DOT for HAART has entered its final six months of operation as a Health Innovation Fund project. Program benefits were clearly demonstrated by meticulous collection of outcome data and by external project evaluation. This project has already fulfilled all of its stated goals by consistently delivering daily directly observed therapy (DOT), psychosocial support, risk behaviour reduction and HIV education to increasing numbers of elusive and high-risk HIV positive patients requiring HAART. A highlight of our third year was the 2003 Duncan & Craig bronze Laurel Award honouring exceptional creativity and innovation by Edmonton non-profit organizations.
In collaboration with representatives from HIV Edmonton, Sexually Transmitted Diseases Clinic and Royal Alexandra Hospital HIV clinic, an additional program, periodic DOT for HAART, is also being developed. This new program would operate concurrently with the present daily DOT for HAART model but would provide adherence support only twice weekly and hence at less cost. Such a modified program would be suitable for more committed HIV positive individuals and graduates from the original daily DOT for HAART program, who may be likely to succeed with less intensive support.
The success of DOT for HAART represents a triumph for Alberta Health and Wellness and its bold HIF initiative that enabled the development of innovative solutions to several critical health care issues. The DOT for HAART approach is emerging as state-of-the-art for effective and cost-saving HIV management in marginalized populations everywhere. This contention is now clearly supported by recent published evidence from several leading HIV researchers in Canada and USA. Without such adherence support and risk reduction initiatives, HIV infected individuals from this high risk and growing category would invariably:
• receive costly HIV medication treatment with no benefit whatsoever
• contribute to the development of HIV drug resistance
• progress to HIV-related illness and Acquired Immunodeficiency Syndrome
• transmit a growing number of new HIV infections
Each of these scenarios is already being borne out and is clearly described in numerous recent HIV studies from Canada and other developed countries. Furthermore, as illustrated in extreme form in many parts of Africa, the economic and societal burden of an uncontrolled HIV epidemic becomes catastrophic. It is therefore essential for DOT for HAART to secure adequate funding for its continuation and expansion after Health Innovation Funding expires in April 2004. This is currently the only successful approach to an urban HIV epidemic that would otherwise remain an untreatable moral, public health and economic calamity for all of society.
New Inner City HIV Cases Fall For the First Time
Newly identified HIV cases in Inner city Edmonton rose steadily until 2001 then began to fall dramatically since then. DOT for HAART began in April 2001 and grew dramatically since then.
This negative association is striking, but are these two events casually related? Public Health officials at Capital Health do not have a definite explanation for the recent overall fall in local newly identified HIV cases. Decreased testing would have to be ruled out. DOT for HAART and other interventions such as education and awareness campaigns and needle exchange programs are likely involved in decreasing recently HIV acquired infection. But newly identified cases also consist of individuals with long term infection who did not undergo testing until recently. The more these long-term cases are identified the less of them remains to be newly identified, and this could appear as a decrease in newly identified cases. Somebody has to sort this out! Meanwhile, DOT for HAART is definitely proud to be associated with this striking decrease in newly identified HIV cases, even though specific causation has not yet been established.
