Skip to main content
Download PDF
Download ePub

Enhancing the delivery of comprehensive care for people living with HIV in Canada: insights from citizen panels and a national stakeholder dialogue

Health Research Policy and Systems volume 22, Article number: 62 (2024) Cite this article

Abstract

Background

People living with human immunodeficiency virus (HIV) are living longer with health-related disability associated with ageing, including complex conditions. However, health systems in Canada have not adapted to meet these comprehensive care needs.

Methods

We convened three citizen panels and a national stakeholder dialogue. The panels were informed by a plain-language citizen brief that outlined data and evidence about the challenge/problem, elements of an approach for addressing it and implementation considerations. The national dialogue was informed by a more detailed version of the same brief that included a thematic analysis of the findings from the panels.

Results

The 31 citizen panel participants emphasized the need for more prevention, testing and social supports, increased public education to address stigma and access to more timely data to inform system changes. The 21 system leaders emphasized the need to enhance person-centred care and for implementing learning and improvement across provinces, territories and Indigenous communities. Citizens and system leaders highlighted that policy actions need to acknowledge that HIV remains unique among conditions faced by Canadians.

Conclusions

Action will require a national learning collaborative to support spread and scale of successful prevention, care and support initiatives. Such a collaborative should be grounded in a rapid-learning and improvement approach that is anchored on the needs, perspectives and aspirations of people living with HIV; driven by timely data and evidence; supported by appropriate decision supports and aligned governance, financial and delivery arrangements; and enabled with a culture of and competencies for rapid learning and improvement.

Peer Review reports

Introduction

Many provinces and territories in Canada have prioritized health-system reforms including integrated care for people living with complex conditions across health-system sectors and with social systems [1,2,3,4]. However, care for people living with human immunodeficiency virus (HIV) poses unique challenges, such as addressing stigma and discrimination, poverty, food security, homelessness, cognitive impairments and mental health and addictions that require tailored responses [5,6,7]. In addition, people living with HIV who take antiretroviral medications are living longer with HIV and with more chronic conditions [8,9,10,11,12].

Canadian federal and some provincial governments have supported achieving (and surpassing) the 90–90–90 targets set by the Joint United Nations Programme on HIV/AIDS (UNAIDS) [13]. As of 2016, 86% of Canadians living with HIV were diagnosed; 81% of Canadians diagnosed with HIV were on treatment; and 91% of Canadians living with HIV on treatment had achieved viral suppression [13,14,15,16]. However, HIV incidence rates have not declined. Planned efforts to address these targets and incorporate prevention have been included in the Pan-Canadian Sexually Transmitted and Blood-Borne Infections (STBBI) Framework for Action, which is focussed on four pillars: (1) prevention, (2) testing, (3) linkage to care and treatment and (4) ongoing care and support [17]. To be successful, these efforts will need to focus on addressing the many complex and inter-related challenges that face people living with HIV [5, 6]. For example, as compared with other chronic diseases, HIV-related stigma is a unique consideration and has been identified as one of the biggest challenges facing people living with HIV [7]. This stigmatization has been found to be associated with increased rates of depression, lower social support, anxiety, quality of life, physical health, emotional and mental distress and trauma and sexual risk, and significantly impacts people’s ability to engage with a fragmented health system [7, 18].

Methods

Our goal was to spark action to address these challenges by convening deliberations across Canada with people living with, at risk of and affected by HIV, and with system leaders (policymakers, stakeholders and researchers) who could champion needed changes. To do this, we convened: (1) citizen panels with people living with, at risk of and affected by HIV to learn about their views of and experiences in relation to these challenges and their values and preferences for policy options to address the challenges and (2) a national stakeholder dialogue with HIV health system leaders to identify steps that can be taken to address the challenges. The approaches used for each are described in detail in the separate documents we have published, which include a citizen brief, panels summary, evidence brief and dialogue summary [19,20,21,22]. We provide a concise overview of our approach below. In this paper, we integrate the findings from both components to provide insights from citizens and system leaders about the important next steps identified for enhancing comprehensive care for people living with HIV in Canada.

The project was led by an interdisciplinary steering committee, which included people living with HIV as well as policymakers, clinicians and researchers with expertise in HIV-related policy, care and support. The committee guided the project from start to finish, including establishing the scope of the project, providing feedback on the citizen and evidence brief, identifying key informants to engage to provide feedback on the citizen and evidence brief, shaping the recruitment criteria for the citizen panels, identifying participants for the stakeholder dialogue and providing feedback on the analysis of the deliberations.

First, we convened three citizen panels in 2019 in Manitoba (March 22), Ontario (April 5) and Newfoundland and Labrador (April 22) that sought to engage participants from each Canadian province. Each panel was informed by a plain-language citizen brief that described what is known on the basis of data and evidence and insights from 25 key informants [19, 21]. The deliberations focussed on describing the underlying problem related to enhancing comprehensive care for people living with HIV in Canada, three possible elements of an approach to addressing the problem, and implementation considerations for the elements. Panellists were recruited through the AskingCanadians™ panels, which include more than 600 000 Canadians that are affiliated with loyalty programs in Canada and are representative of all the Statistics Canada demographic categories. We sought to engage 14–16 panellists living with or affected by HIV for each panel who were diverse in terms of gender, age, sexual orientation, socioeconomic status, ethnocultural background and geographic residence (both in terms of provinces they live in and from urban, suburban and rural/remote settings). The deliberations were facilitated by one of two team members (MGW and CM) and followed the structure of the citizen brief. We summarized key insights from the panel using themes that the facilitators identified and refined from their detailed notes in each panel. Within panels, these themes were discussed and refined with panellists through mid-day summaries that were reviewed and discussed. In addition, our wrap-up deliberations for each were used to debrief with the panellists to ensure that we accurately documented and understood the experiences, values and preferences that were articulated during the deliberations. We also used this time to ensure that areas of common ground and divergence were accurately captured and framed in a way that reflected the deliberations. We continued to identify and refine themes through subsequent panels and used our detailed notes to capture areas of consistency across panels, as well as insights that were unique to a particular panel. After all of the panels were convened, we selectively revisited recordings to ensure accuracy of notes, themes identified and illustrative quotes.

In May 2019, we convened a stakeholder dialogue that was informed by pre-circulated evidence brief [22] (a more detailed version of the citizen brief), which included key findings from the panels. We identified participants in collaboration with the project steering committee on the basis of their ability to: (1) bring unique views, experiences and tacit knowledge to bear on the challenge and learn from the research evidence and from others’ views, experiences and tacit knowledge and (2) champion actions that will address the challenge creatively. The dialogue concluded with a focus on potential next steps that could be taken. Deliberations were facilitated by one of us (MGW) with detailed notes and observations taken by the facilitator and one secretariat (KW), which were used to prepare an analysis of key insights from the deliberations [20]. This included a draft summary of key themes that we provided to all dialogue participants to reflect on before the dialogue was completed. The stakeholder dialogue was convened “off the record” and adhered to the Chatham House Rule (participants are free to use the information received, but neither the identity nor the affiliation of the speaker(s), nor that of any other participant, may be revealed) and therefore deliberations were not recorded.

Key insights from citizen and stakeholder engagement

The citizen panels convened 31 ethnoculturally and socio-economically diverse people living with or affected by HIV from all provinces except Saskatchewan (demographic information provided in the panel summary) [19]. Demographic information of panellists is provided in Table 1. The stakeholder dialogue convened 21 participants, which included people living with HIV and Indigenous people. While most participants held several positions, the principal roles included five federal- and provincial-level policymakers and/or leaders of a health region, five leaders of community-based HIV organizations, five leaders of stakeholder groups (including professional organizations, national and provincial-level groups and citizen-based groups) and six researchers (most of whom were also clinicians).

Table 1 Profile of citizen panel participants (n = 31)
Full size table

Insights about challenges related to the problem

Panellists identified eight challenges, which are summarized in Table 2 and include: (1) lack of comprehensive supports for HIV prevention, (2) limited access to point-of-care testing, (3) stigma is pervasive and layered, (4) lack of public awareness and education to address stigma, (5) privacy and confidentiality in testing and care are not respected, (6) limited access to social-systems supports, (7) the problem is magnified for the most vulnerable and (8) lack of timely data and use of evidence in policy decisions.

Table 2 Summary of citizens’ views about challenges
Full size table

Dialogue participants agreed with these challenges, and expanded the list to include:

  1. (1)

    social and structural challenges including stigma and discrimination are fundamental to address, but continue to lack traction and commitment to change;

  2. (2)

    lack of emphasis on prevention and making available a broad menu of testing options that meet the needs of different communities;

  3. (3)

    lack of coordination across care pathways and throughout the lifespan;

  4. (4)

    limited access to timely data and the many different forms of evidence needed to inform policy and programmatic decision-making; and

  5. (5)

    mechanisms and resources not being in place to support learning across provinces, territories and Indigenous communities.

Insights about elements of a potentially comprehensive approach to address the problem

Citizen panellists and dialogue participants deliberated about three pre-circulated elements of a potentially comprehensive approach to address the problem: (1) strengthening comprehensive HIV care within the health system; (2) providing supports across social systems to address all of the challenges faced by people living with HIV; and (3) adopting a rapid-learning and improvement approach to incrementally strengthen health and social systems. These elements and evidence about them are detailed in the publicly available evidence brief [22]. Values and preferences from citizens and insights from system leaders are summarized in Table 3.

Table 3 Insights from citizens and dialogue participants about three elements of a potential approach to enhancing the delivery of comprehensive care for people living with HIV in Canada
Full size table

Overall, citizens emphasized the need to provide equitable access to integrated comprehensive care to enable people to achieve optimal outcomes regardless of where they live and the challenges they face. Moreover, citizens consistently identified supports across social systems to address the full range of challenges faced by people living with HIV as being the most fundamental, yet potentially most difficult to achieve. In addition, it was identified that actions towards strengthening social systems should be prioritized over others as it will help address challenges (e.g. housing, poverty and stigma) that put people at risk for HIV and make getting diagnosed and engaged in care challenging. Lastly, despite initially struggling with the concept of rapid-learning health systems, there was consensus about the importance of making small yet rapid changes to improve HIV care and supports over time as it was viewed as more achievable than trying to reinvent entire health and social systems.

System leaders in the stakeholder dialogue participants emphasized the need for a combined health and social-system approach to strengthening care for those with HIV. Participants specifically called for a greater role for team-based care that prioritizes mental health and addictions services, and for care that is culturally competent, safe and responsive.

They also identified four themes requiring action: (1) acknowledging that HIV continues to be unique and needs to be accounted for in the pursuit of any next steps; (2) ensuring person-centred and adaptive approaches for strengthening comprehensive HIV care in health systems and providing supports across social systems; (3) underpinning all actions taken with enhanced efforts to address stigma and normalize HIV prevention, testing, care and support; and (4) focussing on achieving the Triple Aim of excellent patient experience, improved patient outcomes and keeping per capita costs manageable.

Implementation considerations

Dialogue participants also identified several implementation considerations that are likely to affect efforts to champion the necessary changes. These potential barriers included: (1) funds traditionally being siloed across government programs in health and social systems, which limits the ability flow funds to support integrated whole-person care; (2) power imbalances between different organizations and stakeholders (e.g. hospitals and credentialed professionals as compared with community and non-credentialed providers), which may make integration difficult; (3) challenges in navigating different priorities and languages used across health and social systems and the sectors within them; and (4) potential perceived delays and/or lack of action due to embedding HIV targets under the broader Pan-Canadian STBBI framework.

Next steps identified by system leaders

Stakeholders were willing to invest in several next steps, including to:

  1. (1)

    focus on improving delivery of prevention, care and support and to achieve the 90–90–90 targets, adding a fourth 90 focussed on improving quality of life, and the goals in STBBI framework (while recognizing the unique and often more complex needs of those in the remaining 10% of each of the targets);

  2. (2)

    continue to strengthen primary-care-based models emphasizing person-centred care (and include the full complement of primary-care-based providers, such as physicians, nurses and pharmacists);

  3. (3)

    identify groups of individuals with shared challenges that can be collectively supported, and shared strengths that can be built upon; and

  4. (4)

    create wrap-around social services and primary care, and inject primary-care elements into social-systems settings (e.g. housing, supervised-injection sites and prisons).

Discussion

Our findings highlight that policy actions across provincial and territorial health systems need to acknowledge that HIV remains unique among conditions faced by Canadians, adopt person-centred approaches to care and address HIV-related stigma. This will require grappling with many long-standing challenges for provincial and territorial health-system reforms in Canada, particularly the lack of integration between health and social care which is typically driven by funding silos, power imbalances and limited coordination which makes intersectoral care difficult to achieve. However, the STBBI framework could be used as a common galvanizing mechanism for provinces and territories for addressing these challenges. Moreover, the framework could provide common ground for establishing greater collaboration across provincial and territorial governments, such as through a learning collaborative that can support an HIV rapid-learning model.

Such a collaborative should be grounded in a rapid-learning and improvement approach [23, 24] that is anchored on the needs, perspectives and aspirations of people living with HIV; driven by timely evidence support; supported by appropriate decision supports and aligned governance, financial and delivery arrangements; and enabled with a culture of and competencies for rapid learning and improvement. This work could be grounded in the recommendations from the Global Commission on Evidence to Address Societal Challenges (GCESC), which is focussed on supporting actions to: (1) formalize and strengthen domestic evidence-support systems; (2) enhance and leverage the global evidence architecture; and (3) engage citizens, citizen leaders and citizen-serving non-governmental organizations (NGOs) in putting evidence at the centre of everyday life. In the recent update to the GCESC, rapid learning and improvement cycles were described as involving three stages [24]. The first stage focusses on making sense of a challenge or opportunity and the population(s) and then prioritizing what needs to be done. This requires continual efforts to identify where there are system gaps and what is driving them, where there are inequities and what challenges are prioritized to address. Next, the focus turns to co-designing new services and service models by identifying evidence-informed solutions that already exist, and how solutions can be adapted/designed with input from system users and communities (in this case, ensuring meaningful involvement of people living with HIV). The last stage of the cycle focusses on implementing, adapting and using system-level monitoring and evaluation (i.e. to determine what works, for whom and what adaptation are needed to support spread and scale). An HIV-focussed learning collaborative was viewed as being able to champion the type of work needed to operationalize this type of rapid-learning and improvement cycle.

Such an approach could be grounded as part of efforts to strengthen evidence-supports systems more broadly [24]. Such systems need to include: (1) structures and processes for those who can use evidence to inform decisions (i.e. on the “evidence demand” side, which can involve incorporating evidence use into routine advisory and decision-making processes, building and sustaining an evidence culture and strengthening capacity for evidence use); (2) mechanisms to enable coordination at the interface between evidence demand and the suppliers of evidence (e.g. by identifying evidence needs of decision-makers, packaging evidence from multiple sources in a way that is useful decision-making processes); and (3) evidence-support units on the evidence-supply side that have the expertise to understand the domestic context, evidence standards and preferred communication formats of decision-makers, and that are structured in a way that make them timely and demand-driven in their supply of evidence (e.g. by contextualizing existing domestic and global evidence in a way that ensures equity considerations are identified and considered) [24].

In considering these broader structures for using rapid-learning and improvement cycles and for strengthening evidence-support systems that have emerged since the deliberations were convened, there were many innovative and promising initiatives with potential for scale-up and spread in other communities, provinces and territories that were discussed during the deliberations which continue to be relevant. For example, many viewed the Ontario Health Teams as an opportunity to advance the implementation of person-centred approaches to care for people living with HIV. Similarly, a rapid-learning model is gaining traction in other provinces such as British Columbia through Michael Smith Health Research BC. Primary-care reform and addressing health human resource challenges continues to be a focal point for health-system reforms across the country and the actions described in this study can inform and be embedded within those efforts. The coronavirus disease 2019 (COVID-19) pandemic was also a catalyst for doing many things different and re-shaping priorities. In relation to this study, the focus on rapidly adjusting to address the needs of those most affected by COVID-19 can be taken as an opportunity to strengthen systems for the most marginalized and in ways that harness the ability to adjust rapidly, evaluate and continue to adjust.

Limitations

A potential limitation of our approach is that we engaged a smaller number of citizens in the panels. We made this choice to prioritize in-depth deliberations with a purposively selected sample of citizens, which in our experience has yielded rich insights. Moreover, we were unable to engage participants from every province. Given that key themes across the three panels were consistent, we are confident that our sample size was appropriate and representative, but may not have adequately represented the needs of black, Indigenous and people of colour. In addition, these findings were used to anchor the deliberations with health and social-system leaders in the stakeholder dialogue. Doing so ensured that our approach was grounded in the experiences, values and preferences of those living with HIV and that the deliberations with health- and social-system leaders were informed both by these insights and the best-available evidence. A final limitation to consider is that while we generated key insights from the deliberations using an iterative approach that is grounded in qualitative methods, we did not conduct a full qualitative analysis that included coding of transcripts. For the citizen panels, we used an iterative approach to identify key themes within and between panels and used recordings to corroborate our detailed notes. Detailed qualitative analysis was, however, not possible for the stakeholder dialogue given that it adopted the Chatham House Rule, which precludes recording of the deliberations.

Conclusions

Action will require a national learning collaborative to support spread and scale of successful prevention, care and support initiatives. Moreover, this type of approach will help operationalize, in at least one sector, the recommendations from the GCESC that emphasizes the need for more coordinated evidence-support systems [24, 25], and doing so in a way that enables rapid-learning and improvement cycles to support spread and scale of promising new system-level innovations.

Availability of data and materials

This manuscript presents results from a series of citizen panels and a national stakeholder dialogue in Canada. All of the reports that this manuscript presents results from are publicly available here: https://www.mcmasterforum.org/find-evidence/products/project/enhancing-the-delivery-of-comprehensive-care-for-people-living-with-hiv-in-canada.

Abbreviations

HIV:

Human immunodeficiency virus

STBBI:

Sexually transmitted and blood-borne infections

UNAIDS:

Joint United Nations Programme on HIV/AIDS

GCESC:

Global Commission on Evidence to Address Societal Challenges

References

  1. Alberta Health Services. Strategic Clinical Networks (SCNs) Edmonton: Alberta Health Services; 2018. https://www.albertahealthservices.ca/about/Page12639.aspx.

  2. Ontario Ministry of Health. Improving health care in Ontario: Ontario Ministry of Health; 2019. https://www.ontario.ca/page/improving-health-care-ontario.

  3. Division of Family Practice (General Practice Service Committee). Patient Medical Homes (PMH) and Primary Care Networks (PCN): Division of Family Practice (General Practice Service Committee); 2020. https://www.divisionsbc.ca/provincial/what-we-do/patient-medical-home.

  4. Peckham A, Ho J, Marchildon G. Policy innovations in primary care across Canada: a rapid review prepared for the Canadian foundation for healthcare improvement. Toronto: North American Observatory on Health Systems and Policies; 2018.

    Google Scholar 

  5. Greene M, Justice AC, Lampiris HW. Management of human immunodeficiency virus infection in advanced age. JAMA. 2013;309(13):1397–405.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Morgan EE, Iudicello JE, Weber E, Duarte NA, Riggs PK, Delano-Wood L, et al. Synergistic effects of HIV infection and older age on daily functioning. J Acquir Immune Defic Syndr. 2012;61(3):341–8.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Rueda S, Mitra S, Chen S, Gogolishvili D, Globerman J, Chambers L, et al. Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: a series of meta-analyses. BMJ Open. 2016;13(6):7.

    Google Scholar 

  8. Kendall CE, Wong J, Taljaard M, Glazier RH, Hogg W, Younger J, et al. A cross-sectional, population-based study of HIV physicians and outpatient health care use by people with HIV in Ontario. BMC Health Serv Res. 2015;15(1):63.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Haddad N, Li J, Totten S, McGuire M. HIV in Canada—Surveillance report, 2017. Can Commun Dis Rep. 2018;44(12):324–32.

    Article  PubMed Central  Google Scholar 

  10. Mahy M, Autenrieth CS, Stanecki K. Increasing trends in HIV prevalence among people aged 50 years and older: Evidence from estimates and survey data. AIDS. 2014;28:S453–9.

    Article  PubMed  Google Scholar 

  11. Wong C, Gange SJ, Moore RD, Justice AC, Buchacz K, Abraham AG, et al. Multimorbidity among persons living with human immunodeficiency virus in the United States. Clin Infect Dis. 2017;66(8):1230–8.

    Article  PubMed Central  Google Scholar 

  12. Sacktor N, Skolasky RL, Seaberg E, Munro C, Becker JT, Martin E, et al. Prevalence of HIV-associated neurocognitive disorders in the Multicenter AIDS Cohort Study. Neurology. 2016;86(4):334–40.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. UNAIDS. 90–90–90 - An ambitious treatment target to help end the AIDS epidemic Geneva: UNAIDS; 2017. http://www.unaids.org/en/resources/documents/2017/90-90-90.

  14. British Columbia Centre for Excellence in HIV/AIDS. 90-90-90 Target for driving down HIV/AIDS infections worldwide inspires new approach to diabetes Vancouver: British Columbia Centre for Excellence in HIV/AIDS; 2017. http://www.cfenet.ubc.ca/news/releases/90-90-90-target-driving-down-hivaids-infections-worldwide-inspires-new-approach.

  15. Government of Canada. Summary: Measuring Canada’s progress on the 90-90-90 HIV targets Ottawa: Government of Canada; 2017. https://www.canada.ca/en/public-health/services/publications/diseases-conditions/summary-measuring-canada-progress-90-90-90-hiv-targets.html.

  16. Wilton J, Liu J, Sullivan A, Kroch A, Sider D, Gilbert M. HIV care cascade in Ontario: Linkage to care, in care, on antiretroviral treatment, and virally suppressed, 2015. Toronto: Ontario HIV Epidemiology and Surveillance Initiative; 2017. Contract No.: 13 June.

  17. Public Health Agency of Canada. Reducing the health impact of sexually transmitted and blood-borne infections in Canada by 2030: A pan-Canadian STBBI framework for action Ottawa: Health Canada; 2018. https://www.canada.ca/en/public-health/services/infectious-diseases/sexual-health-sexually-transmitted-infections/reports-publications/sexually-transmitted-blood-borne-infections-action-framework.html.

  18. Chambers LA, Rueda S, Baker DN, Wilson MG, Deutsch R, Raeifar E, et al. Stigma, HIV and health: a qualitative synthesis. BMC Public Health. 2015;15(1):848.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Mattison C, Wilson M. Panels summary: enhancing the delivery of comprehensive care for people living with HIV in Canada. Hamilton: McMaster Health Forum; 2019.

    Google Scholar 

  20. Waddell K, Wilson M, Lavis J. Dialogue summary: enhancing the delivery of comprehensive care for people living with HIV in Canada. Hamilton: McMaster Health Forum; 2019.

    Google Scholar 

  21. Wilson M, Mattison C, Gao C, Kendall C, Lavis J. Citizen brief: enhancing the delivery of comprehensive care for people living with HIV in Canada. Hamilton: McMaster Health Forum; 2019.

    Google Scholar 

  22. Wilson M, Mattison C, Gao C, Scallan E, Kendall C, Lavis J. Evidence brief: enhancing the delivery of comprehensive care for people living with HIV in Canada. Hamilton: McMaster Health Forum; 2019.

    Google Scholar 

  23. Lavis J, Gauvin F, Mattison C, Moat K, Waddell K, Wilson M, et al. Rapid synthesis: creating rapid-learning health systems in Canada. Hamilton: McMaster Health Forunm; 2018.

    Google Scholar 

  24. Global Commission on Evidence to Address Societal Challenges. Evidence Commission update 2023: Strengthening domestic evidence-support systems, enhancing the global evidence architecture, and putting evidence at the centre of everyday life. Hamilton: McMaster Health Forum; 2023.

    Google Scholar 

  25. Global Commission on Evidence to Address Societal Challenges. The evidence commission report: a wake-up call and path forward for decision makers, evidence intermediaries, and impact-oriented evidence producers. Hamilton: Global Commission on Evidence to Address Societal Challenges; 2022.

    Google Scholar 

Download references

Acknowledgements

Not applicable

Funding

This project was funded by the: (1) Canadian Institutes of Health Research through a patient-oriented research collaboration grant (PEG-157060) and a team grant titled Advancing primary healthcare for persons living HIV with HI in Canada (TT5-128270); and (2) government of Ontario through grants to the Ontario HIV Treatment Network and to the McMaster Health Forum; and (3) Ontario SPOR SUPPORT Unit. The executive director of the Ontario HIV Treatment Network reviewed and approved the manuscript, but the project was overseen by MGW and CEK.

Author information

Author notes

  1. Deceased: Ron Rosenes.

Authors and Affiliations

  1. McMaster Health Forum, McMaster University, 1280 Main Street West, MML-417, Hamilton, ON, L8S 4L6, Canada

    Michael G. Wilson, Kerry Waddell & John N. Lavis

  2. Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada

    Michael G. Wilson & John N. Lavis

  3. Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Canada

    Michael G. Wilson & John N. Lavis

  4. Women’s and Children’s Health, Karolinska Institut, Stockholm, Sweden

    Cristina Mattison

  5. Ontario HIV Treatment Network, Toronto, Canada

    Jean Bacon

  6. Departments of Medicine, Medical Microbiology, and Community Health Sciences, University of Manitoba, Winnipeg, Canada

    Marissa Becker

  7. C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Canada

    Christine Bibeau, Ron Rosenes & Claire E. Kendall

  8. Department of Political Science, McMaster University, Hamilton, Canada

    John N. Lavis

  9. Department of Family Medicine, University of Ottawa, Ottawa, Canada

    Claire E. Kendall

Authors
  1. Michael G. Wilson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cristina Mattison
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kerry Waddell
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jean Bacon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marissa Becker
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christine Bibeau
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. John N. Lavis
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Ron Rosenes
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Claire E. Kendall
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

MGW conceived of the project, oversaw all components and wrote the manuscript. CM drafted the citizen and evidence briefs with MGW that informed the citizen panels and stakeholder dialogue, co-facilitated the citizen panels, led the analysis of the citizen panels and reviewed and approved the manuscript. KW wrote the dialogue summary. JB contributed to establishing the scope of the project and reviewed all project materials. MB contributed to establishing the scope of the project and reviewed all project materials. CB contributed to establishing the scope of the project and reviewed all project materials. JNL contributed to establishing the scope of the project and reviewed all project materials. RR contributed to establishing the scope of the project and reviewed all project materials. CEK oversaw the project with MGW and was a major contributor to drafting the manuscript. All authors were part of the interdisciplinary project steering committee, and reviewed and approved the manuscript.

Corresponding author

Correspondence to Michael G. Wilson.

Ethics declarations

Ethics approval and consent to participate

The Hamilton Integrated Research Ethics Board (HiREB) provided approval for the citizen panels (HiREB project # 13-369). All participants in the citizen panels provided informed consent. No ethics approval was obtained for the stakeholder dialogue as the Hamilton Integrated Ethics Board has indicated that ethics approval is not required for the meeting as it is not recorded. Ethics approval has been acquired for our ongoing evaluation of stakeholder dialogues (HiREB project # 09-336), but those results are not presented here.

Consent for publication

Not applicable.

Competing interests

JB is the Executive Director and JNL is the Chair of the Board of Directors of the Ontario HIV Treatment Network, which is one of the funders of the project. The rest of the authors declare that they have no professional or commercial interests relevant to the project.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wilson, M.G., Mattison, C., Waddell, K. et al. Enhancing the delivery of comprehensive care for people living with HIV in Canada: insights from citizen panels and a national stakeholder dialogue. Health Res Policy Sys 22, 62 (2024). https://doi.org/10.1186/s12961-024-01147-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12961-024-01147-1

Keywords

Health Research Policy and Systems

ISSN: 1478-4505

Contact us