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Applying core theory and spatial analysis to identify hepatitis C virus infection "core areas" in British Columbia,
Zahid A Butt1, Sunny Mak2, Dionne Gesink3
1School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
Insights
Core areas for hepatitis C virus (HCV) transmission were identified in British Columbia using spatial analysis. These HCV hotspots expanded over time, informing targeted public health interventions.
Area of Science:
- Epidemiology
- Spatial Analysis
- Public Health
Background:
- Bacterial sexually transmitted infection "core areas" are known, but their applicability to viral infections like hepatitis C virus (HCV) is unclear.
- Understanding HCV transmission dynamics is crucial for effective public health strategies.
Purpose of the Study:
- To identify and map distinct core areas of HCV infection in British Columbia (BC) from 1990 to 2013.
- To analyze the spatial and temporal expansion of these HCV core areas over time.
Main Methods:
- Utilized the BC Hepatitis Testers Cohort (BC-HTC) data from 1990-2013, encompassing approximately 1.5 million HCV tests.
- Employed geographic mapping and spatial analysis techniques including Kernel Density Estimation, Hotspot analysis, and cluster analysis at the Census dissemination area level.
- Utilized ArcGIS and SatScan software for spatial and temporal analysis across five distinct time periods.
Main Results:
- Consistently identified core areas of HCV infection across BC.
- Observed an expansion of HCV core areas from major city downtowns to smaller urban centers over the study period.
- Identified statistically significant HCV infection clusters (hotspots) in Vancouver, Northern BC, and Vancouver Island, persisting after adjusting for key covariates.
Conclusions:
- The persistence of high HCV diagnosis rate areas supports the theory of "core areas" for HCV transmission.
- Identification of these core areas provides valuable insights for informing and evaluating prevention, care, and treatment programs for HCV.
Abstract:
"Core areas" of transmission for bacterial sexually transmitted infections have been identified. However, it is unclear whether core areas apply to viral infections, such as hepatitis C virus (HCV). We used geographic mapping and spatial analysis to identify distinct core areas of HCV infection in British Columbia (BC) using the BC Hepatitis Testers Cohort (BC-HTC), 1990-2013. The BC-HTC includes all BC residents tested for HCV (~1.5 million; 1990-2013). Core HCV infection areas were identified spatially and temporally for five time periods (1990-1993, 1994-1998, 1999-2003, 2004-2008 and 2009-2013) through thematic mapping, Kernel Density Estimation, Hotspot analysis and cluster analysis at the Census dissemination area level in ArcGIS and SatScan. HCV infection core areas were consistently identified. HCV core areas expanded from the downtown of major cities in different regions of BC (Metro Vancouver, Vancouver Island, and Northern BC; 1990-1998), to smaller cities in Metro Vancouver and Interior BC (2000 onwards). Statistically significant clusters, or hotspots, were also observed for downtown Vancouver, Northern BC (Prince George) and Vancouver Island from 1990 to 2008 with expansion to other urban areas in Metro Vancouver from 1990-2013. Statistically significant clusters persisted after adjustment for injection drug use, number of HCV tests, age, sex, material and social deprivation. Persistence of areas with high HCV diagnoses rates in Vancouver and Prince George supports the theory of core areas of HCV transmission. Identification of core areas can inform prevention, care and treatment programme interventions and evaluate their impact over time.