Hep C in MSM in Vancouver, 2017


Next up as you can see from the slide deck
is Jen Brazeau and she’s just getting her mic clipped.
Whenever you’re ready Jen you can take it away. Okay so hi everyone for
those of you who I have not met before my name is Jennifer Brazeau. My practicum
experience was a little different than most of yours as I completed mine by
distance. I had the pleasure of working with Dr. Nathan Lachowsky and focused my
practicum on his and his colleagues research on Hepatitis C in gay, bisexual and
other men who have sex with men in Vancouver. As my practicum was a little
unconventional I’ll break down what I produced over my 450 hours. There were two
main outcomes for this project. First I contributed to a manuscript and then I
used this information in addition to the literature to create a knowledge
translation tool. For the manuscript I first conducted background research on Hep
C and HIV. I then focused on improving my understanding of academic writing. For
the manuscript I was to evaluate the data, present information in
tables and provide a discussion on key findings. The document then underwent
numerous revisions as our goal is to submit the manuscript to the Journal of
AIDS. The second product a knowledge translation tool disseminates information
to the public and took form of a fact sheet. Not having made a knowledge
translation tool before researching the methods, the models and theories was the
next step. I then compiled the information and drafted the document.
Community partners were then consulted and they gave feedback and the final and
we produced the final knowledge translation tool. The outcome of my
practicum were primarily the manuscript and the knowledge translation tool but
in addition the experience allowed me to build relationships with organizations
and improve my networking skills. Before I go into too much depth about
what I did I’d like to give some background information on my topic.
Hepatitis C is one of the leading cause of liver disease in the world. Hep C is
most commonly passed through blood to blood transmission and having HIV
further increases one’s susceptibility to acquiring Hep C. While rates have been
decreasing overall in Canada the rates for gay, bisexual and other men who
have sex with men population are closer to five times in prevalence.
Blood to blood transmission is still most common the most common method of
getting HCV and can occur through IV drug use. Sharing drug equipment may also
be a method of transmission as according to some past studies nasal secretions have
been found to contain the Hep C virus. Lastly there is increasing evidence for
sexual transmission in HIV positive gay, bisexual and other men who have sex with
men as it can occasionally be found in semen. With respect to Vancouver we found
2% of HIV negative men and 28% of HIV positive men were found with HCV. The main outcome of my practicum was the
creation of the manuscript that would later be submitted for publication. The
paper evaluates the results of the momentum study which was a three year
study investigating Hep C in Vancouver gay, bisexual and other men who have sex
with men. The study utilized respondent driven sampling which is
participants are recruited by other participants. The recruited men were
then tested at baseline for both HCV and HIV which made up our prevalent cases.
Those who are not HCV positive were then went for a follow-up where they are tested again
for HCV. Those who then became HCV positive were our incident cases.
The study results found an associated risk with Indigenous ethnicity, illicit drug
use and escort work in both HIV positive and HIV negative men. However
when accounting for other variables IV drug use was the only drug significant
at a multivariate level. Prevalent HIV positive gay, bi and other men who
have sex with men had an additional risk if they partook in recent condomless
anal sex with a partner of unknown sterile status. As for incident cases all
men were HIV positive, gay and were more more likely to be crystal
methamphetamine users. Interestingly though we did not find an association
in incident cases with IV drug use. The manuscript is still currently undergoing
revision and will be submitted to… A knowledge translation tool was then
created with this information for the general public. In order to do so we
partnered with local HCV organizations to ensure that this material would be
relevant to our population. Three organizations were contacted Youth Co
which is based out of Vancouver Hep C BC and Pacific Hep C which focus
on the province wide. 3 other organizations were found the Healing Our
Spirit BC Aboriginal HIV/AIDS Society, Chee Mamuk, and Fraser Regional
Aboriginal Friendship Centre. However they all focus on Aboriginal
men’s health and as this is a generic fact sheet I did not find
that this would be appropriate and culturally …for those
organizations. As some of you may not have created
knowledge translation tools in the past I would like to give a quick overview to
the knowledge translation process and the models that were used. According to
the Canadian Institute of Health Research knowledge translation is the
process of utilizing information from research and applying it in a
meaningful way. They further explain 4 main
categories to apply knowledge translation synthesis, dissemination,
exchange and ethically sound application of knowledge. Synthesis
involves interpreting research findings in the broader context of the field.
Dissemination involves identifying a target audience and how to convey the
message, exchange is the dialogue with partners and those who will use the tool
and ethically sound application ensures that everything is done respectfully. All
of these elements were kept in mind in creating the fact sheet. In addition to
this specific models guide the process with regard to health promotion two
models are applicable the readiness to change model and the social influences
theory. However the social influences theory was not well suited as it focuses
primarily on the impact of the social group and was more geared toward medical
approaches and practitioners. The readiness to change model is best suited
to this situation as it focuses on the steps of changing individuals
behaviour. Here’s a quick overview of the readiness to change model where there are
two main components to the tool. First we have the stages of our population which
is pre-contemplation, contemplation preparation, action maintenance and termination and
the second is the processes which allow which explain how to move from each step
and how the change is facilitated. In order to ensure that no material is
missed a literature review was conducted. A
search of PubMed and Medline returned 8 articles all of which were
redundant to findings either from the World Health Organization or from our
study. The World Health Organization website was used to
research the most up-to-date information on treatment, risk factors and information.
Treatment, transmission and risk factors. And this is the knowledge
translation tool that was presented to the community partners. … was
particularly helpful and gave us feedback on word choice and layout and we
continue to make changes until we felt that it best suited our needs. While there
have been an abundance of positive experiences and strengths that have come
from this practicum there are a few limitations. A limitation
relating to the use of the readiness to change model for this tool was that we
did not have information regarding stages for the men. Not knowing this
information made the process more difficult as some of the
information may be redundant to what they already know or may not address
where they’re lacking information. Second we found Indigenous ethnicity as a
risk factor for HCV however we’re not sure specifically which behaviours are
causing this increase. The question is what determinants do Indigenous men face
disproportionately that are resulting in this outcome? This is something that we
don’t yet know. The fact sheet has also not yet been distributed and cannot
until the manuscript is published which means that no evaluation regarding its
effect can be done. With this in mind there could be future changes that would
improve the tool which we might have missed.
Lastly due to the nature of this practicum I missed the office experience
and had limited practice with policy analysis. And a special thank you to Dr. Nathan Lachowsky who agreed to supervise my practicum by distance. I would also like
to acknowledge the HCV organizations for their feedback and interest in being
part of this process. Lastly a thank you to the School Public Health and Social
Policy for this opportunity. Thank you. Another really rich practicum experience.
Nate put you through your paces on that one. So questions for Jen? Questions
about Hep C? Questions about knowledge translation? I’ll ask one while people are
thinking. So I guess it’s the tension between what you have in terms of
information and what theory tells you would be best practice in terms of
developing the knowledge translation tool do you want to elaborate a little
bit on some of the missing pieces that it would have been nice? See if I can go back. Yeah so what was particularly useful is that for each of the stages
they’ll explain where people are where the population is located and whether or
not they’re actually looking to make a change. For example pre-contemplation
that means that your population at the time is not at all considering
making a change to whatever habit you’re trying to address. Contemplation is that
they’re planning to do it in the future but not within the six months and then
preparation is within six months. So this would all make a difference in that if
you’re located at a preparation stage you’d be more likely to be looking for
services to making that change while if you’re in pre-contemplation you’re more
looking for your best chances to target them with more
information as to why they should make the change so by not knowing exactly
where the demographic falls it’s hard to make a fact sheet and know exactly what
they would need out of that whereas depending on what stage they’re at they
would need different information to help facilitate to the next step to
change habits. So because people wouldn’t have been able to see it
because it’s pretty tiny when you see it on the screen what did you end up doing
a mishmash of all of those things? Yeah particular stage. Yeah I tried to take
as much as I could anything so it would be applicable to everyone so there is
so here I have generic just facts to more address for people who
don’t know anything and then trying to relate it more to Vancouver and why this
is an issue they should be concerned. And then for those who already know a little
bit this is new information that is just coming out and then to help move the
process forward to tell people to get tested and then these are the organizations
that we worked with that have the most information on Hep C for them. Great
thanks. Any other questions? Okay I get to do my walking yay. I’m just wondering how you incorporated
I’m assuming so just because I’ve worked in the Ministry of Health with some of
the syphilis stuff and confidentiality is such a huge factor in this and it’s a
barrier to why people actually go and get tested or seek out further
information so I’m wondering if that was the factor that you incorporated in the
model to ensure that people can remain or they can approach in a way that’s
best suited to them maybe not in health care system but through online models that
would allow them to assess their risk or assess whether they may be infected
themselves and then to seek help at that point. That’s a good question that’s actually
really interesting. I haven’t overly considered that.The
best I thought of with that was approaching just having the
organizations available. I know that the organizations are pretty great with what
they do but I haven’t really considered the confidentiality aspect of it that’s
good. Any other questions? Seeing none we will say thank you to
Jen excellent presentation

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