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New study looks at how to eliminate hepatitis C in First Nations communities

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A new study has identified gaps in the testing and treatment of hepatitis C among First Nations communities in Ontario, highlighting where to direct efforts to eliminate the viral infection that can cause serious liver damage.

The study, published in the CMAJ on Tuesday, provides clarity about the extent to which First Nations communities in the province are affected by hepatitis C, and informs further steps that are needed to address high rates of infection, said co-author Lyndia Jones, a member of the Health Canada-funded Ontario First Nations HIV/AIDS Education Circle (OFNHAEC). Her group supports those with HIV/AIDS and other blood-borne and sexually transmitted infections.

“This has been really helpful for our Circle because this is the first time we’ve actually had some data and some research to validate the work that we need to do in educating our communities and providing harm-reduction tools and resources,” Ms. Jones said.

Hepatitis C, which is spread through contaminated blood, is a major public-health problem globally, according to senior author Jordan Feld, the interim director of the Toronto Centre for Liver Disease at Toronto General Hospital. Viral hepatitis, of which hepatitis C is one type, causes more deaths per year than HIV, tuberculosis or malaria, he said.

However, owing to advances over the past decade, highly effective treatments are now available with cure rates of more than 95 per cent, Dr. Feld said. The two major treatments used involve either taking one pill a day for three months, or three pills a day for two months, and have very few to no side effects.

In light of these advances, the World Health Organization in 2016 called on countries to commit to a goal of eliminating viral hepatitis as a major public-health threat by 2030. To achieve that goal in Canada, the Canadian Network on Hepatitis C identified First Nations, Inuit and Métis populations as a priority focus.

But until now, there has been little research into the gaps faced by First Nations people accessing care for hepatitis C, said first author Andrew Mendlowitz, a postdoctoral fellow at the Toronto Centre for Liver Disease/Viral Hepatitis Care Network and a postdoctoral trainee at ICES (formerly known as the Institute for Clinical Evaluative Sciences).

The study, conducted through a partnership between OFNHAEC, academic researchers and ICES, examined administrative health data on status First Nations people in Ontario who had tested positive for hepatitis C virus antibodies, between 1999 and 2018. The researchers looked at the various steps, from testing to treatment of the disease, called the “cascade of care,” to identify where there were areas for improvement, as well as where progress had been made, in care over time.

Mr. Mendlowitz said the researchers did see some success; testing and linking patients to treatment increased between 2013 and 2018.

But they also found some gaps in the cascade of care.

At the end of the study period, they found 4,962 people who were alive and had tested positive for the virus. Of those, 17 per cent did not receive a follow-up RNA test to determine whether they had an active infection. And close to 60 per cent who did have a positive RNA test did not begin treatment.

Ms. Jones said First Nations peoples are disproportionately affected by hepatitis C as a result of generations of trauma, from being displaced and put on reserves, to the experience of residential schools and the Sixties Scoop. These and other issues arising from the effects of colonialism have led to mental-health problems and substance use.

Ms. Jones said a lack of access to travel to receive care may be a contributor to the gaps in care they identified, as well as a lack of education and awareness, and fear and stigma tied to the virus. The fact that some patients started treatment but never returned for a follow-up suggests they may have encountered racism and did not feel culturally safe in the health care system, she added.

A harm-reduction approach, which includes providing clean needles, is important, as is the need to continue work to spread the message that help is available for hepatitis C, she said. “There is support and there’s treatment out there.”

 

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How many Nova Scotians are on the doctor wait-list? Number hit 160,000 in June

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September 11, 2024

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HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.

The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.

Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.

“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”

The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.

A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.

Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.

“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.

Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.

The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.

“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.

This report by The Canadian Press was first published Sept. 11, 2024.

The Canadian Press. All rights reserved.

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Newfoundland and Labrador monitoring rise in whooping cough cases: medical officer

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September 10, 2024

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ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.

Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.

Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.

Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.

The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.

“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.

Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.

Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.

Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.

A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.

This report by The Canadian Press was first published Sept. 10, 2024.

The Canadian Press. All rights reserved.

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Bizarre Sunlight Loophole Melts Belly Fat Fast!

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3 days ago

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September 10, 2024

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