Edmonton DOT for HAART: lobbying for sustainable funding as a challenging but critical aspect of effective inner city HIV management

The basis of the present program was a successful Edmonton DOT for HAART pilot project from 2001 to 2004 (see www.DOTforHAART.com). Since then, the operational concept has evolved beyond HIV and now encompasses not only marginalized and vulnerable individuals with HIV infection but also those with any other conditions requiring similarly intensive management. The program operates under the auspices of the DOT for HAART Society, an offshoot of the initial pilot project and now incorporated as a not-for-profit and charitable entity (charitable number pending). Collaboration and cooperation has been sought with the HAART House program, another offshoot of the initial DOT for HAART pilot project and operated through the Boyle McCauley Health Centre. To avoid duplication of services, patients are asked to register at one or the other but not both programs.

The program is intended to operate in conjunction with other community organizations to enhance service delivery in a realm where effective and targeted medical treatment and prevention support is much needed. Based upon ongoing outcome measures, feedback from patients, advice from the treatment community and subsequent funding availability, future expansion of this support and prevention service may be considered. Funding for this exciting "social medicine" initiative is solely maintained by private donations and fundraising through the DOT for HAART Society. It has requested, but does not presently receive, public funding. Yet yearly program costs are only a small fraction of the health care savings it should generate by the prevention of even one new HIV infection (Life with HIV cost US$618,900 in 2004 dollars. Schackman, B. Medical Care, November 2006; vol 44: pp 990-997. News release, Weill Medical College of Cornell University. Bruce R. Schackman, PhD, chief, division of health policy, Weill Cornell Medical College). Indeed, savings (*some documented from the initial DOTforHAART pilot project outcome measures - see www.DOTforHAART.com abstracts and publications) are expected to include:

reduced emergency room* and hospital* over-utilization,
reduced criminal and victimization costs,
reduced misuse of scarce practitioner services and non-attendance
reduced non-adherence to costly medication regimens* and HIV drug resistance
reduced HIV transmission risk behaviour* and HIV transmission

Notably, these benefits would be achieved without additional doctors or clinics and actually with less emergency department visits and less inpatient hospitalization days (see website abstract and publications).