Hepatitis C Testing and Treatment Access Among People Who Inject Drugs

Hepatitis C (HCV) remains a global issue as it affects 2-3% of the world’s population. Despite Canada’s universal access to healthcare, barriers to accessing testing and treatment for HCV has contributed to approximately 250,000 Canadians living with chronic HCV. People who inject drugs (PWID) account for about 60% of all HCV cases in Canada, making them the primary target for public health interventions, namely prevention and harm reduction. Harm reduction efforts have proven effective to reduce the incidence of infectious diseases and to prevent overdoses, but there remains a large proportion of individuals living with the virus who are unaware of their status and who require treatment. Current HCV discourse lacks a local understanding of barriers and facilitators in the Canadian context. This study explored the experience of accessing HCV testing and treatment among PWID, identifying barriers and facilitators to HCV care throughout the individual’s journey from diagnosis to cure within four domains of access: acceptability, availability, affordability, and geographic accessibility. The role of the client-provider relationship and the impact of harm reduction was also considered as it hinders or facilitates the accessibility of HCV testing and treatment. Qualitative interviews were conducted with clients (self-identified current or former intravenous substance user) and health providers in the Waterloo and Peel Regions of Ontario. Stigma and misinformation of HCV and substance use were regarded as systemic forces that perpetuate oppression, reflected throughout all access domains on a community and individual level. Facilitators and solutions identified in this study indicate a need to apply community health models and resources, more widely adopt harm reduction and patient- centred approaches to clinical care, and further consider or utilize intersectoral action to ensure equitable access to health services

Developing a coding taxonomy to analyze dental regulatory complaints

Background: As part of their mandate to protect the public, dental regulatory authorities (DRA) in Canada are responsible for investigating complaints made by members of the public. To gain an understanding of the nature of and trends in complaints made to the Royal College of Dental Surgeons of Ontario (RCDSO), Canada’s largest DRA, a coding taxonomy was developed for systematic analysis of complaints. Methods: The taxonomy was developed through a two-pronged approach. First, the research team searched for existing complaints frameworks and integrated data from a variety of sources to ensure applicability to the dental context in terms of the generated items/complaint codes in the taxonomy. Second, an anonymized sample of complaint letters made by the public to the RCDSO (n = 174) were used to refine the taxonomy. This sample was further used to assess the feasibility of use in a larger content analysis of complaints. Inter-coder reliability was also assessed using a separate sample of letters (n = 110). Results: The resulting taxonomy comprised three domains (Clinical Care and Treatment, Management and Access, and Relationships and Conduct), with seven categories, 23 sub-categories, and over 100 complaint codes. Pilot testing for the feasibility and applicability of the taxonomy’s use for a systematic analysis of complaints proved successful. Conclusions: The resulting coding taxonomy allows for reliable documentation and interpretation of complaints made to a DRA in Canada and potentially other jurisdictions, such that the nature of and trends in complaints can be identified, monitored and used in quality assurance and improvement

Hepatitis C Testing and Treatment Access Among People Who Inject Drugs

Hepatitis C (HCV) remains a global issue as it affects 2-3% of the world’s population. Despite Canada’s universal access to healthcare, barriers to accessing testing and treatment for HCV has contributed to approximately 250,000 Canadians living with chronic HCV. People who inject drugs (PWID) account for about 60% of all HCV cases in Canada, making them the primary target for public health interventions, namely prevention and harm reduction. Harm reduction efforts have proven effective to reduce the incidence of infectious diseases and to prevent overdoses, but there remains a large proportion of individuals living with the virus who are unaware of their status and who require treatment. Current HCV discourse lacks a local understanding of barriers and facilitators in the Canadian context. This study explored the experience of accessing HCV testing and treatment among PWID, identifying barriers and facilitators to HCV care throughout the individual’s journey from diagnosis to cure within four domains of access: acceptability, availability, affordability, and geographic accessibility. The role of the client-provider relationship and the impact of harm reduction was also considered as it hinders or facilitates the accessibility of HCV testing and treatment. Qualitative interviews were conducted with clients (self-identified current or former intravenous substance user) and health providers in the Waterloo and Peel Regions of Ontario. Stigma and misinformation of HCV and substance use were regarded as systemic forces that perpetuate oppression, reflected throughout all access domains on a community and individual level. Facilitators and solutions identified in this study indicate a need to apply community health models and resources, more widely adopt harm reduction and patient- centred approaches to clinical care, and further consider or utilize intersectoral action to ensure equitable access to health services

Comparison of COVID-19 Vaccination Rollout Approaches across Canada

Across Canada, there were notable differences in the rollout of provincial/territorial COVID-19 vaccination programs, reflecting diverse sociodemographic profiles, geopolitical landscapes, health system designs, and pandemic experiences. We collected information regarding underlying principles and goals, governance and authority, transparency and diversity of communications, activities to strengthen infrastructure and workforce capacity, and entitlement and access in four diverse provinces (British Columbia, Saskatchewan, Ontario, Nova Scotia). Through cross-case analysis, we observed significant differences in provincial rollouts of the primary two-dose vaccination series in adults between December 2020 and December 2021. Nova Scotia was the only province to state explicit coverage goals and adhere to plans tying coverage to the relaxation of public health measures. Both Nova Scotia and British Columbia implemented fully centralized vaccination booking systems. In contrast, Saskatchewan's initial highly centralized approach enabled the rapid delivery of first doses; however, rollout of second doses was slower and more decentralized, occurring primarily through community pharmacies. In alignment with its decentralized health system, Ontario pursued a regionalized approach, primarily led by its existing public health unit network. Our research suggests explicit goals, centralized booking, and flexible delivery strategies improved uptake; however, ongoing learning will be crucial for informing the success of future vaccination efforts. Au Canada, le déploiement des programmes provinciaux et territoriaux de vaccination contre la COVID-19 présente des différences notables d'un océan à l'autre. Ces différences reflètent la diversité des profils sociodémographiques, des paysages géopolitiques, des conceptions du système de santé et des expériences pandémiques. Nous avons recueilli des renseignements sur les principes et les objectifs sous-jacents, la gouvernance et l'autorité, la transparence et la diversité des communications, les activités visant à renforcer l'infrastructure et la capacité de la main-d'œuvre ainsi que l'admissibilité et l'accès dans quatre provinces différentes (la Colombie-Britannique, la Saskatchewan, l'Ontario, la Nouvelle-Écosse). Grâce à une analyse transversale des études de cas, nous avons constaté d'importantes différences dans les déploiements provinciaux de la série de primovaccination à deux doses chez les adultes, entre décembre 2020 et décembre 2021. La Nouvelle-Écosse a été la seule province à énoncer des objectifs de couverture explicites et à adhérer à des plans liant la couverture à l'assouplissement des mesures de santé publique. La Nouvelle-Écosse et la Colombie-Britannique ont toutes deux mis en place des systèmes de réservation des vaccins entièrement centralisés. En revanche, l'approche initiale hautement centralisée de la Saskatchewan a permis la livraison rapide des premières doses. Toutefois, le déploiement des deuxièmes doses a été plus lent et plus décentralisé, s'effectuant principalement par le biais des pharmacies communautaires. Conformément à son système de santé décentralisé, l'Ontario a adopté une approche régionalisée, essentiellement dirigée par son réseau existant de bureaux de santé publique. Nos recherches suggèrent que des objectifs explicites, un système de réservation centralisée et des stratégies de prestation flexibles ont amélioré le taux de participation des citoyens. Mais une culture d'apprentissage continu jouera un rôle déterminant pour assurer le succès des futurs efforts de vaccination