1. Children’s & Women’s Health Centre of BC Established in 1994 Women and Family-centered care: *HIV +ve women and their families *Pregnancy care/consultation for HIV +ve women *HIV infected children & children born to HIV +ve women Research in HIV +ve women, HIV and pregnancy, children and youth Advocacy & Education in Women- centered HIV Care Oak Tree Clinic

2. Improvements Increased clinical/outreach capacity Social Worker and new Youth Outreach Worker hired New funding for Outreach nurse - position currently posted Updated HIV and pregnancy guidelines/ intra-partum POC testing guidelines to be completed Oct, 2011 implemented soon at BC Women’s Hospital Initiated research process to explore use of cell phones and texting as a means of supporting patient engagement Implemented a quarterly report for patients not seen in 6 month/12 month Initiated process with lab at BCWH to access BCCFE style CD4 reports: personal and CD4<200, work in progress

3. Continuing Challenges Limited internal systems capacity (data access and ability to track) Limited external systems availability (eg. Mental health services etc.) Significant internal changes (retirements, change over in staff, shifting processes) Staying connected/engaged with mobile patients

4. Lessons learned: Start small, too ambitious is not better Processes take time, longer than expected Small changes can make big differences Others have similar challenges