A collaborative approach to hepatitis C testing in two First Nations communities of northwest Ontario

Abstract

BACKGROUND: Two remote First Nations communities each collaborated with an urban-based liver clinic to organize wide-spread testing, followed by linkage to care for hepatitis C virus (HCV). METHOD: Involvement of community members was central to planning and conduct of the programs. Samples were obtained using dry blood spot cards (DBS). A week-long pilot study in Community 1 investigated the effectiveness of the program, using DBS. Community 2, being larger, more remote, and known to be endemic for HCV was more challenging. Three-week-long testing drives plus a stand-alone testing day were used to collect samples over 5 months. Public Health Agency (PHAC)’s National Laboratory for HIV Reference Services (NLHRS) received and tested the DBS samples for HCV and other blood-borne infections. Outcomes were measured by number of people tested, the quality of the tests, and community members’ satisfaction with the program and retained knowledge about HCV, based on interviews. RESULTS: In Community 1, 226 people were tested for HCV over 4 days. 85% agreed to human immunodeficiency virus (HIV) testing as well. In Community 2, 484 people, one-half of the adult population, were tested. Surveys of participants showed food was the most significant draw, and Facebook the most effective way to inform people of the events. Interviews with staff and participants showed a high level of satisfaction. CONCLUSION: The results suggest this is an effective approach to testing for HCV in unusually challenging settings. Lessons from the program include the power of community involvement; and the effectiveness of a highly targeted health initiative when developed through collaboration.

Assessing the acceptability of dried blood spot testing for HIV and STBBI among Métis people in a community driven pilot project in Alberta, Canada

“…Participants described how having community members modelling getting tested, and hosting DBST at Métis community events may reduce the stigma associated with HIV/STBBI testing and improve awareness of HIV/STBBI in Métis communities. Similarly, preliminary research in First Nations communities has suggested that a community-level DBS intervention may improve levels of STBBI knowledge and awareness [22]. Additionally, in line with our findings, stigma has been identified in the literature as a barrier to STBBI testing for a variety of populations [12,39].…”

“…Both providers and recipients described the DBST process as easy: it was easy to get tested and it was easy to have community members be trained to administer DBST. Our findings regarding the ease and simplicity of the DBST process are corroborated by existing research, which has shown that DBST is straightforward enough for individuals to provide self-collected samples and may lead to increase in STBBI testing [22,35]. Additionally, portability was seen as a beneficial quality, contributing to the "ease" of DBST, by both DBST providers and recipients, and was identified by participants as a strategy for increasing STBBI testing rates and accessibility for Métis community members in rural/remote areas.…”

“…Additionally, portability was seen as a beneficial quality, contributing to the "ease" of DBST, by both DBST providers and recipients, and was identified by participants as a strategy for increasing STBBI testing rates and accessibility for Métis community members in rural/remote areas. The portability of DBST has also been recognized as a factor that may increase testing rates among other populations, including First Nations communities, incarcerated individuals, individuals who inject drugs, and may also be useful in resource-limited settings where phlebotomy may be unsuitable [22,[36][37][38].…”

“…An additional asset of DBST is that in an event context, many individuals can be tested at a single point in time [40,41]. Event-based STBBI testing has been used in a variety of contexts and sexual health interventions have been included in some Indigenous community events including at powwows [22,42]. However, little literature has evaluated DBST in event settings [43].…”

“…It is a portable method of testing blood for the presence of antibodies, and involves using a lancet to prick the fingertip, which is blotted onto a filter paper, then dried and shipped to a laboratory for testing [21]. DBST can be administered by individuals who are not health care providers/clinicians and has been piloted within First Nation communities with limited health care infrastructure [22]. DBST is an alternative to phlebotomy, which is the current standard practice for testing for HIV, HCV, syphilis, and other STBBI across Canada.…”