BC-CfE’s provincial BOOST Collaborative is following on the heels of the successful Vancouver-based BOOST Collaborative. BOOST is inspired by the made-in-BC Treatment as Prevention¨ strategy and supports a Targeted Disease Elimination¨ (TDE¨) approach. This means using tools and strategies that have been proven through the work of the BC-CfE in curbing HIV transmissions. The TDE¨ strategy can address contagious diseases and diseases with a social contagion factor, such as substance use disorders. The first phase of the BOOST Collaborative doubled retention rates in the lifesaving opioid agonist treatment (OAT) for substance use disorders.
Among participating Vancouver Coastal Health (VCH) clinics, the number of individuals retained at three months made a significant jump – from three out of ten to seven out of ten.
The provincial expansion of BOOST has its eye on even greater goals, aiming to ensure that 95% of people with opioid use disorder have an active OAT prescription and 95% of those on OAT are retained at three months (or longer).
On February 14th, BOOST Collaborative teams from across the province-including Prince George, Kelowna, Chilliwack, Victoria, Nanaimo, Surrey and Vancouver’s Downtown Eastside-met for the first learning session in Vancouver. Teams have been tasked with creatively generating tactics and strategies, and even morale-boosting team names, in order to enhance their OAT treatment programs.
Dr. Laura Knebel was part of the pilot BOOST team at the Downtown Community Health Clinic (DCHC) in the heart of the Downtown Eastside. There was trepidation among her staff in the early days of the initiative. Quality improvement tasks, while only intended to take less than 10% of a clinic’s staff time, seemed overwhelming given competing demands.
Looking back on the year-long pilot, Dr. Knebel said the data collected for its quality improvements efforts helped pinpoint needs, while also showing encouraging signs of success. After finding that about half of DCHC clients did not have active OAT prescriptions, clinicians worked to identify a number of clients that could possibly be re-engaged in treatment. DCHC staff are now applying the learnings from BOOST to help clients with other conditions.
BOOST Lead and BC-CfE Senior Medical Director Dr. Rolando Barrios urged teams to take small steps wherever they saw opportunity, rather than waiting for reams of data. “You don’t need perfect data to act,” said Dr. Barrios.
Research supports the BOOST approach, showing the risk of morbidity and mortality decreases by 80% for individuals on effective OAT. Further, access to OAT has also been shown to drastically reduce levels of crime associated with drug use.
The concept of BOOST is reminiscent of the fable about the tiny mouse who pulled the thorn out of the elephant’s foot. The provincial BOOST Collaborative teams are taking on the work of implementing small programmatic changes to improve access to and sustainment in care-and these can have a big impact. This could include administrative tasks of improving intake forms or adding reminder calls to clients.
Provincial BOOST Collaborative
In 2010, the BC-CfE launched the STOP HIV/AIDS¨ Structured Learning Collaborative (the “Collaborative”) to improve the quality of HIV care and services, improve patient engagement & increase sustainment in care, and strengthen partnerships in care. As a result of the BC-CfE’s Collaborative, all participating teams saw improvements: namely, they implemented their learnings to deliver proactive and organized needs-based HIV care, with supports for patient self-management. The STOP HIV/AIDS¨ Collaborative provided the model for the BC-CfE’s BOOST Collaborative to work with provincial Health Authorities to help engage more individuals in treatment for opioid use disorder through opioid agonist treatment.