Vancouver’s Downtown Eastside is well known as a y poor neighbourhood with a large open drug scene and an estimated 18% HIV infection prevalence rate. Although HIV medications are free in British Columbia and available to all HIV-positive people who require them, many do not take advantage of this availability. Barriers to antiretroviral uptake and sustained treatment in the Downtown Eastside population include drug dependency, unstable housing, mental illness, lack of patient education or misinformation, and poor access to medical care. The Maximally Assisted Therapy (MAT) program was started in 1999 by the BC Centre for Excellence in HIV/AIDS to address these barriers and to improve access and adherence to antiretrovirals by HIV-positive people living in the Downtown Eastside.
The MAT program, based within Vancouver’s Downtown Community Health Clinic, is a multi- disciplinary program involving nurses, pharmacists, social workers, and support staff, all of whom work with the clients’ physicians to help stabilize the patients in every way possible. By attaining stability in their lives, these clients have a greater likelihood of taking their antiretrovirals properly. Referred clients come to the MAT clinic daily (or weekly) for all of their medication needs (antiretrovirals plus adjuvant medications). While visiting the MAT clinic, the client receives primary care from the nurses and advocacy services for housing and social issues through the social workers. An MAT pharmacist meets with each client regularly to provide education about medications and to monitor for efficacy and toxicity. Since good adherence is crucial to successful outcomes with antiretroviral therapy (and for prevention of viral resistance), the MAT team conducts an outreach program to bring medications to patients in their homes or on the street if they do not come to the clinic.
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The MAT pharmacists act as HIV consultants for the Downtown Community Health Clinic’s clients, doctors, nurses, and other health care professionals. Through their involvement in the Drug Treatment Program of the BC Centre for Excellence in HIV/AIDS, they are an important resource for educational and logistic information related to the dissemination of HIV drugs throughout the province. The pharmacists also work closely with the clinic’s pharmacy to help organize medication provision and to address potential drug interactions. They are involved in patient medication counselling and follow- up, monitoring of adherence, and review of the results of clinical blood work, as well as providing liaison with hospitals, recovery and treatment programs, and other pharmacies to allow seamless care in the community. Education of students, staff, and clients about the use of HIV medications and their side effects and potential drug interactions is ongoing as regimens change, resistance arises, and new medications are studied. In sum, the MAT pharmacists work with clients, their physicians, other members of the MAT team, and other health care professionals and agencies to develop and implement an individualized care plan for each client.
At present, the MAT Program has about 100 clients and is run by the Vancouver Coastal Health Authority, although the pharmacists’ positions are funded separately through the Drug Treatment Program of the Centre for Excellence. The MAT clinic is open 365 days per year, with a pharmacist available from Monday to Friday. There are currently no plans to expand the program, but the clinic’s goal is to create a policy and procedure manual to enable duplication of the MAT Program in other areas of the city and in other cities. kamagra soft tablets
The pharmacist role within the MAT program is unique and rewarding. The program presents a challenging and extraordinary opportunity to work with a group of generally low-functioning patients who have complex health and social problems, such as hepatitis C co-infection, compromised liver function, mental health issues, criminal offences, and problems related to child custody. There are many ways in which the MAT program can help this population, given the expertise of the team and the time available to work on these issues (clients are seen daily for an indefinite period). This daily interaction also offers the opportunity for the MAT team to develop close relationships with the clients. Many people have been helped to control their HIV disease, despite their often-chaotic lifestyles and drug or alcohol dependence, and that success is rewarding.