title: Helicobacter pylori incidence and re-infection in the Aklavik H. pylori Project.
abstract: BACKGROUND
  The Aklavik H. pylori Project (AHPP) (www.canhelpworkinggroup.ca) is a community-driven project examining Helicobacter pylori infection and its influence on health in a diverse Aboriginal community in the Northwest Territories. Initial research revealed that 58% of 333 participants who underwent a urea breath test (UBT) between 2007 and 2010 were H. pylori-positive. From 2008 to 2010, we offered treatment to H. pylori-positive participants and 113 consented to this treatment.
  
  
  OBJECTIVE
  We estimated H. pylori incidence in AHPP participants who initially tested negative and the re-infection frequency in initially positive participants who were successfully treated to clear the infection.
  
  
  METHODS
  Participants who were initially H. pylori-negative or negative after treatment during 2008-2010 were eligible for inclusion. From November 2011 to June 2012, participants were offered a UBT and the samples were analyzed using infrared spectroscopy (IRIS). Participants with a positive test result were classified as new cases for estimating incidence among participants testing negative at baseline and re-infection among those successfully treated for H. pylori infection.
  
  
  RESULTS
  Among 38 initially negative participants, follow-up UBT showed that 33 remained negative, 3 were positive, and 2 had uncertain status. The estimated incidence proportion during the follow-up period was 8.3% (95% CI: 1.8-22.0%). Among 43 participants with a negative post-treatment UBT, 41 remained negative and 2 were positive. The estimated re-infection proportion during the follow-up period was 4.7% (95% CI: 0.6-16.0%). The frequency of new cases was similar in males and females. Aboriginal participants had a combined re-infection/incidence rate of 2.4% per year (95% CI: 0.8-5.9% per year). All 9 non-Aboriginal participants remained free from infection throughout the study period, as did all 23 participants aged 55 years and above.
  
  
  CONCLUSIONS
  The AHPP has substantially reduced the burden of infection in Aklavik since 2008. Continued monitoring, treatment, community engagement and knowledge translation activities are needed to ensure a lasting benefit of the project.
authors: Department of Anthropology, McMaster University, Hamilton, Canada. sfcarraher@uaa.alaska.edu
authors: Sally
authors: S
authors: Carraher
authors: Hsiu-Ju
authors: HJ
authors: Chang
authors: Rachel
authors: R
authors: Munday
authors: Karen J
authors: KJ
authors: Goodman
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001110:Arctic Regions / Q000453:epidemiology; D001944:Breath Tests; D002648:Child; D002675:Child, Preschool; D055812:Community-Based Participatory Research; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology*; D016480:Helicobacter pylori; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D004930:Inuit; D008297:Male; D008875:Middle Aged; D015873:Northwest Territories / Q000453:epidemiology; D012737:Sex Factors; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents
keywords: Aboriginal health; Arctic; Helicobacter pylori infection; collaborative research; epidemiology; incidence
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