About

The Re-Engagement and Engagement in Treatment for Antiretroviral Interrupted and Naïve populations (RETAIN) Initiative is a new partnership with the BC Centre for Excellence in HIV/AIDS (BC-CfE), Medical Health Officers from each health authority and HIV outreach personnel throughout British Columbia.

The RETAIN Initiative seeks to promote treatment initiation for HIV-positive British Columbians who have never been treated with HIV antiretroviral therapy (ART) and treatment re-initiation for individuals who have interrupted HIV treatment through ART. On sustained and consistent treatment, people living with HIV (PLWH) can achieve a viral load that is undetectable by standard blood tests. HIV treatment improves an individual’s quality of life and longevity, while nearly eliminating the chances of transmitting HIV to others. This is the evidence-based concept behind Treatment as Prevention®.

The RETAIN Initiative has two main interventions:

Clinician Alerts

The BC-CfE sends routine alerts to physicians regarding their patients who have interrupted ART. Additionally, alerts have been launched for physicians linked to patients newly diagnosed with HIV who have not yet accessed ART. Both of these alerts include contact information for local public health support.

Routine Coordination of Outreach Support

The core component of RETAIN is the routine province-wide coordination of public health support for PLWH who have interrupted ART or who have yet to initiate therapy. PLWH will be eligible for this outreach support if: 1) they have interrupted treatment for longer than four months, or 2) they have not yet started treatment more than eight months after a high plasma viral load is reported.

Public health support specified by the RETAIN Initiative aims to ensure all PLWH have opportunities to access care and treatment. However, the views and decisions of those PLWH who wish to remain off treatment will be respected. All patient information is kept confidential and is not shared beyond the most trusted public health channels. The Office of the Information and Privacy Commissioner for BC has reviewed this initiative, and it adheres to strict privacy standards and all applicable privacy legislation.

Background

Benefits of antiretroviral therapy (ART) to treat HIV include reductions in morbidity, mortality and transmission resulting in significant improvements to individual health and a virtual elimination of HIV transmission. At any given time in British Columbia, one out of three PLWH have a detectable HIV viral load (the level of virus in the blood, which can be an indicator of health). Only two out of three PLWH in BC remain on consistent ART, meaning ART interruption remains a major obstacle to improved health outcomes and reduced transmission.

Additionally, cases of delayed initiation of ART for newly diagnosed PLWH remain persistent. A Canada-wide survey, led by the BC-CfE, found nearly half of the individuals living with HIV started when they had already reached an AIDS-defining illness. Treatment as Prevention® improves the health and longevity of people living with HIV, and curbs the HIV epidemic.

More information:

What is the role of the BC Centre for Excellence in HIV/AIDS (BC-CfE) in caring for British Columbians living with HIV?

The BC-CfE is dedicated to improving the health of British Columbians with HIV through the development, ongoing monitoring and dissemination of comprehensive research and treatment programs for HIV and related diseases. The BC-CfE is a key provincial resource, serving all health authorities, regions and citizens of BC.

One component of the BC-CfE is the Drug Treatment Program (DTP), created based on guidelines generated by the BC-CfE Committee for Drug Evaluation and Therapy. Information from all DTP participants is entered into a secure database, providing data for scientific studies of patients receiving antiretroviral therapy. This database acts as a registry of all HIV-treating physicians in the province, as well as an “early warning system” to alert government about the trajectory of the disease.

Who is involved the RETAIN Initiative?

RETAIN is a collaboration between the BC-CfE, Medical Health Officers from each of the five provincial health authorities, and HIV outreach nursing staff throughout BC.

What is the purpose of RETAIN?

It provides further support for people living with HIV who have, for a variety of reasons, not initiated or who have interrupted antiretroviral therapy (ART). The initiative provides public health support and assistance to improve access to care and treatment for those living with HIV who are not accessing treatment. Research shows sustained and consistent HIV treatment improves individual health while decreasing HIV transmission.

How does the RETAIN Initiative communicate with physicians?

The BC-CfE sends routine alerts to physicians regarding their patients who have interrupted antiretroviral therapy (ART) and for physicians linked to patients newly diagnosed with HIV who have not yet accessed ART. Both of these alerts include contact information for local public health support, should doctors or patients wish to engage assistance to reach any of their patients.

How does outreach staff receive personal information about individuals contacted through RETAIN?

In order to better serve those living with HIV in BC, select information is confidentially shared between specific BC-CfE staff and public health staff. Public health referrals for RETAIN are not based on any information shared by physicians.

Once they have received an alert, physicians have the opportunity to provide any available information or feedback on the circumstances of their patient’s treatment interruptions or delays in treatment initiation. The physician can also make attempts to reach their patient over a two-month period. Following this period, the RETAIN Initiative will refer an individual to public health for support.

Who is eligible to be part of the RETAIN Initiative outreach?

Following initial outreach attempts to physicians, the core component of RETAIN is the routine province-wide coordination of public health support for people living with HIV who have interrupted ART or who have yet to initiate therapy. Stringent criteria are employed to determine who is eligible for public health outreach support. People living with HIV will be eligible for this outreach support if: 1) they have interrupted treatment for longer than four months, or 2) they have not yet started treatment more than eight months after a high plasma viral load is reported.

The plasma viral load refers to the amount of HIV virus in the blood of an individual living with HIV, and is an indicator of their health status. On sustained and consistent treatment, an individual living with HIV can achieve a viral load that cannot be detected by standard blood tests. This improves their health and longevity, while reducing the chances of HIV transmission to others.

Has there been legal review of this?

The RETAIN Initiative and all relevant documentation were reviewed by the Health Information Privacy and Security Standing Committee, which represents the Privacy Offices of all BC Health Authorities. The Office of the Information and Privacy Commissioner for BC has reviewed the RETAIN Initiative to their satisfaction.

Why is RETAIN important?

Treatment interruptions and delayed initiation are harmful to individual health and present possible public health risks. BC provincial HIV treatment guidelines urge immediate and sustained treatment for those diagnosed with HIV. Research shows early, consistent and sustained treatment improves the health of people living with HIV, while reducing HIV transmission.

Can a person living with HIV decide not to take antiretroviral therapy (ART), even after being contacted through RETAIN?

It is the right of the individual to make the decision to initiate ART and to remain on treatment consistently. The protocols in the RETAIN Initiative do not force or coerce anyone to take ART. RETAIN is concerned with offering people living with HIV more opportunities to engage in care and sustained treatment.

Was this being done before?

RETAIN is a new initiative of the BC Centre for Excellence in HIV/AIDS (BC-CfE). While HIV is a reportable condition in BC, HIV outreach staff were not previously informed about treatment interruptions or delayed initiation of antiretroviral therapy (ART). Some physicians had elected, at their own discretion, to refer patients to public health outreach teams throughout BC. However, there was no routine coordination of this support prior to the launch of the RETAIN Initiative.

RETAIN is the first program in BC to implement a routine coordinated public health response to help reach individuals living with HIV who are not accessing or have interrupted treatment.

Would you like to provide information about RETAIN to other health care providers or to clients? Please find here posters available for downloading and printing.

RETAIN-Poster for Clinicians

RETAIN-Postcard for Clients

For more information, please contact RETAIN@cfenet.ubc.ca.