Not the usual suspects: patient engagement and the HIV care cascade - - PowerPoint PPT Presentation

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Not the usual suspects: patient engagement and the HIV care cascade - - PowerPoint PPT Presentation

Dec 07, 2023 18 likes •251 views

Not the usual suspects: patient engagement and the HIV care cascade Malika Sharma, MD FRCPC MEd OHTN Endgame: Closing the gaps in the care cascade Disclosures Currently funded by the CIHR CTN/CANFAR Postdoctoral fellowship Previously

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Not the usual suspects: patient engagement and the HIV care cascade

Malika Sharma, MD FRCPC MEd OHTN Endgame: Closing the gaps in the care cascade

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Disclosures

  • Currently funded by the CIHR CTN/CANFAR

Postdoctoral fellowship

  • Previously funding by the University of Toronto

Clinician Educator Training Program

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Outline

  • 1. Synthesize existing data on the HIV cascade of care

& gaps for particular groups

  • 2. Consider patient‐centered elements of the

cascade

  • 3. Discuss patient engagement as a means of

humanizing the cascade

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The Care Cascade

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ART is not enough

Timing

  • f care

Access to care

Individual & Patient level

  • utcomes
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The HIV Care Cascade

Mugavero 2013 Nosyk 2015

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Calculating the Cascade

Medland et al 2015

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The cascade in context: Incarceration

Iroh et al 2015

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Cascade in Context: Youth

Zanoni and Mayer 2014

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Cascade in Context: Maternal Health

  • Transitioning care pre/peri/postpartum
  • Loss of focus on women’s health needs in the context of

PMTCT

  • Pregnancy may preclude adequate time for assessment and

drug readiness

  • Failure to include male partners
  • Confidentiality, stigma

Colvin et al 2014

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Cascade in Context: Commercial Sex Workers

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The Care Cascade: Patient‐centered Solutions?

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Qualitative data: much to teach us

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  • Examples:
  • Rural & remote: Telehealth
  • Women: settlement & interpretation services
  • Indigenous: telehealth, local availability
  • Food security
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www.ohtn.on.ca/insideandout/assets/docs/inside‐and‐out‐conference‐backgrounder.pdf

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Transitioning from Adolescent to Adult Care in HIV

  • Multidisciplinary team approach
  • Mutually developed culturally appropriate

transition planning before the transition takes place

  • Education of adolescents for greater autonomy
  • Patient’s transition readiness (including knowledge

and skills) using checklists and workbooks

  • Formal written transition policies
  • Registries for monitoring and evaluation of

transition

OHTN RAPID RESPONSE SERVICE | #96, JULY 2015

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Patient Engagement

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Engagement in care is only one way

  • f talking about patient engagement
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Patients are being engaged by hospitals, policymakers, and educators

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Not all patient engagement is created equal

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Involving PHAs in the HIV Cascade

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Conclusion

  • The cascade of care has largely been defined in

ways that are mostly data‐ and expert‐driven

  • Gaps in the cascade exist for several important

populations

  • Identifying non‐traditional and non‐hierarchical

sources of expertise can help close gaps in the cascade and help make it a meaningful, relevant, and a potential tool for patient empowerment.