Types of organizations with integrated models across Canada
In Canada, there is no one model of program integration in hepatitis C. The range of organizations and services available and the way in which hepatitis C services are provided differs across and even within provinces and territories.
Some regions, mainly low-density areas, do not have differentiated hepatitis C services. To a large extent services are already “integrated” in these regions; the challenge is to build the capacity of existing services to include hepatitis C. In other regions, mainly high-density areas, services are differentiated and the challenge is integration. Insome places, clients may have to migrate to another province or territory to receive care and support.
There is an even greater variation in models serving Indigenous populations because of complex jurisdictional landscape issues and inconsistencies in terms of policies and self-government agreements across the country.
Integrated models of care are being created/adapted by various types of organizations in a range of settings
A number of community health centres (where clinical and community services are coordinated and housed together) have integrated hepatitis C into their core work with specific populations. Many of these community health centres serve high-need marginalized communities and provide a comprehensive range of primary care services including access to a multidisciplinary hepatitis C team. Examples of community health centres that have integrated hepatitis C into their core work include: South Riverdale Community Health Centre in Toronto; Calgary Urban Project Society in Calgary; and Vancouver Coastal Health’s Pender Clinic.
A number of AIDS service organizations have expanded their focus beyond HIV in response to the changing needs of their client base. This pattern is particularly relevant to AIDS service organizations that serve communities where drug use and co-infection with HIV and hepatitis C are prevalent, including Centre Sida Amitié in St-Jérôme, Quebec; Elevate Northwestern Ontario (formerly AIDS Thunder Bay); Nine Circles Community Health Centre in Winnipeg; and ASK Wellness Centre in Kamloops, British Columbia.
In some regions, public health agencies are taking the lead with integrated hepatitis C programming. The Yukon is an example of a low-density region using a fully integrated hepatitis C testing, treatment, care and support model that is centralized within public health. The hepatitis C program is embedded within the larger program for sexually transmitted and blood-borne infections. Hepatitis C testing, treatment and care are fully integrated into public health. A public health nurse works with a specialist to ensure that all people who are tested are connected to treatment and care.
Some hepatitis C clinical programs have developed integrated program models to work more effectively with clients who face barriers to care, including the telemedicine program at the Ottawa Hospital and Sanguen Health Centre in Guelph and Waterloo, Ontario.
There are a number of Indigenous-led models both on- and off-Reserve, including models under the jurisdiction of Indigenous health authorities, including Ahtahkakoop Health Centre on a Reserve in Saskatchewan.
There are organizations and integrated models operated by and for people who use injection drugs, as well as organizations and programs led by people with lived experience of hepatitis C. For example, L’Association pour la Defense des Droits et l’Inclusion des Personnes qui Consomment des Drogues Quebec (ADDICQ) is a peer-driven provincial network of people who use drugs in Quebec advocating for improved health services, including hepatitis C services.
Many of these integrated hepatitis C programs are nurse-led. A lead nurse works to connect clients with a range of primary and specialty care services along the continuum of care and develops programming based on the needs of clients. Nurse-led integrated hepatitis C programs include The Hepatitis C Program at Pender Community Health Centre in Vancouver and The Hepatitis C Education and Support Program run out of the North End Community Health Centre in Halifax.
Although the deliberative dialogue did not include specific focus on prison-related programming, there are some hepatitis C programs inside federal and provincial prisons and for people who have been released.[fn]Betteridge G, Dias G. Hard times: HIV and hepatitis C prevention programming for prisoners in Canada. Canadian HIV/AIDS Legal Network and Prisoners’ HIV/AIDS Support Action Network (PASAN.) 2007. Available from: http://library.catie.ca/PDF/P47/24875.pdf[/fn]Peer health groups operated by people who are incarcerated are offering hepatitis C education and connecting people with health services. Some public health institutions, community health centres, AIDS service organizations, Indigenous organizations and prisoner justice organizations are also providing hepatitis C programs inside prisons.[fn]Ibid[/fn]
Settlement centres, newcomer organizations, community centres and community development organizations are beginning to engage in hepatitis C awareness-raising activities and are starting to incorporate hepatitis C initiatives into their work.