A new blueprint to eliminate hepatitis C in Canada was released on May 24, laying out a roadmap to diagnose, treat and prevent infections and re-infections.
The Blueprint to Inform Hepatitis C Elimination Efforts in Canada
was developed by the Canadian Hepatitis C Network (CanHepC) to help Canada achieve the World Health Organization’s goal to eliminate hepatitis C as a public health threat by 2030. The Network, funded by the Canadian Institutes of Health Research, includes BC Centre for Disease Control (BCCDC) staff as part of the research team.
“Hepatitis C is the first chronic viral infection for which medical researchers have developed a cure,” said Dr. Mel Krajden, medical lead for hepatitis for the BCCDC and medical director of BCCDC Public Health Laboratory. “This miracle is all-the-more astounding when you consider the hep C virus itself was only discovered 30 years ago, in 1989.”
Until recently, treating hepatitis C involved up to 48 weeks of gruelling therapy with significant side effects and only cured 40 to 50 per cent of people. Today, direct-acting antiviral drugs are publicly funded and available to all eligible Canadians living with hepatitis C. These oral drugs cure about 95 per cent of people, require only eight to 12 weeks, and have few, or no, side effects.
People cured of hepatitis C demonstrate dramatic reductions in their risk of dying, developing cirrhosis or liver cancer, or needing a liver transplant. They also have a lower risk of dying from strokes, heart attacks, kidney failure, and their quality of life is improved.
“Not only are there individual benefits to being cured, but societal benefits accrue, too. A cured person no longer transmits hep C to others if they engage in risk behaviours,” said Krajden.
A blueprint for elimination
With the diagnostic tools and curative treatments to eliminate hepatitis C available in Canada, the 2030 goal is in reach.
“To provide the necessary prevention, care and treatment services, we need to understand why certain populations are at an increased risk of becoming infected and provide services that support their needs – this is true patient-centric care,” said Krajden. “This means we need to learn how overlapping, intersectional factors -- such as colonization, poverty, homelessness and/or mental health and stigma -- perpetuate their vulnerability and reduce their access to comprehensive healthcare services, including harm reduction, and we need to work together to overcome those structural barriers. “
Research into these issues helped shape the Blueprint to Inform Hepatitis C Elimination Efforts in Canada
. B.C. was an important Blueprint contributor as it has been at the forefront of using linked laboratory and administrative data to understand the role of vulnerability on health outcomes. The BCCDC’s BC-Hepatitis Testers Cohort
, a database containing anonymized medical information on testing, healthcare utilization and outcomes dating back to 1990, has become internationally recognized for its comprehensive and population-level information. Knowledge gained from this cohort helps us understand how to tailor health services to the needs of individuals and the various affected populations.
The Blueprint recognizes that hep C disproportionately affects five priority populations:
- People who inject or use drugs – These people are not only at risk of hep C, but can also die from overdoses and other high-risk activities. For this population, harm reduction must be part of the care package and needs to include wraparound mental health and addictions services.
- Indigenous peoples (First Nation, Inuit, Métis) - Historic and present colonial policies and systems that disrupt connection to land, language, and culture, diminish Indigenous sovereignty resulting intergenerational trauma contributes to the adverse social determinants of health in Indigenous people which also impacts hepatitis C risks. There is also disparity in access to health services. They require holistic wellness-based health promotion, prevention, care and treatment designed by Indigenous people to address their underlying health disparities.
- People with experience in the federal or provincial prison systems - Many in this population group were incarcerated as a result of the criminalization of drug use. They are disproportionately affected or at risk of acquiring hep C. As has occurred in Portugal, decriminalization of possession for personal use could help reduce the impact of hep C infections and opioid overdose deaths.
- Immigrants and newcomers – Often come from countries where hep C is commonly transmitted from unsafe medical practices. These people will require culturally designed and linguistically appropriate services to enhance screening/engagement into care.
- Gay, bisexual and men who have sex with men – This group of people need low-threshold access to testing and harm reduction to prevent the risk of hep C, HIV infection and other sexually transmitted infections.
One additional at-risk population that deserves attention is baby boomers. Born between 1945 and 1975, the baby boomer cohort represents older adults who were infected prior to the availability of tests to diagnose the virus and prevent its spread. Baby boomers typically do not contribute to transmission, and may not even know that they are infected, but are now presenting with progressive liver diseases and cancers. This cohort could benefit greatly from a one-time offer to be tested. If infected, baby boomers would be offered cost-effective and curative treatment.
“Curing hep C in these priority populations not only prevents progressive liver damage, but it also stops ongoing transmission from person-to-person,” said Krajden. “The blueprint can help guide us in eliminating hep C from Canada so that future generations may never need to experience the disease and its devastating health impacts.”