An Adaptive Approach and Community-Led Model to Enable Access to Treatment and Cure Hepatitis C in Rural and Indigenous Communities for People Who Inject Drugs in Saskatchewan, Canada

Author: Stuart Skinner Stephanie Konrad Mamata Pandey

Theme: Models of Care Year: 2022

Background: In Saskatchewan, half the population live outside urban centers dispersed over 651,900
km2. Saskatchewan’s Hepatitis C (HCV) rates (2019) are among the highest in Canada, with most
infections related to injection drug use (IDU). In 2019, rates among Saskatchewan First Nation
communities were fives times the Canadian rate. Rural First Nations are a hard-to-reach population
facing additional barriers to accessing HCV treatment, including transportation, communication, and
discrimination. In partnership with Indigenous communities, the Wellness Wheel utilizes an adaptive
approach to address challenges to HCV care for rural residents and Indigenous communities.
Model Description: With approval from communities’ Chief and Council, HCV care models were
developed and delivered with the support of outreach and virtual Wellness Wheel medical clinics (via an
urban clinical team) in collaboration with individual community healthcare teams. Each model fit the
existing community resources, strengths, and capacities, providing a low-barrier, de-stigmatized and
client-centered care. One model offered treatment in conjunction with a community Suboxone program
reaching those with a history of or active IDU. Another model utilized a community-developed HCV
screening pathway to screen, diagnose and expedite linkage to HCV treatment and case management. A
third model delivered care in a nearby town to enable local access to care and services for residents in
neighbouring Indigenous communities, eliminating travel and healthcare navigation challenges.
Effectiveness: See the HCV Cascade of care outcomes figure, as of October 2019.
Conclusions: HCV treatment access can be significantly improved for those with previous or active IDU
through tailored and accessible outreach care models adapted to complement community-specific
resources, capacities, needs and challenges. These type of adaptive outreach models can be expanded
to other rural and hard-to-reach populations. The results highlight the critical importance of community
partnership and healthcare flexibility to improve HCV treatment access and ultimately reach HCV
Disclosure of Interest Statement:
Stephanie Konrad and Mamata Pandey have not conflict of interest to disclose.

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