Liver Health Event: De-Stigmatizing Hepatitis C To Enhance Screening And Linkage To Care In Indigenous Communities

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

Theme: Models of Care Year: 2018

Background: In Ahtahkakoop Cree Nation an Indigenous community (Saskatchewan, Canada), approximately 200 individuals (~12% prevalence) are hepatitis C (HCV) antibody positive. Retrospective review (2017) indicated that majority lacked confirmatory testing and only few received HCV treatment. Following consultation with community members, Elders and individuals with lived experienced, Ahtahkakoop leadership proposed development of a community-based program for screening and treatment. Approach: A team of ten community members, healthcare professionals and consultants developed a screening pathway referred to as Liver Health Event (LHE), to process 60 patients in 300 minutes maximizing efficiency. The event ran quarterly to reach known HCV diagnosed clients not engaged in treatment, high risk behaviors, born between 1945–1975, known HIV diagnosis and open to any community member interested in liver health. The screening pathway involves 6 stations namely registration and education, blood pressure, weight and spot blood sugar, point of care testing, phlebotomy, immunizations and fibro scanning. A floating case manager guides clients to appropriate stations reducing wait times and arranges follow-up. Broad education on liver disease, the provision of food and door prizes encourages screening uptake while reducing stigma and creating a supportive and safe space. Individuals with lived experience are actively involved with program goals and program promotion at the peer-to-peer level. Outcome: Six LHE were delivered, 283 were screened (~16% of the population), 51 had injection drug use history, of which 20 currently injecting, 49 HCV positive individuals linked to care, 4 new positives. Conclusion: Community led HCV events can de-stigmatize HCV, increase HCV testing and linkage to care, and provide foundation to address other liver conditions in Indigenous communities amongst individuals actively using substance. Community consultation and leadership support is crucial for programming success. Future efforts will be directed toward developing a plan to prevent reinfection and reduce new infections.

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