Atazanavir and HIV Care for People Experiencing Homelessness

HIV treatment works, but people without stable housing face big hurdles. In November 2023 we focused on Atazanavir and how clinics, outreach teams, and pharmacies in Canada can make this drug actually reach people living on the street. This page sums up what helps and what to watch for.

Why Atazanavir can help

Atazanavir is a protease inhibitor used in antiretroviral therapy. It’s usually given once a day with a booster (ritonavir or cobicistat). For some patients, its once-daily schedule and a generally favorable impact on blood lipids make it a reasonable option. It can be chosen when other drugs aren’t suitable because of resistance or side effects.

That said, Atazanavir needs stomach acid to be absorbed well. That means acid-reducing medicines like proton-pump inhibitors can lower its effectiveness. It can also cause jaundice in some people because it raises bilirubin — not dangerous in most cases, but it’s visible and can alarm patients. Those are the key medical points outreach teams should know when offering the drug.

How to make treatment work on the street

People without stable housing face practical problems: pills get lost, appointments are missed, and refrigeration or secure storage isn’t available. Here are clear, actionable tactics used by Canadian programs that showed real results.

1) Low-barrier access: Offer walk-in clinic times, same-day prescriptions, and street-level outreach. Mobile units and drop-in services reduce missed starts.

2) Simplify regimens: When medically appropriate, pick once-daily dosing and limit the number of pills. If Atazanavir is needed, keep interactions in mind and avoid pairing it with strong acid reducers.

3) Direct support: Use pill packs, blister packs, or small daily envelopes. Some teams use directly observed therapy (DOT) at shelters or meal sites for people who need extra help with adherence.

4) Peer navigators and case managers: People with lived experience help build trust, remind clients about refills, and escort them to labs or appointments.

5) Pharmacy partnerships: Work with community pharmacies that offer free delivery, flexible hours, and private counselling. In Canada, provincial drug plans and community health centers can often cover or reduce costs — outreach workers should know local programs and eligibility steps.

6) Monitor simply and often: Check viral load and basic labs, and watch for bilirubin or liver changes. Use phone or outreach reminders for lab days and follow-ups.

7) Address co-factors: Treat substance use, mental health, and dental issues alongside HIV care. Integrated services increase the chance someone will stay on treatment.

Practical checklist for outreach teams: 1) Confirm no contraindicated acid-reducer; 2) Offer once-daily packaging; 3) Link to a local pharmacy with flexible services; 4) Set up lab reminders; 5) Use peer support for follow-up. These steps cut missed doses and keep viral suppression on track.

If you’re running a clinic or outreach program, start small: test one or two of these approaches, track missed doses and viral load, then scale what works. For people living with HIV on the street, small practical changes can make a big difference in treatment success.