Five things service providers should know about hepatitis C

The pace of hepatitis C research has been so rapid, it’s sometimes hard to keep up. In the past year alone, we have seen new Canadian screening and treatment guidelines and expanded access to new treatments that cure the infection in most people.

To help service providers prepare for World Hepatitis Day (July 28), we’ve listed the top five things we should all know and be sharing with service users living with or at risk for hepatitis C.

New treatments cure almost everyone of hepatitis C

People diagnosed with hepatitis C in the past may recall an older generation of hepatitis C drugs with harsh side effects and only a moderate rate of success. Newer direct-acting antiviral treatments cure almost everyone of hepatitis C, with few side effects. And thanks to negotiations between provincial governments and pharmaceutical companies, the price of these drugs has come down significantly. As a result, most public drug plans have relaxed their eligibility rules for these medications, and we are approaching universal one-time treatment coverage for hepatitis C from coast to coast.

Hepatitis C is more prevalent among immigrants in Canada

It is estimated that 35% of people who test positive for hepatitis C in Canada were born outside of the country. Some immigrants mistakenly believe that hepatitis C screening is part of the immigration process, and may live for years with undiagnosed infection. They also face additional barriers to testing and treatment once they arrive in Canada, and healthcare providers may overlook the unique risk factors for hepatitis C infection among this population, which differ from the Canadian-born population.

Two-thirds of people who inject drugs have been infected with hepatitis C

An estimated 68% of people who inject drugs will test positive for hepatitis C antibodies, evidence of a current or past infection with the virus. Sharing drug use equipment is the most common mode of hepatitis C transmission in Canada, and even cleaning needles with bleach is insufficient to kill the virus. Only harm reduction services that offer new drug use equipment, such as needle syringe programs and supervised injection sites, are scientifically proven to reduce the risk of hepatitis C transmission among people who inject drugs.

Risk-based screening doesn’t reach everyone at risk

Previous Canadian hepatitis C screening guidelines focused on populations considered at high risk of infection. The problem with this approach is that a person can live with hepatitis C for 20 to 30 years without any symptoms, meaning an exposure may have occurred decades ago. Older Canadians may have forgotten or be unaware about potential exposures in their past, and healthcare providers may assume their patients have never been at risk. New guidelines published in 2018 recommend that all Canadians born between 1945 and 1975 be offered a hepatitis C test, helping to reach the 44% of Canadians with hepatitis C who are undiagnosed.

Everyone with hepatitis C should be offered treatment

New guidelines published this year recommend that Canadian healthcare providers offer treatment to all people living with chronic hepatitis C infection, regardless of the state of their liver injury or whether they are using drugs. With new data showing the clinical effectiveness and cost effectiveness of universal treatment, there is no longer any reason for a person to be denied or delayed access to hepatitis C treatment and care.