This article was originally posted on the website for the Saskatchewan Medical Association.
A Saskatchewan primary-care physician has a simple message for doctors who are thinking of expanding their capacity to care for people with HIV.
“Do it!” said Dr. Laura Marshall, a La Ronge family physician.
“It’s rewarding work, and clinically it is very interesting, but at the same time fairly straightforward. You can make a big difference in a patient’s health and wellness.”
Dr. Marshall was one of three Saskatchewan primary-care physicians or family medicine grads who received scholarships to participate in the British Columbia Centre for Excellence in HIV/AIDS’ Intensive Preceptorship Program. The five-day clinical placement, which was completed in November 2018 at St. Paul’s Hospital in Vancouver, was open to physicians who have a strong interest in caring for people living with HIV and who want to mentor their colleagues as their knowledge and experience grows. (The BC Centre for Excellence in HIV/AIDS offers a range of online and offline training programs.)
The scholarships were offered by the Saskatchewan Infectious Disease Care Network in conjunction with the Ministry of Health and the Public Health Agency of Canada.
Dr. Marshall has been a physician in La Ronge for seven years and has been working with HIV patients for five years. Dr. Tasha McNamara, a second-year family medicine resident in Saskatoon, and Dr. Sarafa Tijani of Regina were also selected for the program.
Dr. McNamara told the SMA that as a soon-to-be family physician she wants to incorporate HIV care as part of her practice, but didn’t feel prepared until participating in recent workshops and the preceptor program in BC.
“As family physicians, I feel we are fortunate to develop continuity with our patients and often act as their first contact to health services,” she said. “I believe we are situated in one of the best positions for infectious disease prevention, diagnosis and management.”
Multidisciplinary approch effective
In Saskatchewan, treatment for HIV need not have to wait for a referral to a specialist, she added. “Family physicians should bridge the gap in initiating treatment and assist in the ongoing monitoring and continuity to their care, including aspects unrelated to their HIV diagnosis.”
Both physicians took note of the multidisciplinary approach taken by the BC-CfE. That collaboration included infectious disease specialists, family doctors, pharmacists, nurses, social worker, to name a few. The range of resources provided by staff and the programming available to patients helps them stay the course in their treatment plans, Dr. McNamara said.
“Providing this network of continuity, in a comfortable setting for patients, contributes to successful retention in care to the point where the majority of the family medicine clinic visits I observed at the centre mainly focused on common presenting complaints as seen at any clinic,” said Dr. McNamara. “HIV wasn’t the forefront of their visit. Engagement in treatment is key, along with helping patients overcome the initial concerns and barriers of diagnosis.”
Dr. Marshall also observed that “there isn’t the same stigma around HIV, or at least not to as great of a degree” as there is in Saskatchewan. “At the BC-CfE, testing is done routinely, people are knowledgeable about the disease and the risk of transmission. I feel Saskatchewan still has a ways to go for that.” The preceptor program in BC showed the Saskatchewan physicians that a family doctor can only do so much, Dr. Marshall said. “The most challenging part of providing primary care is helping patients with all the aspects of their life that aren’t medical,” she said. “A lot of people are marginalized, have addictions issues and food and housing insecurity. Many of the social determinants of health are not met and helping with these are a big challenge and needs a lot of work on the provincial level.”
Treatment has come a long way
Dr. McNamara said as a family medicine resident, the most intimidating part is the feeling that initiating HIV treatment is beyond her scope. The number of combinations of medications can seem daunting. But she said HIV treatment has come a long way and the options are simpler than she had expected.
“As family physicians we wouldn’t be expected to treat complex patients and therefore I think HIV from a primary care perspective is much less of a challenge than I assumed,” she added. “Personally, the challenging part I think will be to find ways to engage patients with HIV living chaotic lifestyles.” Family physicians are well-positioned to help HIV-positive people who are leading high-risk lifestyles to receive the care they need, where they need it. Doctors can help patients lead full lives – even if the patient doubts that is possible, Dr. McNamara said.
The week at the BC Centre for Excellence in HIV/AIDS showed her that managing a patient with HIV can be routine, so much so that family physicians can turn their attention to all aspects of that person’s health. “
Maybe that is the reward,” she said, “that if as family physicians we can make their care more accessible and continuous, then their disease doesn’t differ from any other chronic illness, and doesn’t define the person or their health.”
Find out more about the BC-CfE’s Education and Training Programs.