Indigenous methodologies in practice through community engagement and telehealth outreach increase hepatitis C access to care in Alberta, Canada

ABSTRACT

Background and aims: Hepatitis C virus (HCV) is a major public health burden in Canada, with prevalence in Indigenous (First Nation, Metis and Inuit) communities 4–6 times higher than non-Indigenous population. Conventional care models have created barriers to curative DAA therapy in remote Indigenous communities. Innovative approaches are required to improve access to HCV services.Method: The ECHO+ telehealth program in Alberta aims to increase access to HCV treatment through a hub-and-spoke model led by a hepatologist (hub) working with Indigenous communities (spokes) designing a model of care tailored to local needs. We incorporated Indigenous ways of knowingl (see figure), including building a predominantly Indigenous team, and embedding the 5 R’s of Indigenous Research Methodology (Respect, Relationship, Relevance, Reciprocity, and Responsibility). ECHO+ builds relationships with Indigenous community healthcare teams while using a novel co-design approach to remove barriers while increasing awareness, screening for HCV, and providing telehealth access to specialist care. Results: Collaborative methods included developing information resources translated into local languages;building infrastructure and supporting community-directed implementation to include other health topics. Due to the COVID-19 pandemic, virtual awareness presentations (HCV awareness topics, community interaction and knowledge sharing, opportunity to follow up with mailed resources packages, and sharing lived experience stories from Indigenous youth and Elders) have been shared with every Indigenous community in Alberta. Practitioners were interviewed to identify barriers to care. Biweekly Zoom meetings with community healthcare teams have expanded during the pandemic to include pandemic topics, and other liver diseases. Collaboration between ECHO+ and Indigenous community leadership and healthcare teams has improved HCV screening, de-stigmatization, increased treatment access, and supported local community healthcare providers to effectively access DAA therapy. Thus, currently 92% of the 53 Indigenous communities in Alberta have engaged with ECHO+, compared to 23% before this approach. This reflects success of the 5R method.(Figure Presented) Conclusion: A culturally-sensitive framework combines Indigenous with western approaches to improve access to HCV awareness and care in remote Indigenous communities. This approach has increased community communication and involvement, facilitated engagement with every Indigenous community, and provided practical support throughout the pandemic.