Populations Disproportionately Affected by Hepatitis C

Marginalized

There are 250,000 Canadians infected with HCV and of those 18% are estimated to be co-infected with HIV[1]. In Canada, the highest rates of hepatitis C are in marginalized populations such as Aboriginal, immigrant and injection drug user populations [2, 3]. Populations with HCV are vulnerable to other STBBIs, tuberculosis, addictions and mental health issues due to common risk factors and inequities in the social determinants of health[4]. Vulnerable populations have less access to education and care so they are hard to reach, engage and retain in care [5]. This project encourages vulnerable populations to engage in care beyond acute episodic encounters.

Immigrants

Canada’s foreign born population represents over 20% of the HCV population, the majority of which come from countries with high rates of HCV and HBV such as Asia (including the Middle East and Iran), Africa, the Caribbean and South America [6]. Immigrant populations require targeted efforts because their knowledge about HCV is low and they are among those least likely to seek HCV care or have a family doctor [7]. Engaging these populations is challenging as they often have a complicated past that includes misunderstanding and mistrust of service provides. Using the network member links into immigrant communities will enable communication that is built around trusting relationships.

Baby boomers

Although they are less likely to be marginalized baby boomers is a high priority, need-to-reach group. According to US data, baby boomers are 5 times more likely to have HCV and 3 out of 4 people are unaware of their infection [8]. Corresponding data is lacking for Canada but have been shown to be similar in BC [9].  In a 2012 Canadian survey, baby boomers knew the least about HCV and were less likely than younger age groups to have been tested [10].  Yet, as a group, baby boomers are at a stage where preventing the effects of chronic illnesses like HCV is of greater importance. Many are experienced computer users and have a level of education that requires detailed or comprehensive health information for use in making self-management decisions. [9]

References

    1. Amin, J., et al., HIV and hepatitis C coinfection within the CAESAR study. HIV Medicine, 2004. 5(3): p. 174-179.
    2. Minuk, G.Y., et al., Viral hepatitis in a Canadian First Nations community. Canadian Journal of Gastroenterology, 2003. 17(10): p. 593-596.
    3. Roy, K., et al., Monitoring hepatitis C virus infection among injecting drug users in the European Union: A review of the literature. Epidemiology and Infection, 2002. 129: p. 577-585.
    4. Wilson, M., et al. (2009) Treatment, care and support for people co-infected with HIV and hepatitis C: a scoping review. . Open Med Volume, e184-95
    5. Patrick, D.M., et al., Public health and hepatitis C. Canadian Journal of Public Health, 2000. 91(Suppl 1): p. S18-S21.
    6. Remis, R., Modelling the incidence and prevalence of hepatitis C infection and its sequelae in Canada. Final Report. 2007, Public Health Agency of Canada: Ottawa.
    7. The Canadian Liver Foundation, Liver Disease in Canada. A Crisis in the Making. 2013: Markham, Ontario. p. 1-70.
    8. Smith, B.D., et al., Recommendations for the identification of chronic hepatitis C virus infection among persons born during 1945-1965. MMWR Recommendations and Reports, 2012. 61: p. 1-32.
    9. Krajden, M., et al. Cost implications of one-time HCV screening of the 1945 to 1965 birth cohort in British Columbia. in CDDW/Annual CASL Winter Meeting. 2013. Victoria, British Columbia.
    10. Ipsos Reid. Hepatitis C: Knowledge and Perceptions among General Population and GPs.  2012  [cited October 4 2013]; Available from: http://ipsos-na.com/news-polls/pressrelease.aspx?id=5977.

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