The Aya Circle of Care: An Afrocentric Model of Intensive HIV Case Management for Black Communities in Toronto, Canada

Background: The Greater Toronto Area (GTA) is the epicenter of the Black HIV epidemic in Canada. The GTA alone accounted for 60% of the HIV diagnoses among Black people. Despite this, we have limited access to culturally and racially effective HIV primary healthcare services to improve health and well-being and reduce HIV infections. The Aya Circle of Care pilot program has been created as the first intensive HIV case management primary healthcare program for ACB communities in Canada.

Objectives: The goal of our participatory research project was to identify barriers and facilitators to ensure that Black community members who test HIV positive are linked to a racially and culturally informed intensive case management team within 72 hours of diagnosis. The Aya Circle of Care intensive case management team comprises a nurse practitioner, a nurse, a social worker, and a peer navigator who will provide comprehensive assessment, treatment, rehabilitation, and support services. The pilot project aimed to

• Reduce structural barriers by providing racially and culturally informed, individualized engagement for Black people living with HIV.
• Evaluate the feasibility, reach, and sustainability of an Intensive case management pilot program for Black people living with HIV.
• Refine the model of care and develop an implementation plan for scaling up and replicating an Afrocentric intensive HIV case management program.

Methods: We conducted a descriptive qualitative process using face-to-face semi-structured key informant interviews (N=20) with policymakers, researchers, service providers, and healthcare providers with expertise in HIV and Black communities. Five focus groups ( N=30) with Black people living with HIV were also conducted. Data was analyzed using conventional content analysis.

Results: Early measures of pilot project success were identified by community members as, the Community Advisory Committee leading the process, endorsement, and support from existing AIDS Service Organizations serving Black populations, engagement and participation of Black people living with HIV in all stages of the project, a full intensive case management team and services in place, a well-defined HIV referral process and HIV care pathway created with timely referrals. Informants proposed critical themes for the stabilization of the program. The program should centralize the social determinants of health and address health disparities experienced by Black populations. The program should develop effective pathways to increase the timeliness of linking to primary healthcare, retaining care, adherence to treatment, and maintaining viral suppression. The program should be geographically focused, grounded in Afrocentric principles, and focus on navigating the effects of structural anti-Black racism. Black providers within Black-focused organizations should lead services, address HIV stigma, provide services for family units, and support those at risk for HIV.

Conclusions: The proposed project's impact was evidenced by its relevance for Black people living with HIV and its role in filling a knowledge gap in the effectiveness of HIV services and addressing existing inequalities in health outcomes. Increasing access to intensive case management and primary healthcare services that are comprehensive, culturally, and racially appropriate is crucial for improving health and well-being among Black populations living with HIV in Canada.