Taking stock on the state of hepatitis C today

Laurence Mersilian: The emergence of the global COVID-19 pandemic has unfortunately created additional challenges that have slowed global progress toward elimination—we have seen a disproportionate impact on marginalized populations. Scaling back of harm reduction programs due to COVID-19 restrictions increases the potential rates of HCV infection and reinfection, while paused HCV testing in overtaxed labs has affected treatment start rates, as priorities shifted and as patients became hesitant to enter healthcare centres. As we transition into a post-COVID world, there will be a need to re-engage HCV treaters and priority populations, and an opportunity to leverage learnings and infrastructure from COVID-19.

Mersilian: We have identified five priority populations who carry the largest burden of HCV in Canada: people who inject drugs (PWID) Indigenous people, incarcerated individuals, immigrants & newcomers, gay, bisexual, and men who have sex with men.1 These five priority populations have a history in Canada of inequitable access to healthcare. Where these populations intersect that inequity becomes more layered and pronounced. We need to screen these individuals where they live, right in their communities and in the locations, they frequent, such as needle exchange centres.

(Action Hepatitis Canada – Progress toward viral hepatitis elimination in Canada – page 8)

Mersilian: Stigma around this virus and limited access to care is preventing many people from getting screened and treated. For the identified priority populations, we need community-based, peer supports that link to healthcare for harm reduction, culturally safe/responsive care models including primary, mobile and telehealth. Lastly, HCV prevention, testing, and education integrated into sexual health clinics is also needed.

Mersilian: We have identified the priority populations and we have approved treatments. But we need to step up before the rates of infections and reinfections spike. It is still a possibility to eliminate HCV if we quickly and efficiently address the challenges we are currently facing. Once challenge is with screening. The proper screening tools are not yet available in Canada. When reflex testing* will be in the hands of all the first-line aid workers, then we will have a fighting chance. Let’s implement a plan of action that will help us rebuild our linkage to care.  

Here are some important facts about HCV:

• In Canada, an estimated 250,000 people are living with Hepatitis C (HCV) but almost half of Canadians infected are unaware they are living with the disease.¹ 
• HCV is a virus that attacks the liver and if left untreated could lead to cirrhosis, liver failure and even liver cancer.²
• Hepatitis C is a silent and slow disease. Without proper testing, you won’t know if you are living with this disease until liver damage is very advanced.²
• A simple blood tests can determine if you have HCV^.2
• HCV is passed on from blood-to-blood contact.²
• The federal government and the World Health Organization (WHO) have pledged to eliminate HCV by 2030.¹
• The Canadian Network on Hepatitis C (CanHepC) developed the Blueprint to inform Hepatitis C elimination efforts in Canada and progress is being made but more needs to be done to meet the 2030 deadline.¹    
• Unlike Hepatitis A & B, there is no vaccine for Hepatitis C.²

For more information on CAPAHC:
https://www.capahc.com/

1 Canadian Network on Hepatitis C (CanHepC). Blueprint to inform hepatitis C elimination efforts in Canada. 
https://cdn.ca.yapla.com/company/CPYfgPV3CnIUJxhGEwBsuytvM/asset/files/Elimination/Blueprint/blueprint_hcv_2019_05.pdf
2 Canadian Liver Foundation. Hepatitis C. 
https://www.liver.ca/patients-caregivers/liver-diseases/hepatitis-c/

* HCV RNA test