Project Title
Beyond Blue Door: Evaluating interventions to bridge knowledge and service gaps for people with HIV with precarious or no health insurance coverage
Project Leads
Objectives
The key objectives of Beyond Blue Door implementation study are: (1) to generate knowledge on the determinants of HIV related health disparities experienced by non-insured or precariously insured people living with HIV (PLHIV); (2) to evaluate the effectiveness and sustainability of the innovative Blue Door Clinic initiatives to support linkage to stable, long-term primary care; and (3) to identify evidence-based strategies to advance policy and service access for marginalized and vulnerable PLHIV populations.
Research questions
The study aimed to answer: (1) What are the structural drivers of health disparities among PLHIV with precarious or no health coverage; (2) How effective and sustainable is the Blue Door Clinic as an innovative intervention? (3) What contributes to the effective implementation of the Bloor Door Clinic as an intervention?
Background
Access to health care and treatment is a structural driver of the HIV epidemic at both the individual and population levels while the advances of HIV treatment have made ground breaking progress in preventing HIV infections and improving the health outcomes of many PLHIV, the disease continues to impact specific vulnerable and marginalized communities at disproportionate levels. PLHIV, who have precarious immigration status or no health care coverage, represent a diverse group of people that makes up a significant proportion of the 10-10-10% gaps in the HIV care engagement cascade. These gaps impact both individual health as well as the overall effectiveness in curbing the epidemic. Many newly diagnosed people face major barriers to health care access because of their precarious immigration status and/or lack of health care coverage, with a majority of them contracting the virus after arrival in Toronto. The Blue Door Clinic, established in 2019 through shared vision, advocacy and dialogue among service providers and policy makers, is a ground-breaking, multidisciplinary coalition of service agencies providing HIV treatment, community support, and linkages to ongoing services for PLHIV with precarious or no healthcare coverage. This study evaluates the Blue Door Clinic as an innovative intervention to inform policy and services.
Methods
We used a mixed methods approach in two phases. In Phase One qualitative narrative data was collected through focus groups and individual interviews with non-insured or precariously insured PLHIV (n=30), service providers and decision makers (n=21) to increase our understanding of the social determinants and health disparities affecting PLHIV with precarious or no health insurance. Phase two included both quantitative and qualitative data collection aimed at evaluating the effectiveness and impact of the Blue Door Clinic. Quantitative data included cumulative service statistics of clients at the clinic (n=159) related to linkage to and retention in primary care, and referral to access social determinants. Qualitative data was gathered through focus groups with PLHIV who had accessed services at the clinic (n=31), along with internal and external service providers (n=35). Focus groups in this stage centered on experiences of service access at the clinic, strengths, challenges and ideas for growth and enhancement.
Current Status
We are in knowledge translation and policy action stage.
Expected completion
March 2024
Co-researchers & Partners
Casey House, Community Alliance for Accessible Treatment; Sherborne Health Centre; Toronto People with AIDS Foundation; Parkdale Queen West Community Centre; Centre for Spanish speaking people; Hassle Free Clinic; Regent Park Community Health; Centre, Ontario Aboriginal HIV/AIDS Strategy, Ontario Health Toronto, University Paris 8; Black Coalition for AIDS Prevention
Funding
Ontario HIV Treatment Support Network
Publication
- Beyond Blue Door Research Report released on September 12, 2023. Please follow the link to read and download.
- Dr. Alan Li, Dr. Josephine Wong and Alessandro Bisignano of the Investigators’ Team presented the Beyond Blue Door Research Report at the CAAT’s Annual Meeting on September 12, 2023. https://www.youtube.com/watch?v=VaNq_cYU9VM
Key words
uninsured and/precarious insured; immigrants, refugees and people with precarious status; access to HIV treatment and care; implementation science