Community Led Hepatitis C Treatment Amongst People With Active Injection Drug Use In An Indigenous Community In Canada

Author: Reed N, Ahenakew V, Pandey M, Skinner S, Gallagher L , Despins R, Loutfy M

Theme: Models of Care Year: 2018

Background: Despite 12% prevalence of Hepatitis C (HCV) antibody, all related to injection drug use (IDU), few individuals accessed treatment in Ahtahkakoop Cree Nation, an Indigenous community (Saskatchewan, Canada). Following consultation with community members, Ahtahkakoop community leadership a HCV treatment model was developed to increase access to treatment even amongst those still actively injecting. Approach: This community led HCV treatment model involves intensive case management coordinated by a nurse and an outreach worker. Clients previously identified, or testing positive are assessed for treatment readiness. HCV viral load and genotype, liver testing and ultrasound are done. Treatment access is improved through in-community consultation with Infectious Disease specialists. Treatment, education and support are provided by a local pharmacist and dedicated community-based HCV nurse. Medications are delivered directly to patients in-community and directly observed therapy is implemented where appropriate. Client’s commitment to treatment and harm reduction is supported by the HCV treatment nurse. Clients are linked with a mental health and addiction counsellor and cultural resources as required. Cohort treatment is provided and each cohort forms their own peer support group that is coordinated by the outreach worker for on-treatment support. Outcome: Currently, 46 engaged in treatment, of which 20 were injection drug during treatment, 34 completed treatment, 14/14 cured and SVR 12 results are available, 9/14 cured are still injecting drugs. Conclusion: A community developed and led HCV treatment model, delivered in Indigenous community can improve access to HCV treatment, even amongst those individuals who are still injecting drugs. Client’s treatment engagement is enhanced through education, support and peer groups. A dedicated nurse and outreach worker is crucial for orchestrating a multidisciplinary healthcare team ensuring seamless and timely care. Moving forward the aim is to engage all positive clients, regardless of on-going injection drug use, to achieve HCV elimination.

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