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236

INFLUENCE OF IMMIGRATION STATUS ON CHRONIC HEPATITIS C VIRUS INFECTION MANAGEMENT

C Giordano^1,2, B Hutton¹, C Cooper^1
1The University of Ottawa Division of Infection Diseases and Ottawa Health Research Institute Methods Centre, Ottawa, ON

²2007 Canadian Liver Foundation Summer Studentship Award Recipient
INTRODUCTION: HCV-infected patients from endemic regions of the world immigrate to Canada and are subsequently referred to viral hepatitis clinics for management. Cultural differences and language barriers are potential obstacles to receiving HCV treatment. We set out to describe the racial / ethnic diversity of a HCV-infected population receiving care at a tertiary care, hospital-based viral hepatitis clinic and to identify differences in investigations, HCV therapy access and HCV therapy outcomes between Canadian-born and foreign-born patients.
METHODS: The Ottawa Hospital Viral Hepatitis Program Clinical Database (SPSS 14.0) was utilized to identify HCV-infected patients followed between June 2000 and May 2007. Information on immigration history, country of origin and race is contained within this database. Information on HCV work-up, treatment and outcome [i.e. Sustained Virological Response (SVR)] was compared by these parameters (Chi square, Student’s t test).
RESULTS: 1060 HCV-infected patients were assessed (70% male; 84% white, 8% black, 6% oriental, 2% Native). 23% were born outside of Canada. The mean age at the time of first evaluation was 44 and 49 years for Canadian-born and immigrant referrals, respectively. The median biopsy stage (2) and grade (2) did not differ by group.
Table 1. Measures of HCV Management Access                                

Measure of HCV Management Access	Immigrant to Canada	Canadian-Born	P Value
Underwent Biopsy	42%	45%	NS
Initiated HCV Antiviral Therapy	25%	32%	0.04
Use of Erythropoietin	7%	12%	NS
Achieved SVR	43%	43%	NS

Access to liver biopsy and HCV antiviral therapy initiation did not differ by race. SVR was 25% in blacks compared to 45% for other races.
CONCLUSION: The ultimate goal of this work is to ensure optimal care for all HCV patients. To this end further evaluation to understand why fewer immigrant patients initiated HCV therapy, with a focus on language barriers, is planned.

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