It’s not just about hep C : evaluation of the Cedar Project’s culturally safe intervention supporting hepatitis C treatment among urban Indigenous Peoples who use drugs in BC

Direct-acting antiviral therapies have transformed hepatitis C (HCV) treatment with improved tolerability and cure rates. Yet the pervasiveness of anti-Indigenous racism and stigma within the healthcare system raises concerns regarding access and quality of treatment provided to Indigenous Peoples who use drugs (PWUD) affected by this illness. In response, Indigenous Partners of the Cedar Project developed the Blanket Program, an intervention designed to provide culturally safe support before, during, and after treatment. This initiative took place within the Cedar Project’s ongoing cohort study focused on the health of urban Indigenous PWUD in BC. The current dissertation sought to evaluate the Blanket Program using a mixed methods approach to determine whether and how this intervention provided culturally safe care that supported HCV treatment among Indigenous PWUD. Qualitative findings demonstrated that participants perceived the Blanket Program to effectively support (1) treatment access, adherence, and completion, (2) connections to other services of need, and, importantly, (3) provided culturally safe care where they felt safe, seen and valued. Intervention success was attributed to its relationship-centred approach to culturally safe treatment, which involved providing (1) strengths-based case planning that honoured participants’ autonomy and wholistic needs alongside (2) navigational support that prioritised the relational and social justice dimensions of care, reinforced over time and space. Quantitative outcomes reaffirmed these findings as participants achieved high cure (92%) and low reinfection rates following the Blanket Program, with 91% remaining HCV-free 294 days post-treatment. However, this intervention faced challenges operating in a context where external resources and services were scarce and culturally unsafe, compounded by onerous HCV testing requirements. Together, these factors restricted the Blanket Program's ability to enrol the most structurally iv vulnerable, such as those without housing. Contextual factors also hindered the intervention in connecting enrolled participants to desired goals: housing, healing, and substance use treatments. Recommendations to enhance the Blanket Program and treatment access more broadly included: (1) integrating culturally-centred wholistic programming into intervention design; (2) implementing and evaluating the Blanket Program in ‘real-world’ clinical settings; (3) removing barriers to same-day prescribing for HCV therapies; and (4) increasing culturally responsive housing and substance use treatments.