Linda Clinic is a community-based health care facility for and by people living with HIV (PLHIV) in Narva, Estonia. Linda Clinic provides services to people living with HIV, in a low-threshold, stigma- and judgment-free setting, leading towards the best possible health outcomes for each individual. All services provided are free of charge. Our community-based approach is unique in Europe, and works on the principles of user driven care.
Linda Clinic is a non-profit medical service provider in the field of infectious diseases and operates through Linda HIV Foundation, which was established in 2012 by AIDS Healthcare Foundation (AHF) and Estonian Network of People Living with HIV (EHPV).
Narva has the highest percentage of people living with HIV (PLHIV) in the European Union, estimated at about 4%. Of all the PHLIV in Estonia, 25% live in Narva and, in fact, 50% live in the Idu-Virumaa County, of which Narva is the largest city.
The lack of employment opportunities starting from the 90s in and around Narva has led to a steep increase in intravenous drug use, which in its turn has led to the high prevalence of HIV in area. Stigma, fear and lack of opportunities prevent many people that use drugs to find their way to the care services they need. A mere 20% of people in need of treatment actually receive it. This is a huge challenge that requires a novel approach. The Linda Clinic aims to fill the critical gap of treatment and care to this vulnerable group of people.
The Linda Clinic works on the principles of user driven care. The key characteristics of user driven care are the combination of physical and mental wellbeing, and the involvement of the users of care in defining the best possible health outcomes. In other words, user-driven care is an approach that ensures that services are patient-centred.
User-driven care has the following characteristics:
• Health is approached in a holistic and comprehensive manner, not just based on medical needs.
• Users are assisted with their care through a case management approach, which involves the identification and management of a user’s problems and coordination of their solution. A coach, coordinator or case manager assists the user to manage their navigation through the services.
• Services are integrated, instead of existing separately. Users are seen as whole persons, not just the medical problems they present with. They are guided from service to service with as little separation and facility-induced inconvenience as possible.
• Power is shared between users and service providers. This contrasts with physician-driven top-down services that focus more on the provision of care. User-driven care requires that users drive their care with healthcare providers supporting them with services.
• Users have a key role in the provision of care through:
• Being empowered to think and act in their own interests.
• The provision of feedback and input into the creation and delivery of care.
• The delivery care as peer healthcare providers, sponsors, peer supporters, etc.
• The governance of healthcare facilities through advisory or decision-making bodies, such as committee and boards.
• Being involved in health promotion and prevention in the community.
Dr Juta Kogan works as a physician in Ida-Viru County, the epicentre of the Estonian HIV epidemic.
Besides her general practice in Toila, she is an infectious diseases doctor at Ida-Viru Central Hospital and the Linda Clinic. Dr Kogan has for years worked with HIV-positive inmates at Viru Prison. She sees nearly 500 HIV positive patients, most of whom are Russian speaking and use drugs.
My name is Natalja Amman. I am a nurse at the Linda Clinic.
I have worked in the medical profession for over 25 years. I couldn’t imagine working in any other field. I previously worked at Narva Hospital. I attended to the paediatric ward and the maternity ward, including intensive care for newborns. I am also experienced in finding suitable psychological approaches to patients.
I was attracted by the prospect of working at the Linda Clinic because it is such a challenging and vital service nowadays. My hobbies include horticulture and travelling.
The management board of the Linda HIV Foundation consists of:
The supervisory board of the Linda HIV Foundation consists of: