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Tsui N, Tjong GB, Simms AJ, Edwards SA, Cripps S. Hepatitis C (HCV) prevalence in citizens of the Métis Nation of Ontario. BMC Infect Dis 2024; 24:287. [PMID: 38448806 PMCID: PMC10916169 DOI: 10.1186/s12879-024-09171-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/24/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection is a major global concern, with Indigenous Peoples bearing the highest burden. Previous studies exploring HCV prevalence within Indigenous populations have predominantly used a pan-Indigenous approach, consequently resulting in limited availability of Métis-specific HCV data. The Métis are one of the three recognized groups of Indigenous Peoples in Canada with a distinct history and language. The Métis Nation of Ontario (MNO) is the only recognized Métis government in Ontario. This study aims to examine the prevalence of self-reported HCV testing and positive results among citizens of the MNO, as well as to explore the association between sociodemographic variables and HCV testing and positive results. METHODS A population-based online survey was implemented by the MNO using their citizenship registry between May 6 and June 13, 2022. The survey included questions about hepatitis C testing and results, socio-demographics, and other health related outcomes. Census sampling was used, and 3,206 MNO citizens responded to the hepatitis C-related questions. Descriptive statistics and bivariate analysis were used to analyze the survey data. RESULTS Among the respondents, 827 (25.8%, CI: 24.3-27.3) reported having undergone HCV testing and 58 indicated testing positive, resulting in a prevalence of 1.8% (CI: 1.3-2.3). Respondents with a strong sense of community belonging, higher education levels, and lower household income were more likely to report having undergone HCV testing. Among those who had undergone testing, older age groups, individuals with lower education levels, and retired individuals were more likely to test positive for HCV. CONCLUSION This study is the first Métis-led and Métis-specific study to report on HCV prevalence among Métis citizens. This research contributes to the knowledge base for Métis health and will support the MNO's health promotion program and resources for HCV. Future research will examine the actual HCV incidence and prevalence among MNO citizens.
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Affiliation(s)
- Noel Tsui
- Métis Nation of Ontario, 66 Slater Street, Ottawa, ON, K1P 5H1, Canada.
- ICES Central, V1 06, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
| | - Gabriel B Tjong
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada
| | - Abigail J Simms
- Métis Nation of Ontario, 66 Slater Street, Ottawa, ON, K1P 5H1, Canada
- ICES Central, V1 06, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Sarah A Edwards
- Métis Nation of Ontario, 66 Slater Street, Ottawa, ON, K1P 5H1, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada
- ICES Central, V1 06, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada
| | - Shelley Cripps
- Métis Nation of Ontario, 66 Slater Street, Ottawa, ON, K1P 5H1, Canada
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Lee NR, King A, Vigil D, Mullaney D, Sanderson PR, Ametepee T, Hammitt LL. Infectious diseases in Indigenous populations in North America: learning from the past to create a more equitable future. THE LANCET. INFECTIOUS DISEASES 2023; 23:e431-e444. [PMID: 37148904 PMCID: PMC10156139 DOI: 10.1016/s1473-3099(23)00190-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 05/08/2023]
Abstract
The COVID-19 pandemic, although a profound reminder of endured injustices by and the disparate impact of infectious diseases on Indigenous populations, has also served as an example of Indigenous strength and the ability to thrive anew. Many infectious diseases share common risk factors that are directly tied to the ongoing effects of colonisation. We provide historical context and case studies that illustrate both challenges and successes related to infectious disease mitigation in Indigenous populations in the USA and Canada. Infectious disease disparities, driven by persistent inequities in socioeconomic determinants of health, underscore the urgent need for action. We call on governments, public health leaders, industry representatives, and researchers to reject harmful research practices and to adopt a framework for achieving sustainable improvements in the health of Indigenous people that is both adequately resourced and grounded in respect for tribal sovereignty and Indigenous knowledge.
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Affiliation(s)
- Naomi R Lee
- Department of Chemistry and Biochemistry, Northern Arizona University, Flagstaff, AZ, USA
| | - Alexandra King
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Deionna Vigil
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Dustin Mullaney
- Department of Biology, Northern Arizona University, Flagstaff, AZ, USA
| | - Priscilla R Sanderson
- Department of Health Sciences, College of Health and Human Services, Northern Arizona University, Flagstaff, AZ, USA
| | - Taiwo Ametepee
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Laura L Hammitt
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Gudi SK, Eltonsy S, Delaney J, Osiowy C, Taylor C, Kaita K, Alessi-Severini S. Annual trends of hepatitis C virus infection in Manitoba between 1998 and 2018: A focus on special populations. CANADIAN LIVER JOURNAL 2023; 6:249-260. [PMID: 37503521 PMCID: PMC10370720 DOI: 10.3138/canlivj-2022-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 11/02/2022] [Indexed: 07/29/2023]
Abstract
Background Hepatitis C virus (HCV) infection is a major cause of liver-related morbidity and mortality worldwide. Epidemiological data of HCV infection in the Canadian province of Manitoba are limited. Methods A population-based retrospective study was conducted using data from the Manitoba Centre for Health Policy repository. Using the test results provided by the Cadham provincial laboratory, individuals in Manitoba with a diagnosis of HCV infection were identified. Annual prevalence and incidence rates (crude and standardized) were calculated for the overall population and stratified by sex, regional health authority (RHA), residence area, income quintile, and special population groups (children, older adults, and pregnant persons). Results A total of 8,721 HCV cases were diagnosed between 1998 and 2018 in Manitoba. Overall crude HCV incidence and prevalence were estimated as 0.03% and 0.37% during the study period, respectively. No significant change was observed in the standardized HCV incidence rate (per 100,000) during the study period (54.3 in 1998 and 54.8 in 2018). However, the standardized HCV prevalence (per 100,000) increased from 52.5 (95% CI 39.2-68.7) in 1998 to 655.2 (95% CI 605.9-707.3) in 2018. An overall average incidence rate based on sex, RHA, region, income, and special population groups was observed to be higher in males (40.1), Winnipeg RHA (42.7), urban region (42.3), low-income quintiles (78.5), and pregnant persons (94.3), respectively. Conclusion Although incidence rates of HCV infection in Manitoba appeared to have initially declined, rates showed an upward trend by the end of the study period while prevalence increased steadily.
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Affiliation(s)
- Sai Krishna Gudi
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sherif Eltonsy
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joseph Delaney
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Carla Osiowy
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Carole Taylor
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kelly Kaita
- Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Ambulatory Care for Section of Hepatology, Winnipeg, Manitoba, Canada
- Viral Hepatitis Investigative Unit, Winnipeg, Manitoba, Canada
| | - Silvia Alessi-Severini
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
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Lim D, Phillips E, Bradley C, Ward J. Barriers and Facilitators to Hepatitis C Virus (HCV) Treatment for Aboriginal and Torres Strait Islander Peoples in Rural South Australia: A Service Providers' Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4415. [PMID: 36901423 PMCID: PMC10002019 DOI: 10.3390/ijerph20054415] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 02/26/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
This study explored the barriers and facilitators to hepatitis C virus (HCV) treatment for Aboriginal and Torres Strait Islander peoples in rural South Australia as viewed from a healthcare provider perspective in the era of direct acting antivirals (DAAs). Phase 1 was a qualitative systematic review examining the barriers and enablers to diagnosis and treatment amongst Indigenous peoples living with HCV worldwide. Phase 2 was a qualitative descriptive study with healthcare workers from six de-identified rural and regional Aboriginal Community-Controlled Health Services in South Australia. The results from both methods were integrated at the analysis phase to understand how HCV treatment could be improved for rural Aboriginal and Torres Strait Islander peoples. Five main themes emerged: the importance of HCV education, recognizing competing social and cultural demands, the impact of holistic care delivery and client experience, the effect of internal barriers, and overlapping stigma, discrimination, and shame determine how Indigenous peoples navigate the healthcare system and their decision to engage in HCV care. Continued efforts to facilitate the uptake of DAA medications by Aboriginal and Torres Strait peoples in rural areas should utilize a multifaceted approach incorporating education to community and cultural awareness to reduce stigma and discrimination.
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Affiliation(s)
- David Lim
- Translational Health Research Institute, School of Health Sciences, Campbelltown, NSW 2560, Australia
| | - Emily Phillips
- National Aboriginal Community Controlled Health Organisation, Canberra, ACT 2601, Australia
| | - Clare Bradley
- Poche Centre for Indigenous Health, The University of Queensland, Toowong, QLD 4066, Australia
| | - James Ward
- Poche Centre for Indigenous Health, The University of Queensland, Toowong, QLD 4066, Australia
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Mendlowitz AB, Bremner KE, Feld JJ, Jones L, Hill E, Antone E, Liberty L, Boucher R, Krahn MD. Lessons from First Nations partnerships in hepatitis C research and the co-creation of knowledge. CANADIAN LIVER JOURNAL 2023; 6:46-55. [PMID: 36908573 PMCID: PMC9997512 DOI: 10.3138/canlivj-2022-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/03/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND: Administrative health data provide a rich and powerful tool for health services research. Partnership between researchers and the Ontario First Nations HIV/AIDS Education Circle (OFNHAEC) allowed for comprehensive analyses of the health and economic impacts of hepatitis C virus (HCV) infection in First Nations populations across Ontario, using administrative data. Examples of meaningful involvement of First Nations partners in research using secondary data sources demonstrate how community-based participatory research principles can be adapted to empower First Nations stakeholders and decision-makers. The aim of this review is to summarize and reflect on lessons learned in producing meaningful and actionable First Nations HCV research using health administrative data, from the perspective of health services researchers who collaborated for the first time with First Nations partners. METHODS: We discuss how our relationship with OFNHAEC formed and how engagement contextualized findings and provided opportunities for fostering trust and mutual capacity building. Methods included adherence to data governance principles, agreements outlining ethical conduct, and establishing commitment between partners. RESULTS: Engagement with OFNHAEC enhanced cultural understandings in study conception, design, and analysis, and enabled meaningful lessons for both parties through contextualizing findings together. Partnership ensured attention to factors, such as strength-based approaches and limitations of administrative data in their representation of First Nations peoples, that are not considered in standard HCV health services research using administrative health data. CONCLUSIONS: Collaboration throughout the HCV research provided first-hand experience of the relevance, representation, and importance of incorporating First Nations perspectives in health services research using administrative data.
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Affiliation(s)
- Andrew B Mendlowitz
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), Toronto General Hospital, Toronto, Ontario, Canada.,Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Karen E Bremner
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada
| | - Jordan J Feld
- Toronto Centre for Liver Disease/Viral Hepatitis Care Network (VIRCAN), Toronto General Hospital, Toronto, Ontario, Canada
| | - Lyndia Jones
- Ontario First Nations HIV/AIDS Education Circle (OFNHAEC), London, Ontario, Canada
| | - Evelynne Hill
- Ontario First Nations HIV/AIDS Education Circle (OFNHAEC), London, Ontario, Canada
| | - Elly Antone
- Ontario First Nations HIV/AIDS Education Circle (OFNHAEC), London, Ontario, Canada
| | - Laura Liberty
- Ontario First Nations HIV/AIDS Education Circle (OFNHAEC), London, Ontario, Canada
| | - Rene Boucher
- Ontario First Nations HIV/AIDS Education Circle (OFNHAEC), London, Ontario, Canada
| | - Murray D Krahn
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, Toronto, Ontario, Canada.,Deceased 01 07 22
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Dunn KPR, Williams KP, Egan CE, Potestio ML, Lee SS. ECHO+: Improving access to hepatitis C care within Indigenous communities in Alberta, Canada. CANADIAN LIVER JOURNAL 2022; 5:113-123. [PMID: 35991479 PMCID: PMC9236587 DOI: 10.3138/canlivj-2021-0027] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/15/2021] [Indexed: 07/29/2023]
Abstract
BACKGROUND Indigenous populations experience higher rates of hepatitis C virus (HCV) infections in Canada. The Extension for Community Health Outcomes+ (ECHO+) telehealth model was implemented in Alberta to support HCV screening and treatment, using Zoom technology to support Indigenous patient access to specialist care closer to home. Our goal was to expand this program to more Indigenous communities in Alberta, using various Indigenous-led or co-designed methods. METHODS The ECHO+ team implemented a Two-Eyed Seeing framework, incorporating Indigenous wholistic approaches alongside Western treatment. This approach works with principles of respect, reciprocity, and relationality. The ECHO+ team identified Indigenous-specific challenges, including access to liver specialist care, HCV awareness, stigma, barriers to screening and lack of culturally relevant approaches. RESULTS Access to HCV care via this program significantly increased HCV antiviral use in the past 5 years. Key lessons learned include Indigenous-led relationship building and development of project outputs in response to community needs influences impact and increases relevant changes increasing access to HCV care. Implementation of ECHO+ was carried out through biweekly telehealth sessions, problem solving in partnership with Indigenous communities, increased HCV awareness, and flexibility resulting from the impacts of COVID-19. CONCLUSION Improving Indigenous patient lives and reducing inequity requires supporting local primary health care providers to create and sustain integrated HCV prevention, diagnosis, treatment, and support services within a culturally safe and reciprocal model. ECHO+ uses telehealth and culturally appropriate methodology and interventions alongside multiple stakeholder collaborations to improve health outcomes for HCV.
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Affiliation(s)
- Kate PR Dunn
- Indigenous Wellness Core, Alberta Health Services, Calgary, Alberta, Canada
- These authors contributed equally and are co-first authors
| | - Kienan P Williams
- Indigenous Wellness Core, Alberta Health Services, Calgary, Alberta, Canada
- These authors contributed equally and are co-first authors
| | - Cari E Egan
- Indigenous Wellness Core, Alberta Health Services, Calgary, Alberta, Canada
| | - Melissa L Potestio
- Indigenous Wellness Core, Alberta Health Services, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Co-senior authors
| | - Samuel S Lee
- Liver Unit, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Co-senior authors
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7
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Mendlowitz A, Bremner KE, Walker JD, Wong WWL, Feld JJ, Sander B, Jones L, Isaranuwatchai W, Krahn M. Hepatitis C virus infection in First Nations populations in Ontario from 2006 to 2014: a population-based retrospective cohort analysis. CMAJ Open 2021; 9:E886-E896. [PMID: 34584007 PMCID: PMC8486470 DOI: 10.9778/cmajo.20200164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Hepatitis C virus (HCV) infection causes substantial morbidity and mortality in Canada and is of concern among First Nations communities. In partnership with the Ontario First Nations HIV/AIDS Education Circle, we described trends in HCV testing and epidemiologic features among Status First Nations people in Ontario. METHODS In this retrospective study, we used health administrative databases for 2006-2014 in Ontario with 3 cohorts of Status First Nations people: those tested for HCV for the first time, those who tested positive for HCV antibodies or RNA, and those with no HCV laboratory or testing records. We examined cohort characteristics, and the annual prevalence and incidence of testing and diagnosis of HCV infection. Outcomes were stratified by region, sex and residence within or outside of First Nations communities. RESULTS During the study period, 2423 Status First Nations people were diagnosed with HCV infection, 20 481 received their first test, and 135 185 had no test record. The point prevalence of ever having been tested increased from 6.3 (95% confidence interval [CI] 6.2-6.5) per 100 people in 2006 to 16.2 (95% CI 16.0-16.4) per 100 people in 2014. The point prevalence of diagnosed HCV infection increased from 0.9 (95% CI 0.9-1.0) to 2.0 (95% CI 1.9-2.0) per 100 people. The incidence of first test and of diagnosis increased from 12.1 (95% CI 11.5-12.6) to 21.3 (95% CI 20.5-22.1) per 1000 person-years and from 1.3 (95% CI 1.1-1.5) to 2.3 (95% CI 2.1-2.6) per 1000 person-years, respectively. Testing, diagnosis and prevalence of HCV infection were consistently higher among people living outside of versus within First Nations communities, but larger increases over time were observed among those living within First Nations communities. INTERPRETATION Testing and diagnosis of HCV infection increased from 2006 to 2014 among Status First Nations people in Ontario. Our findings indicate the need for population-level efforts to eliminate hepatitis C in First Nations communities.
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Affiliation(s)
- Andrew Mendlowitz
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont.
| | - Karen E Bremner
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
| | - Jennifer D Walker
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
| | - William W L Wong
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
| | - Jordan J Feld
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
| | - Lyndia Jones
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
| | - Wanrudee Isaranuwatchai
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
| | - Murray Krahn
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
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8
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Mendlowitz A, Bremner KE, Walker JD, Wong WWL, Feld JJ, Sander B, Jones L, Isaranuwatchai W, Krahn M. Health care costs associated with hepatitis C virus infection in First Nations populations in Ontario: a retrospective matched cohort study. CMAJ Open 2021; 9:E897-E906. [PMID: 34584004 PMCID: PMC8486469 DOI: 10.9778/cmajo.20200247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Colonization and marginalization have affected the risk for and experience of hepatitis C virus (HCV) infection for First Nations people in Canada. In partnership with the Ontario First Nations HIV/AIDS Education Circle, we estimated the publicly borne health care costs associated with HCV infection among Status First Nations people in Ontario. METHODS In this retrospective matched cohort study, we used linked health administrative databases to identify Status First Nations people in Ontario who tested positive for HCV antibodies or RNA between 2004 and 2014, and Status First Nations people who had no HCV testing records or only a negative test result (control group, matched 2:1 to case participants). We estimated total and net costs (difference between case and control participants) for 4 phases of care: prediagnosis (6 mo before HCV infection diagnosis), initial (after diagnosis), late (liver disease) and terminal (6 mo before death), until death or Dec. 31, 2017, whichever occurred first. We stratified costs by sex and residence within or outside of First Nations communities. All costs were measured in 2018 Canadian dollars. RESULTS From 2004 to 2014, 2197 people were diagnosed with HCV infection. The mean net total costs per 30 days of HCV infection were $348 (95% confidence interval [CI] $277 to $427) for the prediagnosis phase, $377 (95% CI $288 to $470) for the initial phase, $1768 (95% CI $1153 to $2427) for the late phase and $893 (95% CI -$1114 to $3149) for the terminal phase. After diagnosis of HCV infection, net costs varied considerably among those who resided within compared to outside of First Nations communities. Net costs were higher for females than for males except in the terminal phase. INTERPRETATION The costs per 30 days of HCV infection among Status First Nations people in Ontario increased substantially with progression to advanced liver disease and finally to death. These estimates will allow for planning and evaluation of provincial and territorial population-specific hepatitis C control efforts.
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Affiliation(s)
- Andrew Mendlowitz
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont.
| | - Karen E Bremner
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
| | - Jennifer D Walker
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
| | - William W L Wong
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
| | - Jordan J Feld
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
| | - Beate Sander
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
| | - Lyndia Jones
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
| | - Wanrudee Isaranuwatchai
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
| | - Murray Krahn
- Institute of Health Policy, Management and Evaluation (Mendlowitz, Sander, Isaranuwatchai, Krahn), University of Toronto; Toronto Health Economics and Technology Assessment (THETA) Collaborative (Mendlowitz, Bremner, Sander, Krahn), University Health Network; ICES Central (Mendlowitz, Walker, Sander, Krahn), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; School of Pharmacy (Wong), University of Waterloo, Waterloo, Ont.; Toronto Centre for Liver Disease (Feld), Toronto General Hospital; Public Health Ontario (Sander), Toronto, Ont.; Ontario First Nations HIV/AIDS Education Circle (Jones), London, Ont.; St. Michael's Hospital (Isaranuwatchai), Unity Health Toronto, Toronto, Ont
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9
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Tarasuk J, Sullivan M, Bush D, Hui C, Morris M, Starlight T, Cholette F, Jonah L, Bryson M, Paquette D, Masching R. Findings among Indigenous participants of the Tracks survey of people who inject drugs in Canada, Phase 4, 2017-2019. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2021; 47:37-46. [PMID: 33679247 PMCID: PMC7919774 DOI: 10.14745/ccdr.v47i01a07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The Tracks survey of people who inject drugs (PWID) collected data in 14 sentinel sites across Canada (2017-2019). These findings describe the prevalence of human immunodeficiency virus (HIV), hepatitis C and associated risk behaviours among Indigenous participants. METHODS Information regarding socio-demographics, social determinants of health, use of prevention services and testing, drug use, risk behaviours, and HIV and hepatitis C testing, care and treatment was collected through interviewer-administered questionnaires. Biological samples were tested for HIV, hepatitis C antibodies and hepatitis C ribonucleic acid (RNA). Descriptive statistics were calculated and reviewed by an Indigenous-led advisory group using the Two-Eyed Seeing approach. RESULTS Of the 2,383 participants, 997 were Indigenous (82.9% First Nations, 14.9% Métis, 2.2% Inuit). Over half (54.5%) were cisgender male and the average age was 38.9 years. A large proportion (84.0%) reported their mental health as "fair to excellent". High proportions experienced stigma and discrimination (90.2%) and physical, sexual and/or emotional abuse in childhood (87.5%) or with a sexual partner (78.6%). Use of a needle/syringe distribution program (90.5%) and testing for HIV (87.9%) and hepatitis C (87.8%) were high. Prevalence of HIV was 15.4% (78.2% were aware of infection status) and 36.4% were hepatitis C RNA-positive (49.4% were aware of infection status). CONCLUSION High rates of HIV and hepatitis C were identified. Challenges in access to and maintenance of HIV and hepatitis C care and treatment were noted. This information informs harm reduction strategies, including the need to scale-up awareness of prophylaxis in a culturally relevant manner.
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Affiliation(s)
- Jill Tarasuk
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | | | - Donna Bush
- Pauktuutit Inuit Women of Canada, Ottawa, ON
| | - Christian Hui
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
- Canadian Aboriginal AIDS Network, Halifax, NS
- Pauktuutit Inuit Women of Canada, Ottawa, ON
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
| | - Melissa Morris
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
- Canadian Aboriginal AIDS Network, Halifax, NS
- Pauktuutit Inuit Women of Canada, Ottawa, ON
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
| | - Tami Starlight
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
- Canadian Aboriginal AIDS Network, Halifax, NS
- Pauktuutit Inuit Women of Canada, Ottawa, ON
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
| | - François Cholette
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
| | - Leigh Jonah
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - Maggie Bryson
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
| | - Dana Paquette
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON
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10
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Materniak S, Bland S, Margeson A, Webster D, Smyth D, O’Brien M. Differences among hepatitis C patients seen in community and specialist outpatient care settings. CANADIAN LIVER JOURNAL 2020; 3:286-293. [DOI: 10.3138/canlivj-2019-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 10/25/2019] [Indexed: 11/20/2022]
Abstract
Background: In the province of New Brunswick, care for patients infected with hepatitis C is provided in both community-based care settings and specialist-based care settings, but little is known about the differences between these populations. The aim of the current study is to characterize the demographic, socioeconomic, mental health and substance use factors of patients seen in these settings. Methods: Enrolling sites for this study included four specialist office-based clinics and one community-based clinic in three communities in New Brunswick. Personal health data was collected with informed consent via questionnaires and medical records. Non-incarcerated patients seen between April 2014 and April 2016 were included in the analysis. Results: A total of 374 patients were included (34.8% community versus 65.2% specialist office). Patients seen in the community care setting were younger (median age 43.7 versus 49.1 years), less likely to have a primary care provider ( p = .007), rely on social assistance as regular source of income ( p <.001), have been incarcerated ( p = .007), reported sharing drug paraphernalia ( p = .025), had recent injection drug use ( p <.001), reported snorting drugs recently ( p <.001) and reported prior overdose ( p = .025). Community clinic patients also had significantly younger mean age at first use of alcohol (13.6 versus 14.7 years, p = .044), marijuana (14.6 versus 15.8, p = .040), and opioids (23.9 versus 26.5 years, p = .036) over those seen in specialist offices. Conclusions: Unique differences exist between patients seen in community and specialist care settings in New Brunswick. Understanding these differences is an essential first step in developing patient-centred care models.
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Affiliation(s)
- Stefanie Materniak
- Division of Infectious Diseases, Horizon Health Network, Saint John, New Brunswick, Canada
| | | | - Alyssa Margeson
- Division of Infectious Diseases, Horizon Health Network, Moncton, New Brunswick, Canada
| | - Duncan Webster
- Division of Infectious Diseases, Horizon Health Network, Saint John, New Brunswick, Canada
- Dalhousie University, Nova Scotia, Canada
| | - Daniel Smyth
- Dalhousie University, Nova Scotia, Canada
- Division of Infectious Diseases, Horizon Health Network, Moncton, New Brunswick, Canada
| | - Meaghan O’Brien
- Dalhousie University, Nova Scotia, Canada
- Department of Internal Medicine, Horizon Health Network, Upper River Valley, New Brunswick, Canada
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11
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Reilly R, Wand H, McKetin R, Quinn B, Ezard N, Dunlop A, Conigrave K, Treloar C, Roe Y, Gray D, Stephens J, Ward J. Survey methods and characteristics of a sample of Aboriginal and Torres Strait Islander and non-Indigenous people who have recently used methamphetamine: the NIMAC survey. Drug Alcohol Rev 2020; 39:646-655. [PMID: 32573069 DOI: 10.1111/dar.13085] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/10/2020] [Accepted: 04/08/2020] [Indexed: 01/30/2023]
Abstract
INTRODUCTION AND AIMS There is a need for detailed information on methamphetamine use in Aboriginal and Torres Strait Islander communities. We describe a national survey on methamphetamine use among Aboriginal and Torres Strait Islander people and non-Indigenous people. DESIGN AND METHODS Participants aged 16 years or older who reported using methamphetamine in the past year were recruited for a cross-sectional survey through 10 Aboriginal Community Controlled Organisations. Surveys were completed anonymously on electronic tablets. Measures included the Australian Treatment Outcomes Profile, the Severity of Dependence Scale, subscales from Opiate Treatment Index and the Kessler 10. A Chronic Stress Scale was used to assess culturally situated chronic stress factors. RESULTS Of the 734 participants, 416 (59%) were Aboriginal or Torres Strait Islander and 331 (45%) were female. In the previous year, most participants reported smoking (48.7%) or injecting (34%) methamphetamine and 17.4% reported daily use. Aboriginal and Torres Strait Islander people did not differ significantly from non-Indigenous participants on methamphetamine use patterns (age at first use, frequency of use, main mode of use, injecting risk, poly drug use). Aboriginal and Torres Strait Islander participants felt less able to access health care (32% vs. 48%, P < 0.001), including mental health services (19% vs. 29%, P < 0.002), were less likely to report a mental health diagnosis (50% vs. 60%, P < 0.002) and were more likely to turn to family for support (52% vs. 34%, P < 0.001). DISCUSSION AND CONCLUSIONS We recruited and surveyed a large sample of Aboriginal and Torres Strait Islander people from which we can derive detailed comparative data on methamphetamine use and related health service needs for Aboriginal and Torres Strait Islander and non-Indigenous Australians.
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Affiliation(s)
- Rachel Reilly
- Infectious Diseases Aboriginal Health Research, Aboriginal Health Equity Unit, South Australian Health and Medical Research Institute, Adelaide, Australia.,College and Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Handan Wand
- Kirby Institute, UNSW Sydney, Sydney, Australia
| | - Rebecca McKetin
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia
| | - Brendan Quinn
- Longitudinal and Lifecourse Studies, Australian Institute of Family Studies, Melbourne, Australia
| | - Nadine Ezard
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, Australia.,Alcohol and Drug Service, St Vincent's Hospital, Sydney, Australia
| | - Adrian Dunlop
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Kate Conigrave
- School of Medicine, The University of Sydney, Sydney, Australia.,Drug Health Services, Royal Prince Alfred Hospital, Sydney, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Yvette Roe
- Molly Wardaguga Research Centre, Charles Darwin University, Darwin, Australia
| | - Dennis Gray
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Jacqueline Stephens
- Infectious Diseases Aboriginal Health Research, Aboriginal Health Equity Unit, South Australian Health and Medical Research Institute, Adelaide, Australia.,School of Medicine, University of Adelaide, Adelaide, Australia
| | - James Ward
- Infectious Diseases Aboriginal Health Research, Aboriginal Health Equity Unit, South Australian Health and Medical Research Institute, Adelaide, Australia.,College and Medicine and Public Health, Flinders University, Adelaide, Australia
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12
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Polymorphisms in the P2X7 receptor, and differential expression of Toll-like receptor-mediated cytokines and defensins, in a Canadian Indigenous group. Sci Rep 2019; 9:14204. [PMID: 31578370 PMCID: PMC6775093 DOI: 10.1038/s41598-019-50596-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 09/16/2019] [Indexed: 12/21/2022] Open
Abstract
Canadian Indigenous peoples (First Nations and Inuit) exhibit a high burden of infectious diseases including tuberculosis influenced by societal factors, and biological determinants. Toll-like receptor (TLR)-mediated innate immune responses are the first line of defence against infections. We examined the production of a panel of 30 cytokines in peripheral blood-derived mononuclear cells (PBMC) isolated from Indigenous and non-Indigenous participants, following stimulation with five different TLR ligands. The levels of TLR-induced pro-inflammatory cytokines such as IL-12/23p40, IL-16, and IFN-γ, and chemokines (MCP-4, MDC and eotaxin) were different between Indigenous compared to non-Indigenous participants. Antimicrobial cationic host defence peptides (CHDP) induced by TLR activation are critical for resolution of infections and modulate the TLR-to-NFκB pathway to alter downstream cytokine responses. Therefore, we examined the expression of human CHDP defensins and cathelicidin in PBMC. mRNA expression of genes encoding for def-A1 and def-B1 were significantly higher following stimulation with TLR ligands in Indigenous compared to non-Indigenous participants. The purinergic receptor P2X7 known to be activated by ATP released following TLR stimulation, is a receptor for CHDP. Therefore, we further examined single nucleotide polymorphisms (SNP) in P2X7. Indigenous participants had a significantly higher percentage of a P2X7 SNP which is associated with reduced function and lower ability to clear infections. These results suggest that a higher frequency of non-functional P2X7 receptors may influence the activity of downstream immune mediators required for resolution of infections such as pro-inflammatory cytokines and CHDP defensins, thus contributing to higher burden of infections in Indigenous population.
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13
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Edmunds BL, Miller ER, Tsourtos G. The distribution and socioeconomic burden of Hepatitis C virus in South Australia: a cross-sectional study 2010-2016. BMC Public Health 2019; 19:527. [PMID: 31068170 PMCID: PMC6505114 DOI: 10.1186/s12889-019-6847-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 04/17/2019] [Indexed: 02/06/2023] Open
Abstract
Background Hepatitis C virus infection (HCV) is a communicable disease of increasing global importance with 1.75 million new infections and 400,000 related deaths annually. Until recently, treatment options have had low uptake and most infected people remain untreated. New Direct Acting Antiviral medications can clear the virus in around 95% of cases, with few side-effects. These medications are restricted in most countries but freely accessible in Australia, yet most people still remain untreated. This study applies a cross-sectional research design to investigate the socio-spatial distribution of HCV in South Australia, to identify vulnerable populations, and examine epidemiological factors to potentially inform future targeted strategies for improved treatment uptake. Method HCV surveillance data were sourced from South Australia’s Communicable Diseases Control Branch and socio-economic population data from the Australian Bureau of Statistics from January 2010 to December 2016 inclusive. HCV cases were spatially mapped at postcode level. Multivariate logistic regression identified independent predictors of demographic risks for HCV notification and notification source. Results HCV notifications (n = 3356) were seven times more likely to be from people residing in the poorest areas with high rates of non-employment (75%; n = 1876) and injecting drug use (74%; n = 1862) reported. Notifications among Aboriginal and Torres Strait Islander people were around six times that of non-Indigenous people. HCV notifications negatively correlated (Spearman’s rho − 0.426; p < 0.001) with socio-economic status (residential postcode socio-economic resources Index). History of imprisonment independently predicted HCV diagnoses in lesser economically-resourced areas (RR1.5; p < 0.001). Independent predictors of diagnosis elsewhere than in general practices were non-employment (RR 4.6; p = 0.028), being male (RR 2.5; p < 0.001), and younger than mean age at diagnosis (RR 2.1; p = 0.006). Conclusions Most people diagnosed with HCV were from marginalised sub-populations. Given general practitioners are pivotal to providing effective HCV treatment for many people in Australia a most concerning finding was that non-employed people were statistically less likely to be diagnosed by general practitioners. These findings highlight a need for further action aimed at improving healthcare access and treatment uptake to help reduce the burden of HCV for marginalised people, and progress the vision of eliminating HCV as a major public health threat.
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Affiliation(s)
| | - Emma Ruth Miller
- Flinders University, GPO Box 2100, Adelaide, 5001, South Australia.
| | - George Tsourtos
- Flinders University, GPO Box 2100, Adelaide, 5001, South Australia
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14
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Bruce V, Eldredge J, Leyva Y, Mera J, English K, Page K. Hepatitis C Virus Infection in Indigenous Populations in the United States and Canada. Epidemiol Rev 2019; 41:158-167. [PMID: 31781749 PMCID: PMC7305812 DOI: 10.1093/epirev/mxz015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 10/02/2019] [Accepted: 10/29/2019] [Indexed: 12/31/2022] Open
Abstract
American Indian/Alaska Native (AI/AN) and Canadian Indigenous people are disproportionally affected by hepatitis C virus (HCV) infection yet are frequently underrepresented in epidemiologic studies and surveys often used to inform public health efforts. We performed a systematic review of published and unpublished literature and summarized our findings on HCV prevalence in these Indigenous populations. We found a disparity of epidemiologic literature of HCV prevalence among AI/AN in the United States and Indigenous people in Canada. The limited data available, which date from 1995, demonstrate a wide range of HCV prevalence in AI/AN (1.49%-67.60%) and Indigenous populations (2.28%-90.24%). The highest HCV prevalence in both countries was reported in studies that either included or specifically targeted people who inject drugs. Lower prevalence was reported in studies of general Indigenous populations, although in Canada, the lowest prevalence was up to 3-fold higher in Aboriginal people compared with general population estimates. The disparity of available data on HCV prevalence and need for consistent and enhanced HCV surveillance and reporting among Indigenous people are highlighted. HCV affects Indigenous peoples to a greater degree than the general population; thus we recommend tribal and community leaders be engaged in enhanced surveillance efforts and that funds benefitting all Indigenous persons be expanded to help prevent and cover health care expenses to help stop this epidemic.
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Affiliation(s)
- Veronica Bruce
- Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Jonathan Eldredge
- Health Sciences Library and Informatics Center, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Yuridia Leyva
- Office of Research, Center for Healthcare Equity in Kidney Disease, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
| | - Jorge Mera
- Cherokee Nation Health Services, Tahlequah, Oklahoma
| | - Kevin English
- and Albuquerque Area Southwest Tribal Epidemiology Center, Albuquerque Area Indian Health Board, Inc, Albuquerque, New Mexico
| | - Kimberly Page
- Division of Epidemiology, Biostatistics, and Preventive Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico
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15
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Krajden M, Cook D, Janjua NZ. Contextualizing Canada's hepatitis C virus epidemic. CANADIAN LIVER JOURNAL 2018; 1:218-230. [PMID: 35992621 PMCID: PMC9202764 DOI: 10.3138/canlivj.2018-0011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 04/18/2018] [Indexed: 07/29/2023]
Abstract
In 2016, Canada signed on to the World Health Organization (WHO) 2030 hepatitis C virus (HCV) disease elimination targets. Most of Canada's HCV disease burden is among five disproportionately affected population groups: 1) Baby boomers, who are at increased risk of dying from decompensated cirrhosis and hepatocellular carcinoma and for whom one-time screening should be recommended to identify those undiagnosed; 2) People who inject drugs (PWID), whose mortality risks include HCV infection, HCV acquisition risks and co-morbid conditions. While HCV infection in PWID can be effectively cured with direct-acting antivirals, premature deaths from acquisition risks, now exacerbated by Canada's opioid crisis, will need to be addressed to achieve the full benefits of curative treatment. PWID require syndemic-based solutions (harm reduction, addictions and mental health support, and management of co-infections, including HIV); 3) Indigenous populations who will require wellness-based health promotion, prevention, care and treatment designed by Indigenous people to address their underlying health disparities; 4) Immigrants who will require culturally designed and linguistically appropriate services to enhance screening and engagement into care; and (5) For those incarcerated because of drug-related crimes, decriminalization and better access to harm reduction could help reduce the impact of HCV infections and premature mortality. A comprehensive prevention, care and treatment framework is needed for Canada's vulnerable populations, including those co-infected with HIV, if we are to achieve the WHO HCV elimination targets by 2030. The aim of this review is to describe the HCV epidemic in the Canadian context.
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Affiliation(s)
- Mel Krajden
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, British Columbia
- Dept. of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, British Columbia
| | - Darrel Cook
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, British Columbia
| | - Naveed Z Janjua
- Clinical Prevention Services, BC Centre for Disease Control, Vancouver, British Columbia
- School of Population and Public Health, University of British Columbia, Vancouver British Columbia
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16
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Fayed ST, King A, King M, Macklin C, Demeria J, Rabbitskin N, Healy B, Gonzales (Sempulyan) S. In the eyes of Indigenous people in Canada: exposing the underlying colonial etiology of hepatitis C and the imperative for trauma-informed care. CANADIAN LIVER JOURNAL 2018; 1:115-129. [PMID: 35991322 PMCID: PMC9203158 DOI: 10.3138/canlivj.2018-0009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 04/18/2018] [Indexed: 07/29/2023]
Abstract
BACKGROUND The distribution of hepatitis C (HCV) infection in Canada signals a widening gap between Indigenous and non-Indigenous people. Current evidence demonstrates that the rate of HCV infection among Indigenous people is at least five times higher than the rest of Canada. This analysis provides a reconciliatory response, which exposes the colonial etiology of the HCV gap in Canada and proposes potential anti-colonial approaches to HCV wellness and health care for Indigenous people. METHODS This analysis applies Two-Eyed Seeing as a reconciliatory methodology to advance the understanding of HCV burden and identify the key elements of responsive HCV care in the context of Indigenous nations in Canada. RESULTS The analysis underlines the colonial distribution of HCV burden in Canada, highlights Indigenous perspectives on HCV infection, hypothesizes a clinical pathway for the underlying colonial etiology of HCV infection, and identifies Indigenous healing as a promising anti-colonial conceptual approach to HCV wellness and health care among Indigenous people. CONCLUSIONS In the eyes of Indigenous people, HCV infection is a colonial illness that entails healing as an anti-colonial approach to achieving wellness and gaining health. Future empirical research should elaborate on the colonial HCV pathway hypothesis and inform the development of a framework for HCV healing among Indigenous people in Canada.
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Affiliation(s)
| | | | - Malcolm King
- University of Saskatchewan, Saskatoon, Saskatchewan
| | | | | | | | - Bonnie Healy
- Alberta First Nations Information Governance Centre, Calgary, Alberta
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17
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Hepatitis C virus infection in Saskatchewan First Nations communities: Challenges and innovations. ACTA ACUST UNITED AC 2018; 44:173-178. [PMID: 31011298 DOI: 10.14745/ccdr.v44i78a04] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Hepatitis C virus (HCV) infection has become a major public health issue in Canada, and especially in Saskatchewan First Nations (FNs) communities. One of the challenges in eliminating hepatitis C in Canada is accessing hard-to-reach populations, such as FNs people living on reserves. In Canada, HCV is a notifiable disease but complete and timely surveillance of HCV data is not always possible in remote communities. In addition, national surveillance data are insufficient for determining the number of cases of hepatitis C among FNs populations, because many provinces do not collect information according to ethnicity. Statistics for FN communities are available federally through the First Nations and Inuit Health Branch (FNIHB) in partnership with the communities and the province. There are multiple factors associated with the high rates of HCV in FNs communities, including barriers in accessing preventive services, early diagnosis and treatment. These access issues are largely attributable to issues with geographical remoteness, transportation, education and awareness, and a health care system designed around urban health. New and innovative ways of delivering information and services, such as the mobile hepatitis C clinic (Liver Health Days) and the community-driven Sexually Transmitted Bloodborne Infections (STBBI) Know Your Status program, are proving invaluable in remote FNs communities. Extending these in-community and community-driven programs to other FNs communities and to the prison population could be invaluable in working towards the World Health Organization elimination goals of hepatitis C virus for all.
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18
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Akhtar F, Rehman S. A Public Health Analysis on Gaps in Disease Monitoring and Opportunities for Improved Care for the Management of Hepatitis B and C. Cureus 2018; 10:e2077. [PMID: 29560290 PMCID: PMC5856414 DOI: 10.7759/cureus.2077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Hepatitis B and Hepatitis C have been major disease-causing agents among humans since they were discovered in the 1960s. Both cause jaundice-like symptoms initially but their prognosis and treatment are somehow different and depend upon many demographic details, such as the age and susceptibility of the patients and any other comorbid conditions. They clinically present primarily with hepatitis and can have many adverse effects or even be life-threatening at times, if not treated properly. However, their epidemiological background and findings in terms of morbidity, mortality, and case fatality rates are different. The disease burden, impact on the healthcare system, and prevention of the two diseases are quite different. The treatment and management options along with the prevention and control measures share unique strategies for handling the two diseases. The purpose of this review is to highlight the gaps in disease monitoring and to find ways and opportunities that can lead to improved care and better management of Hepatitis B and C locally and globally. Online databases were searched and peer-reviewed articles were selected. Key issues identified were lack of education globally in resource-limited settings, leading to a decreased understanding of the potential hazards associated with needle sharing and lack of access to healthcare because of a lack of insurance. The failure of compliance with vaccination leads to an increase in mother-to-child transmission (MTCT)-related infections. Increased global travel demands a systematic program in most immigrant-receiving countries to screen for hepatitis B virus (HBV)/hepatitis c virus (HCV) infections. Delayed U.S. Food and Drug Administration (FDA) licensing for new drugs hampers the treatment of chronic Hepatitis-B (CHB) among children. With the advancement in science, an effective vaccine against HCV will definitely help in eradicating the infection.
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Gordon J, Bocking N, Pouteau K, Farrell T, Ryan G, Kelly L. First Nations hepatitis C virus infections: Six-year retrospective study of on-reserve rates of newly reported infections in northwestern Ontario. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2017; 63:e488-e494. [PMID: 29138174 PMCID: PMC5685465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To document rates of newly reported hepatitis C virus (HCV) cases from 2010 to 2015 in remote First Nations communities. DESIGN Retrospective analysis of aggregate data of newly reported HCV antibody-positive (Ab+) cases. SETTING Northwestern Ontario. PARTICIPANTS A total of 31 First Nations communities (an on-reserve population of 20 901) supported in health care by the Sioux Lookout First Nations Health Authority. MAIN OUTCOME MEASURES The aggregate characteristic data included year of notification, age range, and sex for a 6-year period (2010 to 2015). RESULTS There were 267 HCV Ab+ cases in the 6-year study period. The incidence in 2015 was 324.2 per 100 000 population. This is 11 times the rate for all of Ontario. The most common associated risk factor was sharing of intravenous drug use equipment. Women made up 52% of patients with newly reported HCV Ab+ cases. More than 45% of cases were in patients between 20 and 29 years of age. CONCLUSION This high burden of newly reported HCV Ab+ cases in geographically remote First Nations communities is concerning, and prevention and treatment resources are needed. This burden of disease might pose more urgent health and social challenges than can be generalized from the experience of the rest of Canada.
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Affiliation(s)
- Janet Gordon
- Chief Operating Officer for the Sioux Lookout First Nations Health Authority in Ontario
| | - Natalie Bocking
- Public health physician in the Sioux Lookout First Nations Health Authority
| | | | - Terri Farrell
- Medical Director for the Sioux Lookout First Nations Health Authority
| | - Gareth Ryan
- Research intern in the Anishinaabe Bimaadiziwin Research Program in Sioux Lookout
| | - Len Kelly
- Research consultant for the Anishinaabe Bimaadiziwin Research Program.
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Koch A, Bruce MG, Ladefoged K. Arctic and Antarctica. Infect Dis (Lond) 2017. [DOI: 10.1002/9781119085751.ch27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Anders Koch
- Department of Epidemiology Research, Statens Serum Institut and Department of Infectious Diseases; Rigshospitalet University Hospital; Copenhagen Denmark
| | - Michael G. Bruce
- Arctic Investigations Program; DPEI, NCEZID, CDC, Anchorage; Alaska USA
| | - Karin Ladefoged
- Department of Internal Medicine; Queen Ingrid's Hospital; Nuuk Greenland
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Marshall AD, Saeed S, Barrett L, Cooper CL, Treloar C, Bruneau J, Feld JJ, Gallagher L, Klein MB, Krajden M, Shoukry NH, Taylor LE, Grebely J. Restrictions for reimbursement of direct-acting antiviral treatment for hepatitis C virus infection in Canada: a descriptive study. CMAJ Open 2016; 4:E605-E614. [PMID: 28018873 PMCID: PMC5173474 DOI: 10.9778/cmajo.20160008] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In Canada, interferon-free, direct-acting antiviral hepatitis C virus (HCV) regimens are costly. This presents challenges for universal drug coverage of the estimated 220 000 people with chronic HCV infection nationwide. The study objective was to appraise criteria for reimbursement of 4 HCV direct-acting antivirals in Canada. METHODS We reviewed the reimbursement criteria for simeprevir, sofosbuvir, ledipasvir-sofosbuvir and paritaprevir-ritonavir-ombitasvir plus dasabuvir in the 10 provinces and 3 territories. Data were extracted from April 2015 to June 2016. The primary outcomes extracted from health ministerial websites were: 1) minimum fibrosis stage required, 2) drug and alcohol use restrictions, 3) HIV coinfection restrictions and 4) prescriber type restrictions. RESULTS Overall, 85%-92% of provinces/territories limited access to patients with moderate fibrosis (Meta-Analysis of Histologic Data in Viral Hepatitis stage F2 or greater, or equivalent). There were no drug and alcohol use restrictions; however, several criteria (e.g., active injection drug use) were left to the discretion of the physician. Quebec did not reimburse simeprevir and sofosbuvir for people coinfected with HIV; no restrictions were found in the remaining jurisdictions. Prescriber type was restricted to specialists in up to 42% of provinces/territories. INTERPRETATION This review of criteria of reimbursement of HCV direct-acting antivirals in Canada showed substantial interjurisdictional heterogeneity. The findings could inform health policy and support the development and adoption of a national HCV strategy.
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Affiliation(s)
- Alison D Marshall
- The Kirby Institute (Marshall, Grebely), UNSW Australia, Sydney, Australia; Department of Epidemiology, Biostatistics and Occupational Health (Saeed), McGill University, Montréal, Que.; Faculty of Medicine (Klein), McGill University, Montréal, Que.; Faculty of Medicine (Barrett), Dalhousie University, Halifax, NS; Department of Medicine (Cooper), University of Ottawa, Ottawa, Ont.; Centre for Social Research in Health (Treloar), UNSW Australia, Sydney, Australia; Centre de recherche du Centre hospitalier de l'Université de Montréal (Bruneau, Shoukry), Montréal, Que.; Liver Centre (Feld), Toronto Western Hospital, University Health Network/University of Toronto, Toronto, Ont.; Vancouver Coastal Health (Gallagher); BC Centre for Disease Control (Krajden), Vancouver, BC; Department of Medicine (Taylor), Brown University, Providence, RI
| | - Sahar Saeed
- The Kirby Institute (Marshall, Grebely), UNSW Australia, Sydney, Australia; Department of Epidemiology, Biostatistics and Occupational Health (Saeed), McGill University, Montréal, Que.; Faculty of Medicine (Klein), McGill University, Montréal, Que.; Faculty of Medicine (Barrett), Dalhousie University, Halifax, NS; Department of Medicine (Cooper), University of Ottawa, Ottawa, Ont.; Centre for Social Research in Health (Treloar), UNSW Australia, Sydney, Australia; Centre de recherche du Centre hospitalier de l'Université de Montréal (Bruneau, Shoukry), Montréal, Que.; Liver Centre (Feld), Toronto Western Hospital, University Health Network/University of Toronto, Toronto, Ont.; Vancouver Coastal Health (Gallagher); BC Centre for Disease Control (Krajden), Vancouver, BC; Department of Medicine (Taylor), Brown University, Providence, RI
| | - Lisa Barrett
- The Kirby Institute (Marshall, Grebely), UNSW Australia, Sydney, Australia; Department of Epidemiology, Biostatistics and Occupational Health (Saeed), McGill University, Montréal, Que.; Faculty of Medicine (Klein), McGill University, Montréal, Que.; Faculty of Medicine (Barrett), Dalhousie University, Halifax, NS; Department of Medicine (Cooper), University of Ottawa, Ottawa, Ont.; Centre for Social Research in Health (Treloar), UNSW Australia, Sydney, Australia; Centre de recherche du Centre hospitalier de l'Université de Montréal (Bruneau, Shoukry), Montréal, Que.; Liver Centre (Feld), Toronto Western Hospital, University Health Network/University of Toronto, Toronto, Ont.; Vancouver Coastal Health (Gallagher); BC Centre for Disease Control (Krajden), Vancouver, BC; Department of Medicine (Taylor), Brown University, Providence, RI
| | - Curtis L Cooper
- The Kirby Institute (Marshall, Grebely), UNSW Australia, Sydney, Australia; Department of Epidemiology, Biostatistics and Occupational Health (Saeed), McGill University, Montréal, Que.; Faculty of Medicine (Klein), McGill University, Montréal, Que.; Faculty of Medicine (Barrett), Dalhousie University, Halifax, NS; Department of Medicine (Cooper), University of Ottawa, Ottawa, Ont.; Centre for Social Research in Health (Treloar), UNSW Australia, Sydney, Australia; Centre de recherche du Centre hospitalier de l'Université de Montréal (Bruneau, Shoukry), Montréal, Que.; Liver Centre (Feld), Toronto Western Hospital, University Health Network/University of Toronto, Toronto, Ont.; Vancouver Coastal Health (Gallagher); BC Centre for Disease Control (Krajden), Vancouver, BC; Department of Medicine (Taylor), Brown University, Providence, RI
| | - Carla Treloar
- The Kirby Institute (Marshall, Grebely), UNSW Australia, Sydney, Australia; Department of Epidemiology, Biostatistics and Occupational Health (Saeed), McGill University, Montréal, Que.; Faculty of Medicine (Klein), McGill University, Montréal, Que.; Faculty of Medicine (Barrett), Dalhousie University, Halifax, NS; Department of Medicine (Cooper), University of Ottawa, Ottawa, Ont.; Centre for Social Research in Health (Treloar), UNSW Australia, Sydney, Australia; Centre de recherche du Centre hospitalier de l'Université de Montréal (Bruneau, Shoukry), Montréal, Que.; Liver Centre (Feld), Toronto Western Hospital, University Health Network/University of Toronto, Toronto, Ont.; Vancouver Coastal Health (Gallagher); BC Centre for Disease Control (Krajden), Vancouver, BC; Department of Medicine (Taylor), Brown University, Providence, RI
| | - Julie Bruneau
- The Kirby Institute (Marshall, Grebely), UNSW Australia, Sydney, Australia; Department of Epidemiology, Biostatistics and Occupational Health (Saeed), McGill University, Montréal, Que.; Faculty of Medicine (Klein), McGill University, Montréal, Que.; Faculty of Medicine (Barrett), Dalhousie University, Halifax, NS; Department of Medicine (Cooper), University of Ottawa, Ottawa, Ont.; Centre for Social Research in Health (Treloar), UNSW Australia, Sydney, Australia; Centre de recherche du Centre hospitalier de l'Université de Montréal (Bruneau, Shoukry), Montréal, Que.; Liver Centre (Feld), Toronto Western Hospital, University Health Network/University of Toronto, Toronto, Ont.; Vancouver Coastal Health (Gallagher); BC Centre for Disease Control (Krajden), Vancouver, BC; Department of Medicine (Taylor), Brown University, Providence, RI
| | - Jordan J Feld
- The Kirby Institute (Marshall, Grebely), UNSW Australia, Sydney, Australia; Department of Epidemiology, Biostatistics and Occupational Health (Saeed), McGill University, Montréal, Que.; Faculty of Medicine (Klein), McGill University, Montréal, Que.; Faculty of Medicine (Barrett), Dalhousie University, Halifax, NS; Department of Medicine (Cooper), University of Ottawa, Ottawa, Ont.; Centre for Social Research in Health (Treloar), UNSW Australia, Sydney, Australia; Centre de recherche du Centre hospitalier de l'Université de Montréal (Bruneau, Shoukry), Montréal, Que.; Liver Centre (Feld), Toronto Western Hospital, University Health Network/University of Toronto, Toronto, Ont.; Vancouver Coastal Health (Gallagher); BC Centre for Disease Control (Krajden), Vancouver, BC; Department of Medicine (Taylor), Brown University, Providence, RI
| | - Lesley Gallagher
- The Kirby Institute (Marshall, Grebely), UNSW Australia, Sydney, Australia; Department of Epidemiology, Biostatistics and Occupational Health (Saeed), McGill University, Montréal, Que.; Faculty of Medicine (Klein), McGill University, Montréal, Que.; Faculty of Medicine (Barrett), Dalhousie University, Halifax, NS; Department of Medicine (Cooper), University of Ottawa, Ottawa, Ont.; Centre for Social Research in Health (Treloar), UNSW Australia, Sydney, Australia; Centre de recherche du Centre hospitalier de l'Université de Montréal (Bruneau, Shoukry), Montréal, Que.; Liver Centre (Feld), Toronto Western Hospital, University Health Network/University of Toronto, Toronto, Ont.; Vancouver Coastal Health (Gallagher); BC Centre for Disease Control (Krajden), Vancouver, BC; Department of Medicine (Taylor), Brown University, Providence, RI
| | - Marina B Klein
- The Kirby Institute (Marshall, Grebely), UNSW Australia, Sydney, Australia; Department of Epidemiology, Biostatistics and Occupational Health (Saeed), McGill University, Montréal, Que.; Faculty of Medicine (Klein), McGill University, Montréal, Que.; Faculty of Medicine (Barrett), Dalhousie University, Halifax, NS; Department of Medicine (Cooper), University of Ottawa, Ottawa, Ont.; Centre for Social Research in Health (Treloar), UNSW Australia, Sydney, Australia; Centre de recherche du Centre hospitalier de l'Université de Montréal (Bruneau, Shoukry), Montréal, Que.; Liver Centre (Feld), Toronto Western Hospital, University Health Network/University of Toronto, Toronto, Ont.; Vancouver Coastal Health (Gallagher); BC Centre for Disease Control (Krajden), Vancouver, BC; Department of Medicine (Taylor), Brown University, Providence, RI
| | - Mel Krajden
- The Kirby Institute (Marshall, Grebely), UNSW Australia, Sydney, Australia; Department of Epidemiology, Biostatistics and Occupational Health (Saeed), McGill University, Montréal, Que.; Faculty of Medicine (Klein), McGill University, Montréal, Que.; Faculty of Medicine (Barrett), Dalhousie University, Halifax, NS; Department of Medicine (Cooper), University of Ottawa, Ottawa, Ont.; Centre for Social Research in Health (Treloar), UNSW Australia, Sydney, Australia; Centre de recherche du Centre hospitalier de l'Université de Montréal (Bruneau, Shoukry), Montréal, Que.; Liver Centre (Feld), Toronto Western Hospital, University Health Network/University of Toronto, Toronto, Ont.; Vancouver Coastal Health (Gallagher); BC Centre for Disease Control (Krajden), Vancouver, BC; Department of Medicine (Taylor), Brown University, Providence, RI
| | - Naglaa H Shoukry
- The Kirby Institute (Marshall, Grebely), UNSW Australia, Sydney, Australia; Department of Epidemiology, Biostatistics and Occupational Health (Saeed), McGill University, Montréal, Que.; Faculty of Medicine (Klein), McGill University, Montréal, Que.; Faculty of Medicine (Barrett), Dalhousie University, Halifax, NS; Department of Medicine (Cooper), University of Ottawa, Ottawa, Ont.; Centre for Social Research in Health (Treloar), UNSW Australia, Sydney, Australia; Centre de recherche du Centre hospitalier de l'Université de Montréal (Bruneau, Shoukry), Montréal, Que.; Liver Centre (Feld), Toronto Western Hospital, University Health Network/University of Toronto, Toronto, Ont.; Vancouver Coastal Health (Gallagher); BC Centre for Disease Control (Krajden), Vancouver, BC; Department of Medicine (Taylor), Brown University, Providence, RI
| | - Lynn E Taylor
- The Kirby Institute (Marshall, Grebely), UNSW Australia, Sydney, Australia; Department of Epidemiology, Biostatistics and Occupational Health (Saeed), McGill University, Montréal, Que.; Faculty of Medicine (Klein), McGill University, Montréal, Que.; Faculty of Medicine (Barrett), Dalhousie University, Halifax, NS; Department of Medicine (Cooper), University of Ottawa, Ottawa, Ont.; Centre for Social Research in Health (Treloar), UNSW Australia, Sydney, Australia; Centre de recherche du Centre hospitalier de l'Université de Montréal (Bruneau, Shoukry), Montréal, Que.; Liver Centre (Feld), Toronto Western Hospital, University Health Network/University of Toronto, Toronto, Ont.; Vancouver Coastal Health (Gallagher); BC Centre for Disease Control (Krajden), Vancouver, BC; Department of Medicine (Taylor), Brown University, Providence, RI
| | - Jason Grebely
- The Kirby Institute (Marshall, Grebely), UNSW Australia, Sydney, Australia; Department of Epidemiology, Biostatistics and Occupational Health (Saeed), McGill University, Montréal, Que.; Faculty of Medicine (Klein), McGill University, Montréal, Que.; Faculty of Medicine (Barrett), Dalhousie University, Halifax, NS; Department of Medicine (Cooper), University of Ottawa, Ottawa, Ont.; Centre for Social Research in Health (Treloar), UNSW Australia, Sydney, Australia; Centre de recherche du Centre hospitalier de l'Université de Montréal (Bruneau, Shoukry), Montréal, Que.; Liver Centre (Feld), Toronto Western Hospital, University Health Network/University of Toronto, Toronto, Ont.; Vancouver Coastal Health (Gallagher); BC Centre for Disease Control (Krajden), Vancouver, BC; Department of Medicine (Taylor), Brown University, Providence, RI
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Moqueet N, Infante-Rivard C, Platt RW, Young J, Cooper C, Hull M, Walmsley S, Klein MB. Favourable IFNL3 genotypes are associated with spontaneous clearance and are differentially distributed in Aboriginals in Canadian HIV-hepatitis C co-infected individuals. Int J Mol Sci 2015; 16:6496-512. [PMID: 25803108 PMCID: PMC4394544 DOI: 10.3390/ijms16036496] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 03/13/2015] [Accepted: 03/13/2015] [Indexed: 12/13/2022] Open
Abstract
Canadian Aboriginals are reported to clear Hepatitis C (HCV) more frequently. We tested the association of spontaneous clearance and three single nucleotide polymorphisms (SNPs) near the Interferon-lambda 3 (IFNL3) gene (rs12979860, rs8099917, functional variant rs8103142) and compared the SNP frequencies between HIV-HCV co-infected whites and Aboriginals from the Canadian Co-infection Cohort. HCV treatment-naïve individuals with at least two HCV RNA tests were included (n = 538). A spontaneous clearance case was defined as someone with two consecutive HCV RNA-negative tests, at least six months apart. Data were analyzed using Cox proportional hazards adjusted for sex and ethnicity. Advantageous variants and haplotypes were more common in Aboriginals than Caucasians: 57% vs. 46% had the rs12979860 CC genotype, respectively; 58% vs. 48%, rs8103142 TT; 74% vs. 67%, the rs12979860 C allele; and 67% vs. 64% the TCT haplotype with three favourable alleles. The adjusted Hazard Ratios (95% CI) for spontaneous clearance were: rs12979860: 3.80 (2.20, 6.54); rs8099917: 5.14 (2.46, 10.72); and rs8103142: 4.36 (2.49, 7.62). Even after adjusting for rs12979860, Aboriginals and females cleared HCV more often, HR (95% CI) = 1.53 (0.89, 2.61) and 1.42 (0.79, 2.53), respectively. Our results suggest that favourable IFNL3 genotypes are more common among Aboriginals than Caucasians, and may partly explain the higher HCV clearance rates seen among Aboriginals.
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Affiliation(s)
- Nasheed Moqueet
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC H3A 1A2, Canada.
| | - Claire Infante-Rivard
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC H3A 1A2, Canada.
| | - Robert W Platt
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC H3A 1A2, Canada.
| | - Jim Young
- Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Basel 4031, Switzerland.
- Department of Medicine, Division of Infectious Diseases/Chronic Viral Illness Service, Royal Victoria Hospital, McGill University Health Centre, 3650 Saint-Urbain Street, Montreal, QC H2X 2P4, Canada.
| | - Curtis Cooper
- The Ottawa Hospital-Research Institute, Ottawa, ON K1Y 4E9, Canada.
| | - Mark Hull
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC V6Z 1Y6, Canada.
| | - Sharon Walmsley
- Toronto General Research Institute, University Health Network, University of Toronto, Toronto, ON M5G 2M9, Canada.
| | - Marina B Klein
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, QC H3A 1A2, Canada.
- Department of Medicine, Division of Infectious Diseases/Chronic Viral Illness Service, Royal Victoria Hospital, McGill University Health Centre, 3650 Saint-Urbain Street, Montreal, QC H2X 2P4, Canada.
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Estimated prevalence of Hepatitis C Virus infection in Canada, 2011. ACTA ACUST UNITED AC 2014; 40:429-436. [PMID: 29769874 DOI: 10.14745/ccdr.v40i19a02] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Prevalence estimates contribute to our understanding of the magnitude of a particular health condition and in planning appropriate public health interventions. Objective To estimate the prevalence of chronic Hepatitis C virus (HCV) infection, anti-HCV-positive status (anti-HCV) and the proportion of undiagnosed HCV infections in Canada. Methods A combination of back-calculation and workbook methods was used. The back-calculation method estimated prevalent chronic HCV infection and the proportion undiagnosed using the Canadian Cancer Registry's data on hepatocellular carcinoma reported between 1992 and 2008 and the Canadian Notifiable Disease Surveillance System's data on Hepatitis C virus (HCV) cases reported between 1991 and 2009 in a Markov multi-state disease progression model with parameters adjusted to Canada. The workbook method divided the total population of Canada into population subsets and developed estimates of population size and anti-HCV prevalence for each. Sub-population size estimates were multiplied by anti-HCV prevalence measures to calculate the prevalence of anti-HCV by sub-population. A measure of spontaneous clearance was used to estimate the number of persons with chronic HCV from estimates of the number of anti-HCV-positive persons. Results The back-calculation method estimated the prevalence of chronic HCV infection at 0.64% and the proportion of undiagnosed chronic HCV infection at 44% in 2011. The workbook method estimated the anti-HCV prevalence at 0.96% (plausibility range: 0.61% to 1.34%) and chronic HCV infection at 0.71% (0.45 - 0.99%). Interpretation By combining mid-point estimates from both methods, it is estimated that between 0.64% to 0.71% of the overall Canadian population was living with chronic HCV infection in 2011 and 44% of these individuals were undiagnosed.
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Hepatitis C virus infection in Canada's First Nations people: a growing problem. CANADIAN JOURNAL OF GASTROENTEROLOGY = JOURNAL CANADIEN DE GASTROENTEROLOGIE 2013; 27:335. [PMID: 23781515 DOI: 10.1155/2013/641585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Hepatitis C virus in American Indian/Alaskan Native and Aboriginal peoples of North America. Viruses 2013; 4:3912-31. [PMID: 23342378 PMCID: PMC3528296 DOI: 10.3390/v4123912] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Liver diseases, such as hepatitis C virus (HCV), are “broken spirit” diseases. The prevalence of HCV infection for American Indian/Alaskan Native (AI/AN) in the United States and Canadian Aboriginals varies; nonetheless, incidence rates of newly diagnosed HCV infection are typically higher relative to non-indigenous people. For AI/AN and Aboriginal peoples risk factors for the diagnosis of HCV can reflect that of the general population: predominately male, a history of injection drug use, in midlife years, with a connection with urban centers. However, the face of the indigenous HCV infected individual is becoming increasingly female and younger compared to non-indigenous counterparts. Epidemiology studies indicate that more effective clearance of acute HCV infection can occur for select Aboriginal populations, a phenomenon which may be linked to unique immune characteristics. For individuals progressing to chronic HCV infection treatment outcomes are comparable to other racial cohorts. Disease progression, however, is propelled by elevated rates of co-morbidities including type 2 diabetes and alcohol use, along with human immunodeficiency virus (HIV) co-infection relative to non-indigenous patients. Historical and personal trauma has a major role in the participation of high risk behaviors and associated diseases. Although emerging treatments provide hope, combating HCV related morbidity and mortality will require interventions that address the etiology of broken spirit diseases.
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