By Cheryl Reitz
The March 6th BCCDC presentation in Prince George was a long-awaited experience for HepCBC! Several of us had been very interested when the BC Centre for Disease Control presented its research into the hepatitis C Cascade of Care in BC. Using their agency’s huge database, researchers showed that of the 73,320 British Columbians who contracted or were diagnosed with hepatitis C in the 20 years between 1992 and 2012, approximately 25% had cleared spontaneously, and 7% had been cured with the treatments available during that time spanning treatment with interferon-only, then interferon plus ribavirin, through the very beginnings of the DAA [direct-acting antiviral] treatments of today). In 2012 hundreds – perhaps thousands – of HCV+ British Columbians were being ‘warehoused’ – avoiding treatment simply because they knew much more effective treatment with few if any side-effects would soon be available to them. It will be incredibly interesting to see how BC’s Cascade of Care changed during the period 2012 through the present, and into the future!
Because of HepCBC’s great concern with monitoring and advocating for HCV treatment equity between BC’s rural/remote/northern (and largely Aboriginal) populations and those living in urban areas, we asked Dr. Naveed Janjua of the BCCDC if his group could divide the BC HCV Cascade of Care into urban and rural components so we could compare patient experiences between the two groups. He agreed that this would be a useful computation; he and Núria Chapinal, PhD (Epidemiologist, Clinical Prevention Services) took it on and Dr. Chapinal prepared a Powerpoint presentation to make public during HepCBC’s visit in Prince George Monday, March 6th. Vanessa West, ED of Positive Living North (PLN) in Prince George and PLN’s HIV/hepatitis C educator Orlando McLeish agreed to open PLN’s large classroom up to the public and to HepCBC while we “beamed in” the BCCDC presentation by Dr. Chapinal over the Internet on our webinar software.
The BC Centre for Disease Control presented a new study on hepatitis C Monday
– photo 250News
As the audience started arriving, the excitement and curiosity in the room were palpable. What had Dr. Chapinal found? Several nurses, a pharmacist, a social worker, a few community members, two HepCBC volunteers (Laurel Gloslee and Cheryl Reitz), several Positive Living North staff and volunteers, and three members of the local press were among the 20 or so people attending in person. Dr. Chapinal, Dr. Alexandra King (Aboriginal physician now based at Lu’ma Aboriginal Medical Clinic in Vancouver), and HepCBC’s Rosemary Plummer, RN attended remotely.
Interestingly, the differences found by Dr. Chapinal were minimal. The only significant finding was that only 6% of those with hepatitis C in rural areas had been successfully cured, compared to 8% of those in urban areas. Dr. Chapinal pointed out that this 25% difference (6% vs. 8%) based on where people live was not as great as that found when comparing the % successfully cured based on socio-economic status. The audience, having expected to hear that differences in rural vs. urban HCV treatment and care were substantial, was pretty shocked at this conclusion.
What followed was a very animated discussion on the parameters used in the study to distinguish between urban and rural (rural was defined as residing in a community of 20,000 inhabitants or less). We also discussed the lack of population-level data: Since more people with hepatitis C will be found in areas such as cities, in which testing is more widely available, urban areas would presumably have a lower % of undiagnosed individuals than rural areas. This would likely skew the rural data so that the % of people with HCV who were cured would appear higher than it actually is. Dr. King and others stressed the need to do a further study comparing BC’s HCV Cascade of Care for Aboriginal vs. non-Aboriginal populations. We also discussed the possibility of comparing rural vs. remote populations; Dr. Chapinal warned that the sample-size of HCV+ people in remote areas would probably be too small to show significant results.
The audience pointed out how people in rural, remote, northern, and largely-Aboriginal communities are disproportionately affected by limited financial resources, lack of education and/or employment opportunities, significantly increased distance from healthcare, addiction, homelessness, and a medical system which took longer to establish modern practices of universal precautions there than in the cities. On top of this, Aboriginal residents have also experienced racism, colonization (including residential schools and Sixties Scoop), and disproportionate levels of incarceration. All of these could result in a higher % of hepatitis C at the population level in the rural/remote/northern/Aboriginal areas, but we cannot confirm this without testing at a population level rather than using the current risk-based testing model.
HepCBC hopes a mutually-beneficial research partnership will be forged between the BCCDC and local residents who share the common goal of eliminating hepatitis C from our province, even in our most remote and hidden communities. Next step: Keep asking questions and let’s all stay in touch!
- HepCBC’s press release: http://hepcbc.ca/2017/03/03/centre-disease-control-releasing-report-hepatitis-c-care-ruralremote-british-columbia/ ,
- The Urban vs Rural Treatment Disparities in BC Webinar: https://www.youtube.com/watch?v=jMd9GtAjveY
- News Coverage: BC Centre for Disease Control releases massive report on Hepatitis C
- BCCDC Cascade of Care site: http://www.ebiomedicine.com/article/S2352-3964(16)30390-5/fulltext