Prevention in Focus

Spring 2018 

Canadian hepatitis C guidelines

By Erica Lee

Guidelines synthesize research literature, the consensus of experts in the field and practiced-based evidence into recommendations that front line service providers can use to develop and deliver evidence-based services and care. In previous issues of Prevention in Focus we reviewed Canadian guidelines on HIV testing and prevention and HIV treatment, care and support. This article will highlight Canadian guidelines on hepatitis C testing, prevention, treatment and care.

Testing

The Canadian Task Force on Preventive Health Care has developed Recommendations on hepatitis C screening for adults to guide hepatitis C testing among adults. The task force does not recommend broad-based screening for adults who are not at high risk for exposure to hepatitis C. The task force recommends that people at increased risk of infection, such as people who have used injection drugs, should be tested, as well as people with symptoms suggestive of hepatitis C infection.

The task force has developed a tool to help clinicians assess a person’s risk for hepatitis C.

The Canadian Liver Foundation, Action Hepatitis Canada and several Canadian liver experts have criticised the screening recommendations.

Post-exposure risk assessment

The guidelines listed here have been developed by provincial and territorial governments. They cover transmission risk assessment following a potential occupational or non-occupational exposure to hepatitis C and other blood-borne infections, testing of the source or recipient of the exposure and counselling and ongoing follow-up. The guidelines can also provide information on local resources or copies of specific forms used in the province or territory.

Alberta guidelines for non-occupational, occupational and Mandatory Testing and Disclosure Act post-exposure management and prophylaxis: HIV, hepatitis B, hepatitis C and sexually transmitted infections – Alberta Health

Blood and body fluid exposure management – Yukon Health and Social Services

Guidelines for the management of exposures to blood and body fluids – Government of Saskatchewan

Guidelines for the management of percutaneous or sexual exposure to bloodborne pathogens – Department of Health and Wellness, Prince Edward Island

Guide pour la prophylaxie et le suivi après une exposition au VIH, au VHB et au VHC – Ministry of Health and Social Services of Quebec

Integrated post-exposure protocol for HIV, HBV and HCV: guidelines for managing exposures to blood and body fluids – Manitoba Health, Seniors and Active Living

Harm reduction

Harm reduction programs help reduce the transmission of hepatitis C and HIV among people who use drugs. The Best practice recommendations for Canadian harm reduction programs that provide service to people who use drugs and are at risk for HIV, HCV, and other harms provide guidance for harm reduction programs by examining the context and effectiveness of practices that facilitate safer drug use and offering recommendations for the delivery of harm reduction services.

Developed by the Working Group on Best Practice for Harm Reduction Programs in Canada, the recommendations include topics such as the distribution of safer drug use equipment, education and overdose prevention. Related concerns are also addressed, such as health and support service delivery and referrals for people who use drugs.

Treatment and care

The following guidelines address the treatment and care of people living with hepatitis C.

An update on the management of chronic hepatitis C: 2015 consensus guidelines from the Canadian Association for the Study of the Liver – These guidelines provide recommendations on drug therapy to treat hepatitis C. They include the assessment of patients before starting therapy, drug therapy in treatment-naive patients, treatment-experienced patients, and patients with different genotypes and antiviral resistance.

CIHR Canadian HIV Trials Network Coinfection and Concurrent Diseases Core Research Group: 2016 updated Canadian HIV/hepatitis C adult guidelines for management and treatment – Recommendations in this guideline cover assessment and monitoring of people co-infected with HIV and hepatitis C, treatment of HIV, treatment of hepatitis C, drug interactions, adverse reactions, adherence and liver transplantation.

The reproductive care of women living with hepatitis C infection – These guidelines from the Society of Obstetricians and Gynaecologists of Canada advise on the care of women with hepatitis C before, during and after pregnancy, as well as the testing for and prevention of hepatitis C in pregnant women.

To find additional Canadian and international guidelines, check out Programming guides and tools in the Strengthening Programming section of the CATIE website.

About the author(s)

Erica Lee is the Information and Evaluation Specialist at CATIE. Since earning her Master of Information Studies, Erica has worked in the health library field, supporting the information needs of frontline service providers and service users. Before joining CATIE, Erica worked as the Librarian at the AIDS Committee of Toronto (ACT).