THRIVE

Vorobyova A

Anna Vorobyova

Research Coordinator

Program(s): Epidemiology and Population Health
Initiative(s): THRIVE

Finding the Balance: Embracing the Two-Eyed Seeing Approach to Understand what Cultural Safety in Care Means to Older Adults Living with HIV

2022 | J Appl Gerontol

PubMed

Abstract:

Older adults living with HIV (OALHIV) are a fast-growing demographic who rely on home and community care (HCC) services. Cultural safety (an environment free of racism that fosters feelings of safety and respect) is integral to HCC services. We conducted 27 semi-structured interviews with OALHIV in Vancouver, British Columbia about their HCC experiences. Excerpts about cultural safety were qualitatively analyzed using Two-Eyed Seeing. Our themes-Voices from across Turtle Island, Voices from the African continent, Western Perspectives, and Universal Principles-indicate that cultural safety is important yet lacking. While specific aspects of culturally safe HCC services varied between and within cultural groups, some aspects were shared by participants across groups (e.g., respect, compassion, and non-judgment).

BC-CfE research scientist Dr. Surita Parashar reflects on World AIDS Day

posted on December 1, 2021

On World AIDS Day, December 1st, we asked Dr. Surita Parashar, a BC-CfE research scientist of the Epidemiology and Population Health Program about her work and how it relates to this year's World AIDS Day theme of ‘End Inequalities. End AIDS. End Pandemics’.

Tell us about your role and the focus/study of your work?

I am the Principle Investigator of Thrive, a research study that investigates the home and community care needs of older adults living with HIV within Vancouver Coastal Health. I am privileged to work alongside an amazing team of Peer Research Associates who co-lead this work. Antonio, Claudette, Patience, and Sharyle are older adults living with HIV who have experiences in common with the study population. They are truly the driving force of this study.

What role does HIV play in your work and how does it impact your participants?

All of our study participants are living with HIV, so HIV is a common thread in participants’ life stories. Our peer research associates speak to folks about aging with HIV and the journey to accessing the care need as they experience ebbs and flows in their health status. However, HIV itself is not the focal point of our discussions with participants and I would even go so far as to say, it’s not the most pressing issue folks have to manage day-to-day. It’s other social-structural issues - securing adequate housing, facing stigma and discrimination in healthcare settings, navigating the opioid crisis - that have the most significant impact on people’s health and well being.

The theme of World AIDS Day this year is ‘End Inequalities. End AIDS. End Pandemics’. How do inequalities in HIV care influence your work and are there opportunities to address inequalities to HIV care in your work?

Advances in access to HIV care - including the universal availability of treatment and the widespread use of life-saving antiretroviral therapy - has resulted in incredible gains in life expectancy amongst people living with HIV in BC. Technically speaking, all people living with HIV have equal opportunity to access and benefit from treatment, so the main issue is not inequalities in HIV care. What persists and undermines these gains are health inequities - systematic differences in the opportunities people living with HIV have to achieve optimal health, which leads to unjust and avoidable differences in health outcomes between different people and sub groups of PLHIV. Thus, despite incredible advances in HIV treatment and prevention, people living with HIV who are marginalized by social-structural inequities disproportionately experience poor health outcomes. We see that amongst members of our communities who use substances, for example.

In regards to learnings from the Thrive study specifically, home and community care is a service available to anyone who is experiencing acute, chronic, or rehabilitative health-care needs. However, many of our study participants who are in need of this service face barriers to accessing it - lack of information, lack of support, stigma, competing needs relating to mental health and substance use disorders. So once again, the main challenge with access to this kind of care is not inequality, it’s inequity.

We have heard many disheartening stories of the stigma, discrimination, and biases of providers that prevent people marginalized by social structural inequity from accessing the care they need. We have also heard incredible stories of resiliency, people taking care of one another, and providers going the extra mile to support their clients in getting the care they need.

We hope through communicating our findings to those who design and operate the home and community care system, we will be able to convey the barriers many people face in accessing this care, as well as the factors that have helped people along in their journey to accessing care - peer support; and patient-centred, culturally safe, tailored supports for people with urgent health needs who experience social-structural inequities.

Can you share any examples of participants overcoming barriers to HIV care thanks to the work you do?

For sure the most significant impact of our work is felt through peer-to-peer connection, thanks to the incredible team of peer research associates being the main point of contact with study participants. Peer research associates know what services are out there; they know the roadblocks and pathways of the care journey from first hand experience, as well as through the other hats they wear as advocates, volunteers, peer navigators, and leaders in their communities. Sometimes connections are made to services that a participant otherwise would not have known about, which could contribute to people overcoming barriers to care. A lot of the time interviewees mention that it felt good to have someone intently listen and care about their story. It’s good to know that at the very least, connecting with peer research associates in the interview process is a positive experience for Thrive participants.

Characteristics of older adults living with HIV accessing home and community care services in British Columbia, Canada

2020 | AIDS Care

Taylor & Francis Online

Abstract:

Over half of people living with HIV (PLHIV) engaged in care in British Columbia (BC) are age ≥50. The public home and community care (HCC) system offers formal support that PLHIV may turn to as they age, but little is known about access specific to PLHIV. Using data from the STOP HIV/AIDS cohort, which includes linked treatment and demographic records for PLHIV accessing care in BC, we compared older PLHIV (defined as those age ≥50) who did and did not access HCC services. We estimated adjusted odds ratios (aORs) for factors associated with HCC service utilization using logistic regression. This study included 5,603 PLHIV age ≥50, 837 (14.94%) of whom accessed any HCC service between 2005 and 2015. Services most commonly used were community nursing (8.98%, n = 503) and rehabilitation (7.73%, n = 433). Those who received HCC were more likely to be female (aOR = 1.56, 95% CI = 1.24, 1.98), have a history of injection drug use (aOR = 1.88, 95% CI = 1.57, 2.25), have a higher Charlson comorbidity score (aOR = 1.11, 95% CI:1.07, 1.15) and to have visited a general practitioner in the past year (aOR = 2.17, 95% CI = 1.77, 2.67). Approximately 15% of older PLHIV have accessed HCC, but the extent of potential unmet need for these services requires further research.

Cardinal C

Claudette Cardinal

Peer Indigenous Research Associate

Program(s): Epidemiology and Population Health
Initiative(s): COAST THRIVE LISA

The enigma of HIV's effects on aging

February 28, 2020

We are in a new era of HIV research and care. We have never known more about the virology of HIV. We also have an array of highly effective antiretroviral therapies which suppress HIV to undetectable levels, while extending the life expectancy of individuals with HIV to close to that of the general population.

These are all significant signs of progress; however, the legacy from the height of the HIV epidemic remains today through another complex and multifaceted healthcare challenge.

The average age of a person living with HIV in Canada is now over 50 years old and this is projected to rise above 65 in the next 10 years. While this is a positive indication of the impact of highly active antiretroviral therapy (HAART) and Treatment as Prevention® in significantly reducing new cases of HIV, this aging population presents with age-related diseases sooner and more frequently than the general population. This includes cardiovascular and metabolic conditions, as well as cognitive impairment and frailty, among others. Little is understood about why this is the case.

The BC Centre for Excellence in HIV/AIDS (BC-CfE) is playing an active role in research to better understand this population’s distinct physiological and psychosocial challenges. Over the last 10 years, BC-CfE researchers have participated in a series of long-term investigations to look more closely at the lifestyle and health factors associated with aging with HIV.

Positive Brain Health Now is one such study. Since 2013, the BC-CfE has participated in this long-term investigation funded by the Canadian Institutes of Health Research (CIHR) with the support of the Canadian HIV Trials Network (CTN).

Led by investigators at McGill University, Positive Brain Health Now researchers are focused on better understanding HIV-related ‘brain health’ factors and how these impact patient outcomes. This includes general cognitive processes such as concentration and memory, mental health and quality of life. By carefully tracking 856 adults living with HIV over time, researchers hope to understand the risk factors associated with declining brain health.

While those living with HIV may experience higher rates of cognitive impairment, they are also more likely to show physical signs of aging sooner than the general population. In the fall of 2019, the BC-CfE joined the CIHR-CTN CHANGE HIV study which investigates frailty and other aging-related conditions in Canadians over the age of 65 living with HIV. The term frailty is commonplace in geriatric medicine and is used as a marker of physical wellbeing.

Speaking about this study, Dr. Silvia Guillemi, Director of Clinical Education at BC-CfE said, “Many studies look at aging, however typically they follow younger populations as they age. With the CHANGE study, we are looking at an older population from the start and charting their progress over five years looking at various aspects of their lives, including physical activity levels, trauma, among others.”

The care and support received at home among older adults with HIV can also impact their overall health outcomes. THRIVE, a study based at the BC-CfE, is exploring experiences accessing home and community supports in BC for those aged 50 years and older. Through qualitative interviews, researchers aim to understand how this population navigates the home and community care system and using novel “service access mapping” interviews, this study will also document the day-to-day experiences of this population - from where they fill prescriptions to where they access food. Participants’ narratives will help researchers understand how shifts in funding priorities have impacted the accessibility and nature of this care.

Dr. Marianne Harris is a clinical research physician with the BC-CfE. Speaking about the importance of aging studies in HIV research, she said, “People living with HIV are now living into their 50s, 60s, 70s and beyond thanks to the success of modern antiretroviral therapy. Now they’re facing a new set of issues that affect their quality of life including loss of memory, muscle weakness, breathing problems and so on. They’re asking, ‘Is this an HIV outcome or is it natural aging, and what can I do about it?’

“The best way to answer these questions is to study a large and diverse group of people living with HIV over time and look at how the effects of aging can be impacted by different interventions and lifestyle changes. It’s important that people living with HIV are actively involved in this research to share their lived experiences and to help us better understand what’s most important to them,” Dr. Harris explained.

According to the World Health Organization 37.9 million people were living with HIV/AIDS globally in 2018. As cure research continues to evolve, we need to ensure that people who are living with HIV, regardless of their age, are empowered and equipped with the knowledge of how to maintain good health and wellbeing.

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Clinical Education & Training

The BC Home and Community Care System and Older Adults Living with HIV.

May 2019

The BC Home and Community Care System and Older Adults Living with HIV

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Salters KA

Kate Salters

Research Scientist

Program(s): Viral Hepatitis Research Program (VHRP)Epidemiology and Population Health
Initiative(s): COAST SHAPE Study THRIVE CANOC LISA

Kate is a Research Scientist with the Epidemiology and Population Health program. Her program of research focuses on health care engagement and health outcomes among people living with HIV and hepatitis C. She completed her PhD in health sciences from Simon Fraser University in 2017 and her scope of expertise includes reproductive health, HIV/AIDS, viral hepatitis, and health systems research. Kate is passionate about conducting clinical and epidemiologic studies that engages with community and helps to inform clinical practice and improve health service delivery.

Parashar S

Dr. Surita Parashar

Research Scientist

Program(s): Epidemiology and Population Health
Initiative(s): THRIVE LISA

Surita Parashar coordinates "At Home At Howe Street, an evaluation of a supportive housing intervention for people living with HIV." This prospective cohort study, conducted in partnership with McLaren Housing Society of BC and funded through a CIHR Population Health Intervention Research grant, investigates the impact of a supportive housing complex on the health of individuals and families affected by HIV.

This study stemmed from Surita's doctoral research at Simon Fraser University's Faculty of Health Sciences, a community based initiative entitled, “The way I see it: a photographic exploration of housing and health among persons living with HIV in Vancouver.” Surita contributes to a number of other studies within the Division of Epidemiology and Population Health including the Dr. Peter Study, the Engage Study and the Longitudinal Investigations into Supportive and Ancillary Health Services (LISA) project.

Lima VD

Dr. Viviane Dias Lima

Scientist and Senior Methodologist

Program(s): Clinical Programs Epidemiology and Population Health
Initiative(s): THRIVE Drug Treatment Program

Viviane Dias Lima is an Associate Professor in the Department of Medicine at the University of British Columbia and joined the British Columbia Centre for Excellence in HIV/AIDS in 2006 as a Research Scientist and Senior Statistician. She has several ongoing collaborations with researchers across Canada, the US, and Europe. She also supervises and guides a group of statisticians, epidemiologists and mathematical modellers.

By combining statistical, mathematical and epidemiological methods, her area of research focus on investigating innovative prevention strategies for the transmission of HIV and novel intervention strategies to avert HIV disease progression. Her research has recently focused on understanding the aging process of people living with HIV.

Her research program creates numerous research opportunities and provides a new setting in BC where trainees will be supported across various disciplinary and methodological backgrounds, further enhancing BC’s competitive advantage in population-health research.

To this end, she currently has research funds to support graduate students interested in working in the research areas mentioned above.

I am situated at the British Columbia Centre for Excellence in HIV/AIDS which is a great environment to conduct research and study. I also have an elective on Clinical Epidemiology in which undergraduate medical students can experience research in the areas mentioned above.

BC Centre for Excellence in HIV/AIDS

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