed decisions.
The guidelines set out evidence-based practices to help engage people with HIV in care in a timely way, retain them in care over time, address challenges that may cause them to fall out of care (e.g. access issues, personal, social and economic circumstances, substance use, incarceration,6 depression, distrust of the medical system, trauma, treatment “fatigue,” feeling “well” so not feeling an urgent need to access care ), assess them for relevant health issues across the life course, and monitor all aspects of their health, including access and adherence to cART.
These guidelines may be used in any Ontario health care setting where people with HIV access care, including specialty HIV clinics, primary care practices, shared care models, through emergency departments, in long-term care settings and in correctional institutions. They may also be a valuable reference tool for providers new to HIV care, and those working in an evolving provincial healthcare delivery system.