Since opening in late 2019, the BC Centre for Excellence in HIV/AIDS’ (BC-CfE) Hope to Health Research and Innovation Complex (H2H) has offered comprehensive health care to residents of Vancouver’s Downtown Eastside. For H2H clients, holistic means a team of healthcare professionals, including doctors, nurses, social workers, and peer research associates, will help with not only medical care, but also in providing psychosocial supports. This can include helping clients find stable housing, income and social support, and providing behavioural interventions, like educating clients in safer substance use.

Located on the 600 block of Powell Street, H2H is comprised of three buildings. At 625 Powell is the primary care clinic. When H2H opened the goal was for up to 1,400 clients with complex needs to have what is referred to as a “medical home”. This concept means offering care centred on individual clients’ needs, within their community, and integrated with other health services. By having a medical home, and by building a trusting relationship with clients, better health outcomes can be achieved.

Clients who come in to H2H will be met by one of two Integrated Care Teams (ICT), which are both supported with shared clinical services, and one triage team, that determines the immediate needs of each client. The data shows the top diagnosis for H2H clients is Mental Health and Substance Use Disorders, whether that disorder is use of opioids, alcohol, or stimulants. The other diagnoses include chronic hepatitis C infection, hypertension, dyslipidemia (high cholesterol), and HIV.

The philosophy of comprehensive care at H2H is summed up by the slogan of “Enroll, Engage and Empower”. Enrolling clients at H2H has succeeded quickly and fully, with a client roster now standing at 1250, close to the original goal of 1,400.

Engaging clients means they continue to see H2H as a place of consistency, where they trust their healthcare providers and are able to be honest about their medical needs without fear of judgment or stigma. Through the systematic method of Quality Improvement, the staff of H2H has decreased disengagement in care at H2H from 42 percent to 15 percent. Research has proven that increased engagement in care improves client outcomes and decreases the use of acute care, such as hospital emergency rooms.

Empowering clients means they are able to set health goals for themselves and craft a care plan with their doctor to meet these goals. The latest available data from H2H shows the percentage of clients with documented health goals and a care plan is above 80 per cent.

For clients with substance use issues, empowerment may mean that they want to stop using street drugs and be prescribed a safer supply. Doctors at H2H can help with this goal by offering opioid agonist therapy (OAT), proven to be an effective treatment for illicit opioid use. OAT involves a client switching from dangerously toxic drugs acquired illegally, to taking the opioid agonists methadone, buprenorphine (Suboxone^®) or slow-release oral morphine. These prescribed medications help to prevent withdrawal and reduce cravings for opioids. OAT helps H2H clients stabilize their lives and greatly reduces drug use related harms.

For clients who continue to use illicit drugs, the H2H building at 611 Powell features a Supervised Consumption Site where clients can bring in their own substances and use them under the supervision of trained staff. By using brand new needles, clean water, and being in a stigma-free indoor space, clients injecting their drugs are considerably safer than if they were using outdoors. Those using at the safer consumption site are also at far less risk of suffering a fatal overdose, as the nurses supervising them will act quickly to reverse overdoses should they occur. In a time of record high drug-related deaths, there has not been a single fatal overdose at H2H.

At 647 Powell the H2H on-site laboratory is led by Dr. Zabrina Brumme. The laboratory tests client’s blood samples to monitor genetic changes in viruses within their bodies, which could lead to more effective tailored therapy. Other testing includes therapeutic drug level monitoring, an important tool for investigating drug absorption, treatment adherence, toxicities, and side-effects. Opportunities to support the work at 625 and 611 Powell are being explored by the laboratory to further personalize and enhance client care.

Dr. Rolando Barrios is the BC-CfE’s Senior Medical Director and has worked in the Downtown Eastside for decades. As the lead physician of H2H, Dr. Barrios said, “Enrolling, engaging and empowering clients at H2H isn’t just a slogan. The staff at H2H truly work hard to help our clients realize their own health goals.