Windows of Opportunity: Integrated Hepatitis C Programming Approaches for Priority Populations

 

Dialogue objectives, process and method of analysis

CATIE organized a national knowledge exchange meeting on February 11–12, 2015, to tackle some of the challenges raised by the changing hepatitis C landscape and to discuss how integrated hepatitis C approaches can be designed to be comprehensive and service user centred. The current state of hepatitis C services and the context of the deliberative dialogue are described in a CATIE backgrounder report.1

The dialogue was designed to bring together people working on the ‘frontlines’ of the response to hepatitis C to discuss good practices in program development and to identify key factors for success that could inform further program development across Canada. Innovative programs around the country are providing hepatitis C services for priority populations across the continuum of care.   In order to replicate, adapt and scale up these programs, the dialogue aimed to uncover essential learning from these programs as well as explore critical next steps in the development of a broad and effective national response.

Objectives

The deliberative dialogue had four primary objectives:

  • to inform priority directions for population-specific hepatitis C programming, services and policy that put service users at the centre of an integrated framework;
  • to provide guidance to new programs across Canada on hepatitis C continuum of care models for specific populations;
  • to facilitate multi-region, cross-sectoral collaboration, knowledge sharing and networking among hepatitis C programming leaders; and
  • to inform a national strategic directions document.

The dialogue focused on hepatitis C continuum of care models and the patient journey through a health equity lens. In particular, the focus was on integrated hepatitis C programming models for priority populations facing the most inequitable risks and burden of ill health related to hepatitis C. Four priority populations were chosen as the focus of discussion: Indigenous peoples, people who use injection drugs, immigrants and newcomers, and older adults.

Dialogue participants discussed challenges and lessons learned from frontline efforts.  The goal was to identify key factors for success in existing integrated programming models in order to determine promising directions in hepatitis C programming, policy and knowledge exchange.

Process

Several strategies were used to help ensure the event was successful:

  1. The process: Direction and engagement
  2. The process: Ensuring an inclusive dialogue
  3. The process: Ensuring a common understanding
  4. The deliberative dialogue agenda and structure: Going from a point of view to a view of points

Before the dialogue, CATIE used a variety of methods to ensure there was extensive input into the development of the event and to enhance engagement at the event. CATIE also worked closely with five population-specific experts to develop overview presentations that summarized key challenges faced by the priority populations. CATIE wanted to ensure that the dialogue was inclusive and that it would facilitate reflection and recognition of multiple perspectives on integrated programming models. With these goals in mind, individuals were selected to attend on the basis of their expertise and experience developing and implementing innovative integrated programming for diverse populations across Canada. The participant selection process was also meant to ensure regional diversity and representation from a range of people involved in the response to hepatitis C, including frontline workers, public health workers, researchers, policy makers and people living with and affected by hepatitis C. CATIE also sought to ensure that there was a balance in the number of participants working with each of the priority populations.2

The final agenda was structured to maximize facilitated discussion among participants (Appendix II) so that they could share experiences, insights, concerns and challenges, and so that they could identify overall national and/or population-level directives to move integrated hepatitis C continuum of care models forward regionally. Participants were provided with various reading materials, including a backgrounder developed by CATIE and six prerecorded online presentations by external experts (Appendix III, list of pre-dialogue materials) to ensure participants attended the meeting with a common understanding of the rapidly changing hepatitis C landscape and of integrated programming.

The meeting started with an overview presentation on the hepatitis C continuum of care, followed by short presentations on various integrated hepatitis C models from across the country. The presentations were followed by a large group discussion about similarities and differences between the various models.

The second day focused on population-level discussions. It started with five population-level presentations that summarized how hepatitis C affects each of the priority populations and identified challenges in programming. The rest of the day consisted of small and large group facilitated population-level discussions to identify population-specific priority directions.

Method of analysis

Notes and recordings from the deliberative dialogue were analyzed to identify common factors that contributed to the success of the various models and population-specific programs presented. Notes and recordings from the population-specific strategy discussions were organized and summarized to identify population-specific priority directions.

  • 1. CATIE. Backgrounder: Context for CATIE’s National Deliberative Dialogue on Integrated Hepatitis C Programming and Services. January 2015.
  • 2. There were 42 participants who were not CATIE employees, including eight from Ontario, four from Quebec, eight from British Columbia, six from the Prairies, five from the Atlantic region, two from the territories, eight national representatives and one international speaker from the U.S (Appendix I, List of meeting participants and advisors).