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BMC Public Health. 2012; 12: 632.
Published online Aug 9, 2012. doi:  10.1186/1471-2458-12-632
PMCID: PMC3490797
The Cedar Project: high incidence of HCV infections in a longitudinal study of young Aboriginal people who use drugs in two Canadian cities
Patricia M Spittal,corresponding author1,2,6 Margo E Pearce,1,2 Negar Chavoshi,1,2 Wayne M Christian,3 Akm Moniruzzaman,4 Mary Teegee,5 and Martin T Schechter1,2
1Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
2University of British Columbia, Vancouver, BC, Canada
3Splatsin Secwepemc Nation, Enderby, BC, Canada
4Simon Fraser University, Vancouver, BC, Canada
5Carrier Sekani Family Services, Prince George, BC, Canada
6St Paul’s Hospital, 620B −1081 Burrard St, Vancouver, BC V6Z 1Y6, Canada
corresponding authorCorresponding author.
Patricia M Spittal: spittal/at/sm.hivnet.ubc.ca; Margo E Pearce: margo.e.pearce/at/gmail.com; Negar Chavoshi: nchavoshi/at/gmail.com; Wayne M Christian: kukpi7_christian/at/splatsin.ca; Akm Moniruzzaman: akmubc/at/yahoo.ca; Mary Teegee: mary/at/csfs.org; Martin T Schechter: martin.schechter/at/ubc.ca
Received November 16, 2011; Accepted July 25, 2012.
Abstract
Background
Factors associated with HCV incidence among young Aboriginal people in Canada are still not well understood. We sought to estimate time to HCV infection and the relative hazard of risk factors associated HCV infection among young Aboriginal people who use injection drugs in two Canadian cities.
Methods
The Cedar Project is a prospective cohort study involving young Aboriginal people in Vancouver and Prince George, British Columbia, who use illicit drugs. Participants’ venous blood samples were drawn and tested for HCV antibodies. Analysis was restricted to participants who use used injection drugs at enrolment or any of follow up visit. Cox proportional hazards regression was used to identify independent predictors of time to HCV seroconversion.
Results
In total, 45 out of 148 participants seroconverted over the study period. Incidence of HCV infection was 26.3 per 100 person-years (95% Confidence Interval [CI]: 16.3, 46.1) among participants who reported using injection drugs for two years or less, 14.4 per 100 person-years (95% CI: 7.7, 28.9) among participants who had been using injection drugs for between two and five years, and 5.1 per 100 person-years (95% CI: 2.6,10.9) among participants who had been using injection drugs for over five years. Independent associations with HCV seroconversion were involvement in sex work in the last six months (Adjusted Hazard Ratio (AHR): 1.59; 95% CI: 1.05, 2.42) compared to no involvement, having been using injection drugs for less than two years (AHR: 4.14; 95% CI: 1.91, 8.94) and for between two and five years (AHR: 2.12; 95%CI: 0.94, 4.77) compared to over five years, daily cocaine injection in the last six months (AHR: 2.47; 95% CI: 1.51, 4.05) compared to less than daily, and sharing intravenous needles in the last six months (AHR: 2.56; 95% CI: 1.47, 4.49) compared to not sharing.
Conclusions
This study contributes to the limited body of research addressing HCV infection among Aboriginal people in Canada. The HCV incidence rate among Cedar Project participants who were new initiates of injection drug use underscores an urgent need for HCV and injection prevention and safety strategies aimed at supporting young people surviving injection drug use and sex work in both cities. Young people must be afforded the opportunity to provide leadership and input in the development of prevention programming.
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