Introduction
The burden of hepatitis C is carried by populations that are underserved by mainstream health services, including people who use injection drugs, people who are in prison, Indigenous populations, street-involved youth, HIV positive men who have sex with men, and immigrants and newcomers. Adults born between 1945 and 1975 have a higher prevalence of chronic hepatitis C than any other age cohort and many of them are also managing co-morbidities and issues related to aging.1 Integrated hepatitis C models have been designed to create more accessible and appropriate services for vulnerable and underserved populations. These models link and provide seamless transition between the various health services to prevent hepatitis C transmission and to test, treat and support individuals who have or are at risk of contracting hepatitis C.
CATIE hosted a National Deliberative Dialogue on Integrated Hepatitis C Programming and Services to identify how integrated models are responding to the unique needs of service users and to identify key factors for success. While program integration in itself goes a long way toward creating more accessible and appropriate services for underserved populations, additional health equity approaches designed to address barriers to care and the social determinants of health are also needed. This report is a thematic synthesis of the key areas discussed, including factors for success and recommendations at the programming, organizational and structural levels. Recommendations for specific populations are discussed throughout the report and summarized in Population-specific priority directions.
This report highlights how integrated hepatitis C programs are being designed and delivered and identifies the factors that are essential for responsive and good practice in hepatitis C services. The key concepts box below details terms that are core to all of the hepatitis C models discussed.
Key concepts
Health equity
Health equity refers to the achievement of equal opportunities for good health for all. Health inequities are health differences between population groups that are systemic, avoidable and unfair. Evidence shows that people from certain population groups experience disparities in their health status, access to services and the quality of care they receive. Factors such as gender identity, race, sexual orientation, immigration status, income and education influence a person’s access to timely, appropriate and high-quality care. Health disparities across population groups are the results of individual, structural, and systemic oppression of these groups by society. In order to achieve health equity, healthcare approaches must acknowledge this oppression and work to address these social ills.
Social determinants of health
The social determinants of health are the social and economic conditions that influence the health of individuals, communities and jurisdictions. An individual’s biological make-up, medical treatments and/or lifestyle choices are not the only factors that shape their health outcomes. Social and economic factors such as having a livable income, stable and safe housing, healthy food, cultural connections, and a personal sense of belonging that includes meaningful engagement in society also play a powerful role in shaping one’s ability to stay healthy. Social determinants of health can also affect one’s ability to access the healthcare system or to receive good treatment once in care.
Priority populations and hepatitis C infection in Canada
Hepatitis C disproportionately affects particular populations in Canada, namely: people who use injection drugs, people who are in prison, Indigenous peoples,2 street-involved youth, immigrants and newcomers to Canada from high-prevalence countries, older adults3, and HIV-positive men who have sex with men. There is overlap among many of these populations.
It is important to understand why particular groups have a high prevalence or high incidence of infection because this informs the development of prevention, testing, treatment and care strategies tailored to the needs of these populations.1. Challacombe, L.The Epidemiology of Hepatitis C in Canada, CATIE Fact Sheets, 2015, available from: http://www.catie.ca/en/fact-sheets/epidemiology/epidemiology-hepatitis-c-canada
2. Indigenous is used herein as an inclusive term for individuals and communities including First Nations, Inuit and Métis.
3. The term older adults is used to represent the age cohort born between 1945 and 1975.