A Day in the Life of an Outreach Nurse: Implementing Treatment as Prevention in the Field

posted on November 18, 2015

In 2009, the BC Government announced the launching of a four-year pilot project based on the Treatment as Prevention strategy pioneered at the BC-CfE. Once component of the program was called Seek and Treat for Optimal Prevention of HIV/AIDS (STOP HIV/AIDS), or STOP. In 2012, before the pilot had wrapped up — and based on its early and remarkable success — the government announced a province-wide expansion. The announcement came with $19.9 million in funding for the growth of the program, in an effort to provide prevention, testing and treatment to hard-to-reach and highly impacted communities.

The BC-CfE has been a driving force in establishing the STOP program and working with the government to support its infrastructure.

The challenging work of outreach nursing is one of the key components to the effective implementation of the STOP HIV/AIDS Initiative. Outreach nurses connect with clients in the community as part of a dedicated team of skilled nurses, social workers, outreach workers and housing outreach workers. They work closely with peer navigators, professionally trained people living with HIV who can offer clients knowledge and insight acquired through lived experience.

The STOP Team works collaboratively with community health centres, physicians, pharmacists, mental health teams, housing support workers and others involved in a client’s support network.

The BC-CfE spoke with STOP outreach nurse Lesa Dumsha, who works with Vancouver Coastal Health, to learn more about the challenges and rewards the position brings. This is a condensed version of the interview.

BC-CfE: What does it mean to be a STOP outreach nurse?

Lesa Dumsha: STOP HIV Outreach Nurses work with approximately 35-40 clients at a time, doing intensive case management. We support clients at all stages of their HIV journey. Our HIV case management team is interdisciplinary in order to meet clients’ holistic goals, including addressing gaps in social determinants of health. These include housing, income stability and nutrition, as well as connection to social and health care resources in the community. The majority of our clients are marginalized and have experienced a great deal of trauma in their lives. Most struggle with addiction and mental illness, making building rapport and a trusting therapeutic relationship key to our client-centered approach.

We also have a team of testing nurses whose focus is on the MSM (men who have sex with men) population. These nurses work with high-risk individuals in culturally sensitive clinics and within Vancouver’s bathhouses, at various hours of the day and night.

BC-CfE: What is a day on the job like?

LD: Every day is different and unpredictable so there is no typical day. Certain clients will be a priority each day for various reasons.

We work as a team to juggle our time to manage caseloads with ever-changing needs. We accompany clients to their appointments. We do a lot of crisis management, from dealing with acute illness/psychosis to supporting clients who are being evicted. We are constantly working to break down barriers to care. We check in with our clients regularly in hopes of finding appropriate moments for health care interventions, like getting blood work done. We also strive to talk to them about topics that are important and relevant to them, like medication management and HIV criminalization.

BC-CfE: How do you see the STOP program working? What is driving the success?

LD: Our success is based on our client-centred approach, our interdisciplinary team services as well as our strong community partnerships. We have had incredible support from our management to be able to be flexible and creative in order to meet the needs of our clients.

Our case management team works in what we call “pods” which consist of an outreach worker, a nurse and a social worker to provide wrap-around care to our clients. We work very closely with our community partners to support our mutual clients: it feels as though we are one big team providing a network of care.

BC-CfE: How do you see Treatment as Prevention (TasP) being implemented on a day-to-day basis?

LD: As TasP is at the core of our mandate, it is at the forefront of our conversations with clients. We make sure they are aware of the importance of treatment for their health, as well as for decreasing the risks of transmission to their partners. This conversation usually occurs when a client is first introduced to us. However, as consistently taking medications is often very difficult for our clients, TasP is an ongoing discussion. We work with clients to build resilience, self-care and independence.

BC-CfE: What is the main goal of your role?

LD: The main goal of our role is to empower our clients. We provide them with the information they need to make decisions about their health. New referrals to our team are typically when clients are at their most vulnerable, often experiencing a sense of despair in a system that does not adequately meet their needs. We try to instil hope and motivation for positive change. Our program wouldn’t work if we focused strictly on HIV. We work with clients to build a foundation from which they can move toward wellness in all aspects of their life. By helping our clients get stable housing, food security, dentures, ID and maximizing their income, we are helping provide them with dignity. This brings the ability for them to be at a place where they can be able to start to manage and sustain their own health.

We are structured to be a short-term, bridging team to connect our disengaged clients into the network of care that’s available in the community. It’s a true honour to support our clients through their tough times and to witness their growth toward wellness.

Read a case study of a STOP client who was successfully engaged in care and achieved undetectable viral load.

Tags:

STOP HIV/AIDS

Treatment as Prevention®

BC Centre for Excellence in HIV/AIDS

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A Day in the Life of an Outreach Nurse: Implementing Treatment as Prevention in the Field

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