Improving Access to Addiction Medical Services for Homeless Indigenous Peoples in Montreal: An Integrated Care Model Across a Community-Based Managed Alcohol Program and Hospital-Based Addiction Services

Author: Stephanie Marsan Barbara Kotsoros Dianna Marini Paula Ng

Theme: Models of Care Year: 2022

Many people within Montreal’s Indigenous community are affected by homelessness and
substance use, a situation explained in part by intergenerational trauma and the loss of cultural
identity as a result of being subject to abusive assimilation practices. These factors compound
existing barriers to accessing care and further compromise the health of community members
with complex health conditions.
Description of model of care/intervention:
Exacerbated by the decline in shelter capacity during the pandemic, Projets autochtones du
Québec (PAQ) identified an urgent need within the urban Indigenous community of Montreal to
develop a managed alcohol program (MAP) offering long-term housing and other
complementary services grounded in Indigenous cultures and values.
In partnership with the Centre hospitalier de l’Université de Montréal (CHUM)’s addiction
medicine service, which provides training and clinical services for the MAP, this integrated
model of care program aims to provide a safe space for 8 Indigenous men in a homeless
situation with severe alcohol use disorder. A medical evaluation is done before admission to the
program and screening for hepatitis C and other STBBIs is offered to each participant.
Between December 2020 and December 2021, 14 people were admitted to the MAP program
and screened for hepatitis C. Among them, 4 tested positive for the Hepatitis C antibody. There
were 2 people among the 4 with a positive HCV RNA. One developed spontaneous clearance
over time and one had a sustained virologic response (SVR) following treatment initiation.
Conclusion and next steps:
PAQ and the CHUM collaboratively developed and implemented an integrated care model that
supports the wellbeing of Indigenous people with chronic illnesses, substance use issues,
including hepatitis C, and complex care plans. Through this collaboration, a better
understanding of the challenges is being gained as well as potential strategies to overcome
Disclosure of Interest Statement:
Stéphanie Marsan: consultant for Indivior.
Barbara Kotsoros: consultant for Abbvie and Gilead.
No pharmaceutical grants were received in the development of this project.

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