Latest Cool Aid Research: Equity-Based Hepatitis C Treatment
Abstract – Background
Knowledge is increasing regarding effective models of Hepatitis C (HCV) care for people who inject drugs (PWID). However, examples implementing such models in primary care are lacking, leaving a gap in our applied understanding of how practically we best scale-up such care: this is critical and urgent if the benefits of treatment advances are to be realized for PWID.
Full report available online until November 8, 2015.
The Cool Aid Community Health Centre (CHC) provides HCV programming for PWID, putting recent advances into practice. A case study of the CHC’s HCV programming describes the practice experience and outcomes of its novel, multidisciplinary, primary care, inner-city HCV treatment program for PWID. This paper describes how this model of care functions to address the many barriers to treatment and successfully facilitate adherence to treatment.
Medical advances for HCV will be ineffectual without effective management of complex barriers to care related to substance use, mental health, trauma, poverty, homelessness, criminalization, cultural issues, stigma and marginalization. HCV treatment for PWIDs benefits from low-threshold settings which are culturally appropriate and where trusting relationships between clients and providers are nurtured. Public investment in primary care treatment for PWID living with HCV, including investments in supports that address the social barriers faced by these vulnerable populations would build on existing evidence and improve HCV outcomes for PWID.
Hepatitis C, HCV, Drug use, PWID, Community Health Centre, Primary care, Health
Journal title: International Journal of Drug Policy
Research at Cool Aid Community Health Centre
Since 1999, the Victoria Cool Aid Society has been engaged in community-based research to improve access to dental care for people living on low incomes. The research has included many collaborators but with the consistent lead of principal investigator Bruce Wallace.
Initial research sought to raise awareness of the financial barriers to accessing dental care and possible responses. The report Brushed Aside: Poverty and Dental Care in Victoria (2000) was utilized by a Steering Group as evidence of the need and local strategies in providing care. The next report, Towards a Downtown Community Dental Clinic in Victoria (2001) presented a proposed model for a reduced-fee dental clinic for downtown Victoria, British Columbia. This report provided new research from key stakeholder interviews, a literature review, and a review of existing clinics in the province.
In 2002, a Community Dental Clinic was developed as part of the Victoria Cool Aid Society’s Community Health Centre. With the support of solid partnerships, and three years of evidence from the community-action research processes, the Community Health Centre was able to secure an annual subsidy from the Vancouver Island Health Authority to support the ongoing operations of the clinic.
Research has continued since that time to learn how to improve dental services in the province.
Improving Access to Dental Services for Low-Income Adults in BC
Throughout British Columbia people are responding to this public health need primarily by creating community-based dental care programs. The research informs community-based responses and government policies to effectively reduce oral health disparities in BC by reducing the financial barriers for adults’ accessing dental care. Findings are used to inform a coordinated, evidence-based strategy that ensures best clinical practices while improving access for the most economically vulnerable citizens.
Cool Aid is the lead on these collaborative research projects, in partnership with the Vancouver Island Public Interest Research Group (VIPIRG), and with government (BC Ministry of Health) and academic (Universty of British Columbia Faculty of Dentistry) researchers.
The Victoria Cool Aid Society’s Community Health Services and the Vancouver Island Public Interest Research Group (VIPIRG) collaborated on action research projects in 2000 and 2001 – research that effectively defined the needs, outlined a feasible response, and ultimately informed the ongoing funding of the Cool Aid Dental Clinic. While the dental clinic helps hundreds of local residents who would otherwise not access dental care, Cool Aid’s continued research can support the development of best practices – both sustainable treatment options such as the clinic and also informing public health policy.
In 2008, Cool Aid and VIPIRG applied for and received funding to undertake research with the overall goal of improving access to dental services for low-income adults in BC. A research report was produced that describes the growth of community-based dental care programs in BC (such as the Cool Aid Dental Clinic) and which sought to better understand the possibilities and limits of community-based responses to provincial oral health disparities. The research found that there exists little data on communities’ oral health needs, no evaluations of existing community-based responses, and overall, a growth-without-planning situation rather than a comprehensive, systematic, and sustainable response to oral health care needs across the province.
In 2009, a research report was completed that surveyed dental provincial services for low-income British Columbians to learn about barriers to oral health care in the province.
The objective of this research was to investigate access to dental care issues and possible barriers for low-income adults in the North Vancouver Island communities of Campbell River and Courtenay-Comox. Cool Aid is proud to be a host site for this report that was produced by Bruce Wallace with funding from the Vancouver Island Health Authority (VIHA) and supported by a Canadian Institutes of Health Research (CIHR) grant held by the UBC Faculty of Dentistry.
Through 60 interviews this research project explores the experiences and perspectives of low income people, local dentists and health and social service providers. Overall, the research heard from both dentists and low-income patients that the current service delivery model and payment options are not working well for either party and that while respondents overwhelmingly consider affordability (financial access) to be the predominant barrier to accessing care, the related issues of availability (physical access) and acceptability (cultural access) must also be addressed if access is to be improved. The findings from these North Vancouver Island communities are not unique to evidence from throughout British Columbia and elsewhere. Rather, the research provides a local example of the oral health inequities known to prevail in Canada. However, while the needs in Campbell River and Courtenay-Comox may reflect the inequities found elsewhere, there are few or no local resources for people who seek dental care but are unable to afford or access treatment.
This report provides evidence collected from a case study of five community-based dental clinics providing dental care to communities facing financial and other barriers to oral health care in BC. Building on our previous research, the findings form part of a larger research project regarding strategies to reduce oral health care disparities in BC. A principal mandate of community dental clinics is to ensure access for vulnerable populations, and community dental clinics often have difficulty providing care at the reduced fees paid for patients on welfare and other government benefit programs. The objective of this study was to collect information on five community dental clinics in BC that provide dental services to economically disadvantaged communities to determine how their operations might be sustained.
This study examines the ways communities throughout British Columbia are trying to improve access to dental services for low-income adults. The community projects surveyed help thousands of British Columbians who otherwise could not access dental care, and found that they are inadequate to solve the dental access problem in BC. A coordinated, evidence-based strategy that recognizes the diverse needs of individuals and communities, and ensures best clinical practices, while improving access for the most economically vulnerable citizens would be prudent, considering the current growth-without-planning situation in the province.
This report is a call to action. Information is presented from over a dozen key informant interviews as well as relevant literature and an inventory of existing dental clinics in British Columbia. A proposal for a downtown dental clinic in Victoria BC is outlined based on the consultations with stakeholders and review of existing clinics.
This exploratory, action-research project by the Vancouver Island Public Interest Research Group (VIPIRG) clearly documents how poverty is preventing people from obtaining necessary dental care. The report presents findings based on a survey of 150 people living on low incomes in Victoria BC. The many quotes from the surveys tell how untreated dental problems become increasingly painful and how what starts as a small toothache becomes a barrier to employment and affects one’s overall health and well-being. A recommended local response is the development of a reduced-fee dental clinic in Victoria to fill the immediate needs, while other recommendations seek larger policy changes.