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.
Highlights
170 million people worldwide are chronically infected with hepatitis C virus (HCV) [1,2,3,4,5,6]
A partnership has been established between public health, First Nations (FNs) communities, FNs leaders, labs and clinical providers to bring testing and care directly to remote FNs communities through the use of mobile hepatitis C clinics, which brings testing, education, fibroscans and Direct Acting Agents (DAA) treatment directly to the Saskatchewan FNs communities
There are multiple factors associated with the high rates of HCV in FNs communities, including barriers to access preventive services, early diagnosis and treatment
Summary
170 million people worldwide are chronically infected with hepatitis C virus (HCV) [1,2,3,4,5,6]. Awareness and expertise developed locally has allowed communities to take ownership of this comprehensive approach to HCV infection, its underlying risk factors and the health of their members by providing culturally-sensitive and accessible care in a team-based model. They have attracted the interest of FNs people affected with HCV but have improved treatment uptake, health outcomes and adherence rates The number of these mobile clinics is increasing as more FNs communities take ownership and leadership in the prevention programs. While offering community-based services for HCV infection, awareness of factors that promote resilience and addressing determinants of health such as intergenerational trauma from a history of colonization and residential schools, racism, overcrowding, education and literacy, social exclusion and gender inequality, could help FNs people access to health care services [16,17]. A partnership has been established between public health, FNs communities, FNs leaders, labs and clinical providers to bring testing and care directly to remote FNs communities through the use of mobile hepatitis C clinics, which brings testing, education, fibroscans and DAA treatment directly to the Saskatchewan FNs communities
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