How hepatitis C testing works: Guidelines and practices

Key points

In Canada, two broad approaches to hepatitis C testing are used: risk-based testing and one-time testing.
Risk-based testing is the main approach to hepatitis testing in Canada. It involves testing people who have an increased chance of being exposed to hepatitis C because they engage in activities that put them at risk for hepatitis C or because they may have been exposed to hepatitis C in the past.
One-time testing is an approach to expand hepatitis C testing to reach the large proportion of people with undiagnosed chronic hepatitis C in Canada.
Hepatitis C testing practices vary across Canada and are determined at a provincial or territorial level. These practices are informed by national guidelines.
Testing can take place in a variety of settings, including healthcare providers’ offices, hospitals, public health clinics, prisons, health centres, and mobile health vans or other outreach settings.

In Canada, two broad approaches to hepatitis C testing are used: risk-based testing and one-time testing.

Risk-based testing

Risk-based testing is the main approach to hepatitis testing in Canada. It involves testing people who have an increased chance of being exposed to hepatitis C. This may be because they engage in activities that put them at risk for hepatitis C (e.g., sharing drug use equipment) or because they may have been exposed to hepatitis C in the past (e.g., received a blood transfusion before routine screening was implemented).

Regular, ongoing testing is recommended for people who have ongoing risks for exposure to hepatitis C.

Risk-based testing can be integrated into existing services, including programs that support the health and well-being of people who use drugs, services for people who are currently incarcerated and other forms of routine testing, such as care for people who are on HIV pre-exposure prophylaxis (PrEP).

One-time testing

One-time testing is an approach to expand hepatitis C testing to reach the large proportion of people with undiagnosed chronic hepatitis C in Canada. This form of testing also addresses barriers to testing, such as limited knowledge about hepatitis C among healthcare providers and patients. Systematically offering a hepatitis C test to everyone within a given group also helps to address hepatitis C stigma by normalizing testing in the general population and in the testing conversations between providers and patients. It also removes the requirement for a person to disclose risk factors to access testing.

Birth cohort: 1945–1975

There is evidence that there is a high prevalence of undiagnosed hepatitis C among people born between 1945 and 1975. Testing and linkage to care can be life-saving in this birth cohort, which also has the highest rates of hepatitis-related liver failure and liver cancer.

One-time hepatitis C testing of everyone in this birth cohort has been recommended by the Canadian Association for the Study of the Liver and the Blueprint to Inform Hepatitis C Elimination Efforts in Canada, but uptake has been limited.

Screening in pregnancy

One-time testing can also be used to find undiagnosed hepatitis C infections among pregnant people. The Society of Obstetricians and Gynaecologists of Canada recommends universal hepatitis C antibody testing in the first trimester of every pregnancy, although implementation of this recommendation varies across Canada.

Guidelines and testing practices in Canada

The main national source for hepatitis C testing guidelines in Canada is the Canadian Association for the Study of the Liver’s guidelines for the management of hepatitis C. These national guidelines inform provincial and territorial testing practices. Some provinces have additional recommendations beyond those included in the national guidelines.

Hepatitis C testing practices vary across Canada. Each province and territory across the country is responsible for determining:

the availability of testing in different settings
which testing technologies are widely available
who can offer and administer testing
what personal information is collected
how the blood samples are processed in the laboratory

Most hepatitis C testing in Canada starts in a healthcare provider’s office, but it is not uncommon for testing to be initiated in other settings, such as hospitals, public health clinics, prisons, health centres, and mobile health vans or other outreach settings.

Resources for service providers