Research paperBeyond viral response: A prospective evaluation of a community-based, multi-disciplinary, peer-driven model of HCV treatment and support
Section snippets
Background
Hepatitis C (HCV) is one of the world's most common chronic viral infections, infecting an estimated 170 million individuals worldwide (World Health Organization [WHO], 1998). In Canada, estimated seroprevalence rates are 0.8%, with 4000–6000 new cases occurring each year (Remis et al., 1998, Zou et al., 2000). Although the majority of new cases of HCV occur among people who inject drugs, most illicit drug users are not treated despite the fact that effective therapies exist. Studies in both
Program model
The Toronto Community Hep C Program (TCHCP) is a partnership between three community-based primary health care centres with integrated specialist support from nearby hospitals. The aim of the program, which began in 2007, is to provide low-barrier HCV treatment and support to people who use illicit drugs and/or have mental health issues. In addition to HCV care and treatment, the program offers comprehensive social, emotional and practical supports. The program is anchored by a weekly
Results
A total of 84 individuals were approached to participate in the study, of which six were excluded (two due to negative HCV RNA, one due to language limitations and three who refused to participate). Data was available for 78 individuals at baseline. Post-group (week 16–18) interviews were completed with 75 (96%) participants and 58 (74%) participants at 1-year post-group. Thirty-one individuals were still receiving support from the program at this latter time period. There were three known
Discussion
This study demonstrated that a multidisciplinary, community-based model of HCV treatment can improve access to care for clients with multiple health and social challenges with impacts beyond HCV including significant improvements to key social determinants of health in terms of housing and income.
Participants served by the TCHCP in this study were highly marginalized. The majority of participants reported very low income and education levels, histories of trauma and incarceration. Current
Conclusions
The Toronto Community Hep C Program successfully provides HCV care and support to highly marginalized individuals who would be unlikely to receive treatment elsewhere. Our study shows that community-based, multidisciplinary, harm reduction models of HCV care driven by peer engagement and group support, can lead to improved access to HCV treatment with benefits that extend beyond HCV to key social determinants of health. Even as treatment regimens for Hepatitis C become shorter and easier to
Conflict of interest statement
None declared.
Acknowledgements
The authors acknowledge the support of Regent Park Community Health Centre, South Riverdale Community Health Centre, Sherbourne Health Centre, the Toronto Community Hep C Program Staff and Patient Advisory Board. This study was supported by funding from the Ontario Ministry of Health and Long Term Care, Hepatitis C Secretariat. The authors would also like to thank all of the Toronto Community Hep C Program clients who participated in this study. The views expressed in this paper are those
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