M E Pearce1, K Jongbloed2, L Demerais3, H MacDonald4, W M Christian5, R Sharma6, N Pick7, E M Yoshida8, P M Spittal9, M B Klein10. 1. Canadian Institutes of Health Research, Canadian HIV Trials Network, 588-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; BC Children's Hospital Research Institute, 950 West 28th Avenue, Vancouver, BC V5Z 4H4, Canada. Electronic address: margo.pearce@bcchr.ca. 2. BC Children's Hospital Research Institute, 950 West 28th Avenue, Vancouver, BC V5Z 4H4, Canada; University of British Columbia, School of Population and Public Health, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada. 3. Cree/Métis, Vancouver Native Health Society, 449 East Hastings Street, Vancouver, BC V6A 1P5, Canada. 4. Mamoo Naakiiwin, P.O. Box #573, Matheson, ON P0K 1N0, Canada. 5. Splatsin Secwepemc Nation, 5775 Old Vernon Rd, Enderby, BC V0E 1V3, Canada. Electronic address: Kukpi7_Christian@splatsin.ca. 6. BC Children's Hospital Research Institute, 950 West 28th Avenue, Vancouver, BC V5Z 4H4, Canada; University of British Columbia, School of Population and Public Health, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada. Electronic address: richa.sharma@bcchr.ca. 7. Canadian Institutes of Health Research, Canadian HIV Trials Network, 588-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; University of British Columbia Faculty of Medicine, Division of Infectious Diseases, 2733 Heather Street, Vancouver, BC, V5Z 3J5, Canada. Electronic address: npick@cw.bc.ca. 8. University of British Columbia, School of Population and Public Health, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada; University of British Columbia Faculty of Medicine, Gastroenterology, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada. Electronic address: eric.yoshida@vch.ca. 9. BC Children's Hospital Research Institute, 950 West 28th Avenue, Vancouver, BC V5Z 4H4, Canada; University of British Columbia, School of Population and Public Health, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada. Electronic address: patricia.spittal@bcchr.ca. 10. Canadian Institutes of Health Research, Canadian HIV Trials Network, 588-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada; Department of Medicine/Division of Infectious Diseases, McGill University Health Centre, 1001 Decarie Blvd, D02.4110, Montreal, QC, Canada. Electronic address: marina.klein@mcgill.ca.
Abstract
BACKGROUND: Colonization and colonial systems have led to the overrepresentation of Indigenous people impacted by substance use and HCV infection in Canada. It is critical to ensure Indigenous people's equitable access to new direct acting antiviral HCV treatments (DAAs). Identifying culturally-safe, healing-centered approaches that support the wellbeing of Indigenous people living with HCV is an essential step toward this goal. We listened to the stories and perspectives of HCV-affected Indigenous people and HCV treatment providers with the aim of providing pragmatic recommendations for decolonizing HCV care. METHODS: Forty-five semi-structured interviews were carried out with Indigenous participants affected by HCV from the Cedar Project (n = 20, British Columbia (BC)) and the Canadian Coinfection Cohort (n = 25, BC; Ontario (ON); Saskatchewan (SK)). In addition, 10 HCV treatment providers were interviewed (n = 4 BC, n = 4 ON, n = 2 SK). Interpretive description identified themes to inform clinical approaches and public health HCV care. Themes and related recommendations were validated by Indigenous health experts and Indigenous participants prior to coding and re-contextualization. RESULTS: Taken together, participants' stories and perceptions were interpreted to coalesce into three overarching and interdependent themes representing their recommendations. First: treatment providers must understand and accept colonization as a determinant of health and wellness among HCV-affected Indigenous people, including ongoing cycles of child apprehension and discrimination within the healthcare system. Second: consistently safe attitudes and actions create trust within HCV treatment provider-patient relationships and open opportunities for engagement into care. Third: treatment providers who identify, build, and strengthen circles of care will have greater success engaging HCV-affected Indigenous people who have used drugs into care. CONCLUSION: There are several pragmatic ways to integrate Truth and Reconciliation as well as Indigenous concepts of whole-person wellness into the HCV cascade of care. By doing so, HCV treatment providers have an opportunity to create greater equity and support long-term wellness of Indigenous patients.
BACKGROUND: Colonization and colonial systems have led to the overrepresentation of Indigenous people impacted by substance use and HCV infection in Canada. It is critical to ensure Indigenous people's equitable access to new direct acting antiviral HCV treatments (DAAs). Identifying culturally-safe, healing-centered approaches that support the wellbeing of Indigenous people living with HCV is an essential step toward this goal. We listened to the stories and perspectives of HCV-affected Indigenous people and HCV treatment providers with the aim of providing pragmatic recommendations for decolonizing HCV care. METHODS: Forty-five semi-structured interviews were carried out with Indigenous participants affected by HCV from the Cedar Project (n = 20, British Columbia (BC)) and the Canadian Coinfection Cohort (n = 25, BC; Ontario (ON); Saskatchewan (SK)). In addition, 10 HCV treatment providers were interviewed (n = 4 BC, n = 4 ON, n = 2 SK). Interpretive description identified themes to inform clinical approaches and public health HCV care. Themes and related recommendations were validated by Indigenous health experts and Indigenous participants prior to coding and re-contextualization. RESULTS: Taken together, participants' stories and perceptions were interpreted to coalesce into three overarching and interdependent themes representing their recommendations. First: treatment providers must understand and accept colonization as a determinant of health and wellness among HCV-affected Indigenous people, including ongoing cycles of child apprehension and discrimination within the healthcare system. Second: consistently safe attitudes and actions create trust within HCV treatment provider-patient relationships and open opportunities for engagement into care. Third: treatment providers who identify, build, and strengthen circles of care will have greater success engaging HCV-affected Indigenous people who have used drugs into care. CONCLUSION: There are several pragmatic ways to integrate Truth and Reconciliation as well as Indigenous concepts of whole-person wellness into the HCV cascade of care. By doing so, HCV treatment providers have an opportunity to create greater equity and support long-term wellness of Indigenous patients.
Authors: Margo E Pearce; Kate Jongbloed; Sherri Pooyak; Wenecwtsin M Christian; Maaxswxw Gibuu White Wolf Mary Teegee; Nadine R Caron; Victoria Thomas; Earl Henderson; David Zamar; Eric M Yoshida; Martin T Schechter; Patricia M Spittal Journal: BMJ Open Date: 2021-07-08 Impact factor: 2.692