Advancing health equity in marginalized populations with or at risk for hepatitis C. Decreasing barriers to comprehensive health care here at RECAP in Saint John, New Brunswick.ResearchA nurse practitioner led interdisciplinary clinic focused on filling the gap in the preventative and chronic healthcare needs of at-risk populations for opiate addiction, and hepatitis C.
Disclaimer
The information presented here represents as accurate a picture of known HCV cases in southern New Brunswick as possible based on available medical records and testing. It is likely that HCV viremic prevalence is higher as we know there are a number of individuals who are likely infected but have not been tested. Similarly, information on high risk activities are extracted from available drug screens, accessible medical records, and review of reasons for ER visits/admissions. The purpose of these numbers is to guide those working with individuals working with people living with or at risk for HCV to understand where progress is most likely being made and where limited resources can be best targeted to improve progress toward elimination.
Definitions
- Active case (also referred to as a viremic case) - this refers to an individual with HCV who has not been successfully treated or cleared the virus on their own. Once an individual tests positive for HCV, they will always be HCV antibody positive on testing going forward, but an active case is one where the individual still shows evidence on blood tests that active virus is present and therefore continues to impact the liver health of the individual as well as pose a risk of possible transmission of HCV to others.
- Connected to care - refers to an individual with active HCV who is currently (within the previous 6 months) connected and working with a provider / clinic toward curing them of the virus.
- Cured - this refers to an individual who was an active case who underwent treatment for HCV and whose blood tests at least 12 weeks post-treatment did not show any evidence of active virus.
- High risk activities - For the purpose of this review, high risk activities refers to injecting and/or snorting drugs and sharing drug use equipment used for injecting and/or snorting drugs. It may also refer to tattoos/piercings done in non-sterile environments (i.e., at home, by a friend, or in jail).
- Re-infection - Refers to an individual who either was previously cured of HCV through treatment or who spontaneously cleared the virus who develop a new active viral load indicating they likely acquired the virus again through high risk activities.
- Spontaneous clearance - Some individuals are able to clear active HCV on their own without treatment. These cases are referred to as having spontaneously cleared HCV.
Technical Notes
Prevalence was calculated using the Statistics Canada 2016 census population numbers for Health Zone 2 as (# of active cases / total population of Zone 2)*100
Review and report conducted by Stefanie Materniak, Research Manager at RECAP and the Infectious Disease Research Unit, for questions regarding the data, please feel free to contact stefaniematerniak@recapsj.ca
EducationBringing together a specialized group of individuals to target research in areas most needed to benefit this marginalized population, their families and communities in the short and long term.
Treating the whole person, with a community focus.
The Centre for Research, Education & Clinical Care of At-Risk Populations aims to provide access to screening, treatment and prevention for populations at risk for hepatitis C and associated communicable diseases.
RECAP’s mission will be accomplished by through the following three pillars:
1) Research – Maintain research through clinical trials, program evaluation and epidemiological studies.
2) Education – Serve as an educational resource and model of care for learners and community.
3) Clinical Care – deliver innovative, specialized, holistic and collaborative clinical care to the individual, family and community.
Educating patients to help them better understand how to help themselves. Educating healthcare students and professionals on the specialized needs of marginalized populations and how to care for them.
Progress Report on Hepatitis C Elimination in southern New Brunswick
It seems logical that if your goal is to eliminate a disease, you need to know the who and where of the hepatitis C cases you are hoping to eventually bring as close as possible to 0. Most estimates of prevalence are obtained through mathematical modelling and while useful, they do not give a full picture of the real people who contribute to this prevalence number.
RECAP's vision is a 'Health Equitable World without Hepatitis C' - a cornerstone piece of achieving that goal is regular evaluation of what is happening on the ground and obtaining as detailed as possible an understanding of where we are succeeding, where we need more work, and where there are issues or concerns are that we may not have anticipated on the road to HCV elimination. Working with Public Health and in collaboration with the Infectious Disease Research Unit within Horizon Health Network, in June 2019 we embarked on the cornerstone of our goal to eliminate HCV from our community. June 2022 marked the fifth review of our progress which we are pleased to present here. To the staff of RECAP and all those who work at treating and managing individuals living with or at risk for hepatitis C - despite a global pandemic - congratulations!. We are moving in the right direction with a 26.5% decrease in our prevalence of chronic HCV infection between June 2019 and June 2022.
See below the slide show for some technical notes/definitions as well as a link to a PDF version of the report.
Clinical Care