Hepatitis C Virus Infection in Indigenous Populations in the United States and Canada

Abstract

American Indian/Alaska Native (AI/AN) and Canadian Indigenous people are disproportionally affected by hepatitis C virus (HCV) infection yet are frequently underrepresented in epidemiologic studies and surveys often used to inform public health efforts. We performed a systematic review of published and unpublished literature and summarized our findings on HCV prevalence in these Indigenous populations. We found a disparity of epidemiologic literature of HCV prevalence among AI/AN in the United States and Indigenous people in Canada. The limited data available, which date from 1995, demonstrate a wide range of HCV prevalence in AI/AN (1.49%–67.60%) and Indigenous populations (2.28%–90.24%). The highest HCV prevalence in both countries was reported in studies that either included or specifically targeted people who inject drugs. Lower prevalence was reported in studies of general Indigenous populations, although in Canada, the lowest prevalence was up to 3-fold higher in Aboriginal people compared with general population estimates. The disparity of available data on HCV prevalence and need for consistent and enhanced HCV surveillance and reporting among Indigenous people are highlighted. HCV affects Indigenous peoples to a greater degree than the general population; thus we recommend tribal and community leaders be engaged in enhanced surveillance efforts and that funds benefitting all Indigenous persons be expanded to help prevent and cover health care expenses to help stop this epidemic.

Evaluation of the Cherokee Nation Hepatitis C Virus Elimination Program in the First 22 Months of Implementation

“…Although methods differ among studies, the 22-month cumulative incidence of anti-HCV seropositivity of 3.2% identified during the HCV elimination program period is higher than the US population estimates of 1.5% 22 and is within the range of most studies conducted in American Indian and Alaska Native communities in the US (1.49%-7.04%). [23][24][25][26] The 22-month cumulative incidence of newly detected anti-HCV seropositivity and current HCV infection in the CNHS were similar to Oklahoma prevalence estimates (3.2% vs 3.3% and 2.2% vs 1.8%, respectively), which are among the highest nationally. 22 However, because the CNHS elimination program included enhanced screening, which likely detected more cases, and covered a period of 22 months, these estimates cannot be compared directly.…”

Exploring how Hospitalization Can Alter Hepatitis C Virus Treatment Prioritization and Trajectories in People who Use Drugs: A Qualitative Analysis

“…While we made efforts to interview participants from non-urban areas and from diverse backgrounds, our study population matches the demographics of our prior AMCS patient evaluation and of the region 22 , 53 . Studies specifically exploring diverse patient experiences with HCV are needed given ongoing racial and ethnic disparities in the HCV care continuum 54 , 55 . All of our participants were seen by an AMCS.…”

“…22,53 Studies specifically exploring diverse patient experiences with HCV are needed given ongoing racial and ethnic disparities in the HCV care continuum. 54,55 All of our participants were seen by an AMCS. Since participants were recruited among those cared for by an AMCS, patients with more stable SUD, or those with unstable SUD who did not want to engage with the AMCS, were not recruited for our study.…”

Effectiveness of direct‐acting antiviral therapy among Aboriginal and Torres Strait Islander peoples with HCV infection in Australia: A national real‐world cohort (REACH‐C)

“…Indigenous peoples are another population requiring focussed attention given the disproportionate burden of HCV infection and potential inequalities in healthcare access 6–8 . Australia's Indigenous peoples, Aboriginal and Torres Strait Islander peoples (hereafter respectfully referred to as Aboriginal ∆ ), have been designated a priority population 3,8–10 .…”

“…Indigenous peoples are another population requiring focussed attention given the disproportionate burden of HCV infection and potential inequalities in healthcare access. [6][7][8] Australia's Indigenous peoples, Aboriginal and Torres Strait Islander peoples (hereafter respectfully referred to as Aboriginal ∆ ), have been designated a priority population. 3,[8][9][10] Ensuring Aboriginal people have equitable access to safe and effective HCV care and treatment is essential for health outcomes and to achieve HCV elimination targets.…”