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The landscape in hepatitis C is changing. New hepatitis C treatments have dramatically increased cure rates, shortened treatment durations and have few side effects. The first national best practice recommendations for harm reduction have been produced, and there is a growing evidence base to inform the development of new age-cohort and risk-based national guidelines for hepatitis C screening and diagnosis. There is also updated epidemiological data on priority populations and new research findings on the sexual transmission of hepatitis C among men who have sex with men. Together, these changes have the potential to significantly transform and improve the national frontline response in hepatitis C prevention, testing, treatment and care for communities and individuals affected and at risk. There is now the possibility of eliminating hepatitis C as a public health threat.
For this goal to become a reality, not only must the new treatments be made accessible to all, but health programs, organizations and systems must be able to properly serve the populations most affected. This includes diagnosing individuals with hepatitis C, providing treatment and care, and preventing further spread of the virus. The burden of hepatitis C is largely carried by populations underserved by the mainstream health system, including people who use injection drugs, people who are in prison, Indigenous populations, street-involved youth, and immigrants and newcomers1 from endemic countries. Older adults have a higher prevalence of chronic hepatitis C than younger people, and they are often dealing with co-morbidities and issues related to aging. The challenge and the opportunity is to develop a health system that responds to the unique realities of populations affected by hepatitis C through a commitment to health equity.
CATIE hosted a National Deliberative Dialogue on Integrated Hepatitis C Programming and Services to explore frontline hepatitis C continuum of care models (prevention, testing, treatment and support) for priority populations and to identify promising directions in hepatitis C programming, policy and knowledge exchange.
The National Deliberative Dialogue highlighted the fact that programs are most relevant and responsive when those most affected shape and tailor programming. Across Canada, service providers and service users are responding to community needs by developing integrated hepatitis C models of care that incorporate a range of broader support services within specific cultural and community contexts. Organizations that promote and foster programs designed and delivered by those most affected are able to be responsive to community needs and provide effective hepatitis C programming. To address the root causes of the epidemic and eliminate hepatitis C as a public health threat, it will be important to maintain and expand the breadth and depth of community-led programs even as treatment times become shorter and easier to manage.
Many integrated hepatitis C models of care have been developed by motivated, driven individuals and organizations, largely working upstream within funding, political and social structures that are not necessarily conducive to the development of creative health equity models. In order for there to be a broader and more effective national response, beyond these outlying and unique integrated hepatitis C models, service providers and service users must mobilize for health sector reforms as well as broader socio-political reforms including the decriminalization of drug use, the development of a national hepatitis C strategy and the promotion of anti-oppression and anti-racism policies. Initiatives that strengthen community systems, including advocacy, cross-movement building and community development, are key factors for success. It is critical that the community mobilize to ensure that the best testing, treatment and care options are available to all, regardless of fibrosis level or social, political, economic, racial and cultural location.
The programming, organizational and structural recommendations within this document can begin to inform a collective response to the hepatitis C epidemic. Each stakeholder has a unique role to play moving forward and the recommendations provide a starting place for more detailed strategizing and action planning which can take place within regions, organizations and communities. As the national knowledge broker in hepatitis C prevention, testing, treatment and care, CATIE will use these recommendations to inform our knowledge exchange work over the next few years. The deliberative dialogue discussions identified that CATIE can continue to play a role in convening these action planning discussions when and where useful, as well as undertake community systems strengthening initiatives and knowledge transfer and exchange activities as outlined in Knowledge exchange resources and tools to build capacity for change. CATIE will continue to engage, consult and follow the guidance of those most affected by hepatitis C as well as a breadth of other stakeholders in defining CATIE’s role and responsibilities in the collective work to eliminatehepatitis C.
At a glance: Recommendations: Programming, organizational and structural recommendations.