https://www.infirmiere-canadienne.com/blogs/ic-contenu/2026/01/12/menes-par-le-personnel-infirmier-clinique
Community clinic focuses on people experiencing homelessness, mental health challenges, substance use disorders, and chronic illnesses
By Tamara Barnett, Kellie Guarasci, Karen Lundgren, & Anne Drost
January 12, 2026
From left, Tamara Barnett, Karen Lundgren, Kellie Guarasci, and Anne Drost are primary care nurses who work at the Cool Aid Community Health Centre in Victoria, B.C. The centre’s nurse-led hepatitis C program has effectively reached and treated more than 900 vulnerable individuals with hepatitis C while continually adapting to the evolving needs of the patient population.
Takeaway messages
- Incorporating primary care nurses who work to their full scope of practice can significantly alleviate the current health-care crisis and shortage of trained health-care providers in Canada while taking the pressure off primary care providers.
- This collaborative, team-based model not only improves access to care for patients and addresses the growing demand for primary care services, but allows for a more efficient use of health-care resources. Nurses can handle many assessments and preventive care services, enabling physicians and nurse practitioners to focus on more complex cases.
- We believe that by fostering a culture of collaboration and creativity, nurses can continue to advance the profession, advocate for better patient driven policies, drive positive change and enhance patient care.
The following article aims to inform and inspire nurses to create and implement nurse-led programs that are relevant to the population and community in which they work. The Cool Aid nurses are a team of registered nurses with certified practice designations who work to an advanced scope in primary care and have observed first-hand how the development and implementation of nurse-led programs contribute to increased job satisfaction and positive patient outcomes.
About Cool Aid
The non-profit Cool Aid Community Health Centre is an inner-city clinic located in Victoria, British Columbia. The health centre is a one-stop shop providing comprehensive health care to more than 7,500 patients, primarily those experiencing homelessness, mental health challenges, substance use disorders, and chronic illnesses. Watch these videos to learn more about Cool Aid’s clients and staff.
The health centre is part of the broader Victoria Cool Aid Society, founded in 1968, which breaks down traditional silos between health and housing. The society has pioneered an integrated model of care that tackles the interconnected issues of poverty, colonization, stigma and homelessness by blending comprehensive health services with housing solutions using a “housing first” philosophy. The “housing first” model addresses the root cause of homelessness and poor health. It acknowledges that addressing one without the other is inadequate and recognizes that stable housing and well-being are inextricably linked. The Victoria Cool Aid Society provides vulnerable populations a wide range of services including health care, dental care, supportive housing, subsidized housing, and emergency shelters.
The Cool Aid Community Health Centre employs a team of registered nurses with a certified practice designation (RN[C]) in sexually transmitted infections (STIs) who work to an advanced practice scope within an interdisciplinary team. According to the British Columbia College of Nurses and Midwives, certified practice in British Columbia gives registered nurses the ability to test, diagnose and treat STIs, including prescribing the designated medications as authorized in the certified practice decision-support tools. This includes contract tracing, public health-required documentation and follow-up.
Nurses practise from a trauma-informed and harm-reduction lens by meeting vulnerable and marginalized clients “where they are at,” with a focus on building relationships and trust over time. Nursing team members are supported to practise to their full scope by our leadership team and medical director, Dr. Chris Fraser.
Thanks to Dr. Fraser and the Cool Aid’s research team’s support and collaboration, the nursing team have developped, implemented, and led several innovative programs. This includes the international award-winning nurse-led hepatitis C treatment program, a human immunodeficiency virus (HIV) treatment program, a nurse-led pre-exposure prophylaxis program (PrEP) and a nurse-led doxycycline post-exposure prophylaxis (doxy-PEP) program.
Eliminating barriers to hepatitis C treatment
For more than 10 years, the low barrier nurse-led hepatitis C treatment program has continued to adjust and adapt to the changing needs of our clients requiring hepatitis C treatment. In 2018, we implemented a “seek and treat” micro-elimination outreach approach to hepatitis C testing and treatment for people who use substances in supportive housing sites. Micro-elimination of hepatitis C is a targeted approach to eradicating hepatitis C in specific populations or settings to achieve the World Health Organization’s goal of eliminating hepatitis C as a public health threat by 2030.
The hepatitis C micro-elimination approach removed barriers to presenting to the clinic for testing and treatment (stigma, mental health challenges, substance use, lack of transportation and homelessness), with the aim of improving screening and linkage to care for people living with the hepatitis C virus. It was successful in curing people living with hepatitis C who had limited contact with the health-care system by providing care where they were located.
The approach included:
- Providing education to the housing support staff on hepatitis C screening and treatment, fostering staff engagement and support in assisting patients throughout their treatment journey
- Mentoring housing staff to provide hepatitis C information, harm reduction education, and supplies to clients
- Removing barriers to accessing hepatitis C treatment by providing low-barrier, on-site hepatitis C testing events such as phlebotomy and fibroscans to assess liver fibrosis (which were required in 2018 to access hepatitis C treatment medications)
- Making the event fun by providing pizza and candy bags to encourage people to be tested
- Focusing on testing people who use drugs and their social contacts to prevent hepatitis C reinfection post-cure
- Implementing individualized hepatitis C treatment plans and flexible medication delivery options to improve adherence
- Conducting regular check-ins and reminders for patients receiving hepatitis C treatment, as needed
More than 900 vulnerable individuals treated
The Cool Aid Community Health Centre’s nurse-led hepatitis C program has effectively reached and treated more than 900 vulnerable individuals with hepatitis C while continually adapting to the evolving needs of the patient population. The following strategies could be adapted and implemented by health-care providers and organizations seeking to improve hepatitis C treatment outcomes in marginalized communities:
- Implement a “seek and treat” approach, with targeted testing events in high-prevalence settings.
- Develop partnerships with shelters, soup kitchens, supportive housing sites, encampments, community partners and opioid agonist therapy clinics to offer on-site hepatitis C testing and treatment.
- Collaborate with jails to provide sexually transmitted and blood-borne infection (STBBI) and hepatitis C testing and treatment for individuals transitioning in and out of corrections.
- Create individualized and tailored treatment plans for patients, accommodating their unique needs and circumstances such as unstable housing and ongoing substance use.
- Implement strategies to prevent hepatitis C reinfection, such as treating social networks simultaneously.
- Implement flexible medication delivery options including a weekly or daily dispensing schedule to help with adherence and to decrease the barriers of going into a pharmacy.
- To meet the evolving needs of the patient population, provide low-threshold, non-stigmatizing care and continuously evaluate your program to adapt your services to meet the needs of the patient population.
Support from peers
To increase the successfulness of a hepatitis C treatment program:
- Employ peers who have completed hepatitis C treatment and have lived experience with mental health and substance use challenges.
- Peers can provide hepatitis C education and testing and treatment with support from nurses and are trusted sources of information in their community.
- Peers can help to reduce stigma and provide education on the effectiveness of hepatitis C treatment and the minimal side effects of treatment while supporting linkage to care and adherence.
- Expand peer programs to include medication delivery for patients who are unhoused and cannot access pharmacies or engage in medication delivery in a traditional way.
- Conduct outreach testing to reach vulnerable populations in non-traditional health-care settings.
- Offer incentives for treatment adherence and completion of follow-up bloodwork.
HIV treatment in primary care setting
The Cool Aid nurses provide relationship-focused, trauma-informed HIV care in the context of primary care. They partner with AIDS Vancouver Island Health and Community Services (a harm reduction and HIV organization) to provide weekly HIV support groups, access to phlebotomy, medication adherence support, and intensive case management to reach the 95-95-95 HIV targets (95% of people living with HIV would know their HIV status, 95% of those diagnosed would receive antiretroviral therapy [ART], and 95% of those receiving ART should achieve viral suppression) set by the United Nations Program on HIV/AIDS. The nurse-led program also organizes HIV education and testing events in the community.
The Cool Aid nurses identified a need within the community to offer low-barrier STBBI testing to gay, bisexual and other men who have sex with men and started a weekly drop-in sexual health clinic. The nurses also started providing outreach to a park where gay, bisexual and other men who have sex with men are known to meet up. This nurse-led program evolved to offer STBBI testing in brothels and at sex parties, and held sexual health clinics on night outreach with the Prostitutes Empowerment Education and Resource Society (PEERS) for men, women and gender-diverse individuals who work in the street-level sex trade. The weekly sexual health clinic has continued to adapt and now offers sexual health services to two-spirit, lesbian, gay, bisexual, transgender, queer or questioning (LGBTQ2S+) clients.
Before the province of British Columbia started providing HIV pre-exposure prophylaxis (PrEP), the nursing team, in collaboration with Dr. Fraser, started a nurse-led pre-exposure prophylaxis program to prevent contracting HIV. The province eventually recognized the need for pre-exposure prophylaxis and launched a comprehensive province-wide program. In recent years, the medical team noticed a rapid increase in syphilis diagnoses within the community and in response the nursing team implemented a nurse-led doxycycline post-exposure prophylaxis (doxy-PEP) program.
Research has demonstrated that doxy-PEP effectively reduces the risk of syphilis and chlamydia in gay, bisexual and other men who have sex with men and transgender women if taken within 72 hours of unprotected sex. Subsequently, the province has implemented a doxy-PEP program as well.
Increased job satisfaction and happiness
The nursing team is encouraged by leadership to follow their interests by continuing with education, attending conferences, and developing specialized expertise in areas that are relevant to their patient populations. The nursing team is regularly sought after by colleagues across health-care disciplines, governing bodies, conferences, Canada’s source for HIV and hepatitis C information (CATIE) and community partners to engage in knowledge translation and present on our nurse-led programs. We provide preceptorship and observation opportunities to other Canadian and international nurses, nurse practitioners and physicians.
The implementation of innovative nurse-led programs — paired with increased nursing autonomy and the opportunity and encouragement to work to our full scope of practice using our unique expertise and skills — has significantly increased job satisfaction and happiness among our nurses. This has given our nursing team a sense of personal pride and team accomplishment, boosted morale, and subsequently elevated the quality of care we provide to our clients.
By empowering our nurses, we have created a more engaged, motivated and effective nursing team that has led to better patient care and outcomes for an often challenging and complex patient population.
Acknowledgements
We would like to extend our heartfelt thanks to Dr. Chris Fraser, medical director at the Cool Aid Community Health Centre, the centre’s dedicated multidisciplinary team, and the incredibly resilient patients we have the privilege of working with. This important work would not be possible without them.
Tamara Barnett, BScN, RN(C), is a primary care nurse and the centre’s Hepatitis C treatment program coordinator and a student in the master of science in nursing program at York University.
Kellie Guarasci, BScN, RN(C), is the centre’s clinical nurse lead and has experience in palliative care, infectious disease, teaching, and community case management.
Karen Lundgren, BScN, RN(C), is the centre’s manager of nursing and outreach site operations and has an interest in sexual health, HIV and primary care.
Anne Drost, BScN, RN(C), has worked at the centre for 23 years and has a keen interest in mental health and addictions, infectious disease, and sexual health.
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#stigma