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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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2
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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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Brener L, Caruana T, Broady T, Cama E, Ezard N, Madden A, Treloar C. Addressing injecting related risks among people who inject both opioids and stimulants: Findings from an Australian survey of people who inject drugs. Addict Behav Rep 2022; 15:100398. [PMID: 35005190 PMCID: PMC8717740 DOI: 10.1016/j.abrep.2021.100398] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/18/2021] [Accepted: 12/08/2021] [Indexed: 01/04/2023] Open
Abstract
Background Opioids and stimulants are the most commonly injected illicit drugs worldwide and in Australia. While some people who inject drugs (PWID) prefer either opioids or stimulants, others regularly use both opioids and stimulants. Limited available research indicates that those who use opioids and stimulants together, either in combination or alternating between the two, may engage in injection-related practices which potentially place them at greater health risk and could lead to poorer health outcomes. Methods Participants were recruited nationally through member organizations of the Australian Injecting and Illicit Drug Users League (AIVL); these organizations represent PWID in each Australian state and territory. This study compared a sample of PWID (N = 535) who reported past-month injection of opioids only (N = 173), stimulants only (N = 208), or both (N = 154) on a range of health and wellbeing outcomes. PWID completed a survey assessing drugs injected, frequency of injecting, receptive equipment sharing, psychological distress, self-reported hepatitis C (HCV) status, experienced and internalized stigma, drug use salience, and community attachment. Results People who injected both opioids and stimulants reported more frequent injecting, more experiences of stigma, and greater reported HCV diagnosis than people who injected stimulants or opioids alone. They also showed greater attachment to a community of PWID and greater salience of drug use to their identity. Conclusions The findings of increased injecting and broader harms associated with injecting both stimulants and opioids are important for tailoring harm reduction and intervention designs for people who use both opioid and stimulant drugs, including prioritizing peer-based approaches.
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Affiliation(s)
- L. Brener
- Centre for Social Research in Health, University of New South Wales, Sydney,
Australia
- Corresponding author at: Centre for Social Research in Health, University of
New South Wales, Sydney 2052, Australia.
| | - T. Caruana
- Centre for Social Research in Health, University of New South Wales, Sydney,
Australia
| | - T. Broady
- Centre for Social Research in Health, University of New South Wales, Sydney,
Australia
| | - E. Cama
- Centre for Social Research in Health, University of New South Wales, Sydney,
Australia
| | - N. Ezard
- St Vincent’s Hospital Sydney, Alcohol and Drug Service and the National
Centre for Clinical Research in Emerging Drugs Drug and Alcohol Clinical Research and
Improvement Network, National Drug and Alcohol Centre, University of New South Wales,
Sydney, Australia
| | - A. Madden
- Centre for Social Research in Health, University of New South Wales, Sydney,
Australia
| | - C. Treloar
- Centre for Social Research in Health, University of New South Wales, Sydney,
Australia
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Lin YH, Lee TH, Wang CK. Influence Analysis of Sustainability Perceptions on Sense of Community and Support for Sustainable Community Development in Relocated Communities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212223. [PMID: 34831979 PMCID: PMC8622289 DOI: 10.3390/ijerph182212223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/12/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022]
Abstract
This study aims to examine a theoretical model using sustainability perceptions, including environmental; sociocultural; economic; and life satisfaction, sense of community, and support for sustainable community development among the indigenous people of two relocated communities in Taiwan. A total of 747 usable questionnaires were collected and analyzed using structural equation modeling. The analytical results indicated that sense of community is an antecedent of support for sustainable community development in both relocated communities. Life satisfaction perceptions can influence the sense of community in Rinari. Additionally, environmental and economic perceptions are antecedents of the sense of community in New Laiyi. Finally, this study provides theoretical implications to fill the gaps in previous research, and offers valuable insights for promoting residents' support for sustainable community development in aboriginal communities; thus, this study has significant contributions, theoretically and practically.
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Affiliation(s)
- Yi-Hsien Lin
- Department of Tourism, Ming Chuan University, Taoyuan 333023, Taiwan;
| | - Tsung-Hung Lee
- Graduate School of Leisure and Exercise Studies, National Yunlin University of Science and Technology, Yunlin 640301, Taiwan
- Correspondence:
| | - Chiu-Kuang Wang
- Department of Accounting, National Yunlin University of Science and Technology, Yunlin 640301, Taiwan;
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Rashidi A, Higgs P, Carruthers S. Factors affecting hepatitis C treatment intentions among Aboriginal people in Western Australia: a mixed-methods study. AUST HEALTH REV 2021; 44:755-762. [PMID: 32854816 DOI: 10.1071/ah19194] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Accepted: 03/20/2020] [Indexed: 01/11/2023]
Abstract
Objective The aim of this study was to identify the hepatitis C treatment intentions of Aboriginal people living with hepatitis C virus (HCV) in Western Australia. Methods This study used a mixed-methods design. In the cross-sectional survey, 123 Aboriginal people who inject drugs and self-report as living with hepatitis C completed a purpose-designed questionnaire. In the qualitative phase, 10 participants were interviewed about the factors influencing their future intentions to undertake hepatitis C treatment. Results Analysis of the survey data revealed significant associations between an intention to undertake hepatitis C treatment and support, community attachment, stable housing and stigma. In addition, there was a high overall level of expressed intention to undertake HCV treatment, with 54% of participants responding positively. Analysis of the qualitative data supported quantitative findings, revealing concerns about stigma, lack of social support and unstable housing as factors affecting the intention to undertake hepatitis C treatment. Conclusion This mixed methods study with Aboriginal people living with self-reported HCV indicates interventions focused on reducing stigma and unstable housing could positively affect hepatitis C treatment intentions. These findings have implications for developing holistic programs to promote and support people on hepatitis C treatment. What is known about the topic? Substantial knowledge gaps need to be resolved if HCV elimination among Aboriginal Australians is to be achieved. Current research has prioritised non-Aboriginal communities. What does this paper add? This study found that stigma and unstable housing require attention if Aboriginal Australians are to obtain the full benefits of direct acting antiviral (DAA) hepatitis C treatment. What are the implications for practitioners? Reducing stigma (in the primary healthcare setting) and providing access to stable housing are vital components of supportive, non-judgemental and culturally appropriate care for Aboriginal people. This study highlights the importance of education for nurses and other primary care providers to increase engagement in the hepatitis cascade of care. To achieve this, scaling-up of HCV treatment engagement, trained Aboriginal community healthcare workers and HCV treatment advocates must mobilise and support Aboriginal people to avoid the negative effects of stigma, build positive and enabling relationships and reinforce positive attitudes towards DAA hepatitis C treatment.
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Affiliation(s)
- Amineh Rashidi
- School of Nursing and Midwifery, Building 21, Room 409, Edith Cowan University, Joondalup Campus, WA 6207, Australia; and Corresponding author.
| | - Peter Higgs
- Department of Public Health, La Trobe University, Plenty Road, Bundoora, Vic. 3083, Australia.
| | - Susan Carruthers
- Peer Based Harm Reduction WA, Bunbury Site, Suite 21 & 22, 7 Aberdeen Street,Perth, WA 6230, Australia.
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Brener L, Broady T, Cama E, Hopwood M, Byrne J, Treloar C. Positive effects of community attachment on internalised stigma and wellbeing among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 97:103323. [PMID: 34146790 DOI: 10.1016/j.drugpo.2021.103323] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/23/2021] [Accepted: 05/25/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Internalised stigma experienced by people who inject drugs (PWID) is known to have negative health consequences. Research has explored factors that may protect or buffer individuals from the negative consequences of internalised stigma. Community attachment, or perceived connection to a community of like people, can have numerous health-related benefits. However, this relationship may be complex for PWID; being part of a social network of PWID may provide opportunity for more frequent drug use and equipment sharing. This study investigated the relationships between community attachment, internalised stigma, and wellbeing among PWID, while also addressing potential health risks associated with PWID community attachment. METHODS PWID (n=603) were recruited through nine peer-based drug user organisations across Australia with assistance from the peak consumer organisation. Participants completed a survey measuring community attachment, internalised stigma, personal wellbeing, injecting frequency, and equipment sharing. RESULTS Greater attachment to a PWID community was associated with lower internalised stigma, but also with sharing of injecting equipment and increased frequency of injecting behaviour. The relationship between community attachment and personal wellbeing was mediated by internalised stigma, however this was only the case for PWID who reported no sharing of injecting equipment. CONCLUSIONS This research highlights the significance of community attachment for PWID while also noting the complexity of this relationship and the potential negative consequences. It is important to view networks of PWID communities as sources of positive social capital, where norms about health behaviours and harm reduction can be promoted and which can buffer community members from the harms associated with stigma.
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Affiliation(s)
- Loren Brener
- Centre for Social Research in Health, UNSW, Sydney, Australia.
| | - Timothy Broady
- Centre for Social Research in Health, UNSW, Sydney, Australia
| | - Elena Cama
- Centre for Social Research in Health, UNSW, Sydney, Australia
| | - Max Hopwood
- Centre for Social Research in Health, UNSW, Sydney, Australia
| | - Jude Byrne
- Australian Injecting & Illicit Drug Users League (AIVL), Canberra, ACT, Australia
| | - Carla Treloar
- Centre for Social Research in Health, UNSW, Sydney, Australia
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7
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Goodyear T, Brown H, Browne AJ, Hoong P, Ti L, Knight R. "I want to get better, but…": identifying the perceptions and experiences of people who inject drugs with respect to evolving hepatitis C virus treatments. Int J Equity Health 2021; 20:81. [PMID: 33740984 PMCID: PMC7977167 DOI: 10.1186/s12939-021-01420-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/04/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The advent of highly tolerable and efficacious direct-acting antiviral (DAA) medications has transformed the hepatitis C virus (HCV) treatment landscape. Yet, people who inject drugs (PWID) - a population with inequitably high rates of HCV and who face significant socio-structural barriers to healthcare access - continue to have disproportionately low rates of DAA uptake. The objective of this study is to explore how PWID with lived experience of HCV perceive and experience DAA treatment, in a setting with universal coverage of these medications since 2018. METHODS Informed by a critical interpretive framework, we thematically analyze data from in-depth, semi-structured interviews conducted between January and June 2018 in Vancouver, Canada, with a purposive sample (n = 56) of PWID at various stages (e.g., pre, peri, post) of DAA treatment. RESULTS The analysis yielded three key themes: (i) life with HCV, (ii) experiences with and perceptions of evolving HCV treatments, and (iii) substance use and the uptake of DAA treatments. First, participants described how health and healthcare conditions, such as the deprioritizing of HCV (e.g., due to: being asymptomatic, healthcare provider inaction, gatekeeping) and catalysts to care (e.g., symptom onset, treatment for co-morbidities) shaped DAA treatment motivation and access. Second, participants described how individual and community-level accounts of evolving HCV treatments, including skepticism following negative experiences with Interferon-based treatment and uncertainty regarding treatment eligibility, negatively influenced willingness and opportunities to access DAAs. Concurrently, participants described how peer and community endorsement of DAAs was positively associated with treatment uptake. Third, participants favoured HCV care that was grounded in harm reduction, which included the integration of DAAs with other substance use-related services (e.g., opioid agonist therapy, HIV care), and which was often contrasted against abstinence-focused care wherein substance use is framed as a contraindication to HCV treatment access. CONCLUSIONS These findings underscore several equity-oriented healthcare service delivery and clinician adaptations that are required to scale up DAAs among PWID living with HCV, including the provision of harm reduction-focused, non-stigmatizing, integrated, and peer-led care that responds to power differentials.
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Affiliation(s)
- Trevor Goodyear
- School of Nursing, University of British Columbia, Vancouver, Canada
- British Columbia Centre on Substance Use, 400-1045 Howe St, V6Z 2A9, Vancouver, BC, Canada
| | - Helen Brown
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Annette J Browne
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - Peter Hoong
- British Columbia Centre on Substance Use, 400-1045 Howe St, V6Z 2A9, Vancouver, BC, Canada
| | - Lianping Ti
- British Columbia Centre on Substance Use, 400-1045 Howe St, V6Z 2A9, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Rod Knight
- British Columbia Centre on Substance Use, 400-1045 Howe St, V6Z 2A9, Vancouver, BC, Canada.
- Department of Medicine, University of British Columbia, Vancouver, Canada.
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8
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Gorman E, Heritage B, Shepherd CCJ, Marriott R. A psychometric evaluation of the Connor–Davidson Resilience Scale for Australian Aboriginal youth. AUSTRALIAN PSYCHOLOGIST 2021. [DOI: 10.1080/00050067.2020.1829453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Ella Gorman
- Discipline of Psychology, Murdoch University, Perth, Australia
- Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Perth, Australia
| | - Brody Heritage
- Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Perth, Australia
| | - Carrington C. J. Shepherd
- Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Perth, Australia
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Rhonda Marriott
- Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Perth, Australia
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Pearce ME, Jongbloed K, Demerais L, MacDonald H, Christian WM, Sharma R, Pick N, Yoshida EM, Spittal PM, Klein MB. "Another thing to live for": Supporting HCV treatment and cure among Indigenous people impacted by substance use in Canadian cities. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 74:52-61. [PMID: 31525640 DOI: 10.1016/j.drugpo.2019.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 07/17/2019] [Accepted: 08/26/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Colonization and colonial systems have led to the overrepresentation of Indigenous people impacted by substance use and HCV infection in Canada. It is critical to ensure Indigenous people's equitable access to new direct acting antiviral HCV treatments (DAAs). Identifying culturally-safe, healing-centered approaches that support the wellbeing of Indigenous people living with HCV is an essential step toward this goal. We listened to the stories and perspectives of HCV-affected Indigenous people and HCV treatment providers with the aim of providing pragmatic recommendations for decolonizing HCV care. METHODS Forty-five semi-structured interviews were carried out with Indigenous participants affected by HCV from the Cedar Project (n = 20, British Columbia (BC)) and the Canadian Coinfection Cohort (n = 25, BC; Ontario (ON); Saskatchewan (SK)). In addition, 10 HCV treatment providers were interviewed (n = 4 BC, n = 4 ON, n = 2 SK). Interpretive description identified themes to inform clinical approaches and public health HCV care. Themes and related recommendations were validated by Indigenous health experts and Indigenous participants prior to coding and re-contextualization. RESULTS Taken together, participants' stories and perceptions were interpreted to coalesce into three overarching and interdependent themes representing their recommendations. First: treatment providers must understand and accept colonization as a determinant of health and wellness among HCV-affected Indigenous people, including ongoing cycles of child apprehension and discrimination within the healthcare system. Second: consistently safe attitudes and actions create trust within HCV treatment provider-patient relationships and open opportunities for engagement into care. Third: treatment providers who identify, build, and strengthen circles of care will have greater success engaging HCV-affected Indigenous people who have used drugs into care. CONCLUSION There are several pragmatic ways to integrate Truth and Reconciliation as well as Indigenous concepts of whole-person wellness into the HCV cascade of care. By doing so, HCV treatment providers have an opportunity to create greater equity and support long-term wellness of Indigenous patients.
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Affiliation(s)
- M E Pearce
- Canadian Institutes of Health Research, Canadian HIV Trials Network, 588-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; BC Children's Hospital Research Institute, 950 West 28th Avenue, Vancouver, BC V5Z 4H4, Canada.
| | - K Jongbloed
- BC Children's Hospital Research Institute, 950 West 28th Avenue, Vancouver, BC V5Z 4H4, Canada; University of British Columbia, School of Population and Public Health, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada
| | - L Demerais
- Cree/Métis, Vancouver Native Health Society, 449 East Hastings Street, Vancouver, BC V6A 1P5, Canada
| | - H MacDonald
- Mamoo Naakiiwin, P.O. Box #573, Matheson, ON P0K 1N0, Canada
| | - W M Christian
- Splatsin Secwepemc Nation, 5775 Old Vernon Rd, Enderby, BC V0E 1V3, Canada.
| | - R Sharma
- BC Children's Hospital Research Institute, 950 West 28th Avenue, Vancouver, BC V5Z 4H4, Canada; University of British Columbia, School of Population and Public Health, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada.
| | - N Pick
- Canadian Institutes of Health Research, Canadian HIV Trials Network, 588-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; University of British Columbia Faculty of Medicine, Division of Infectious Diseases, 2733 Heather Street, Vancouver, BC, V5Z 3J5, Canada.
| | - E M Yoshida
- University of British Columbia, School of Population and Public Health, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada; University of British Columbia Faculty of Medicine, Gastroenterology, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada.
| | - P M Spittal
- BC Children's Hospital Research Institute, 950 West 28th Avenue, Vancouver, BC V5Z 4H4, Canada; University of British Columbia, School of Population and Public Health, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada.
| | - M B Klein
- Canadian Institutes of Health Research, Canadian HIV Trials Network, 588-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Department of Medicine/Division of Infectious Diseases, McGill University Health Centre, 1001 Decarie Blvd, D02.4110, Montreal, QC, Canada.
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10
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Lakhan P, Askew D, Hayman N, Pokino LA, Sendall C, Clark PJ. Optimising Hepatitis C care in an urban Aboriginal and Torres Strait Islander primary health care clinic. Aust N Z J Public Health 2019; 43:228-235. [PMID: 30908846 DOI: 10.1111/1753-6405.12888] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Revised: 02/01/2018] [Accepted: 02/01/2019] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE Describe the sociodemographic and clinical characteristics of patients with Hepatitis C Virus (HCV) attending an urban Indigenous primary health clinic (IPHC) in Brisbane, Australia. METHODS A retrospective chart review of sociodemographic characteristics, presence of liver disease and treatments, lifestyle behaviours and comorbidities in patients with a HCV infection was conducted between October 2015 and March 2016. RESULTS One hundred and thirteen patients with confirmed HCV infection were aged between seven and 63 years; 66% were male, and 84% were Indigenous. Sixty-nine per cent had been incarcerated; 41% had experienced conflict or domestic violence; 47% were injecting drugs; 72% had depression; and 61% had anxiety. Cirrhosis was present in 7/95 patients with adequate data and associated with age (p=0.02). Eleven patients had commenced direct acting antiviral (DAA) therapy in the 18 months that it had been available. CONCLUSIONS The study highlights the opportunities for enhancing treatment of patients with HCV infection. Opportunities to improve treatment rates in an Indigenous primary healthcare include optimising diagnostic pathways, improving patient engagement, and general practitioner and peer worker participation. Implications for public health: HCV poses a serious threat to public health in Australia and IPHCs are key sites to addressing this for Indigenous people. Optimising care of patients with HCV attending IPHC requires recognition of the complex health needs and social context, to reduce the incidence and consequences of HCV infection.
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Affiliation(s)
- Prabha Lakhan
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland
| | - Deborah Askew
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland.,The University of Queensland, Primary Care Clinical Unit, Royal Brisbane and Women's Hospital, Queensland
| | - Noel Hayman
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland
| | - Leigh-Anne Pokino
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland
| | - Cheryl Sendall
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland
| | - Paul J Clark
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland.,Faculty of Medicine, The University of Queensland.,Department of Gastroenterology, The Princess Alexandra and Mater Hospitals, Queensland
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