Hepatitis C: Why testing matters

Key points

The only way to know if a person has hepatitis C is for them to get tested.
Early diagnosis is important because it enables timely treatment and care, which can help prevent liver damage and other health complications, while also reducing transmission in the community.
There are many reasons someone may request a hepatitis C test or have one recommended to them.
A person can experience multiple barriers that make it difficult for them to access hepatitis C testing. Addressing these barriers can improve access to testing.

The only way to know if a person has hepatitis C is for them to get tested.

Hepatitis C is often asymptomatic, meaning someone can live for 20 to 30 years without experiencing symptoms. As a result, many people may not realize they have hepatitis C and may not seek testing or diagnosis. When left untreated, chronic hepatitis C can lead to inflammation and scarring of the liver. Over time, the ongoing injury to the liver can lead to cirrhosis or cancer.

Why early diagnosis is important

Early diagnosis is important because it enables timely treatment and care, which can prevent liver damage and liver disease. Curing hepatitis C ensures the virus is no longer in the body, so it can’t cause any more inflammation or injury to the liver, which can prevent liver damage and reduce the risk of health complications like cirrhosis and liver cancer. When a person is engaged in hepatitis C treatment and care, they can also access other care and supports to improve their health and well-being.

Early diagnosis and timely treatment can also have a positive effect on prevention efforts. A person who is cured of hepatitis C can no longer pass the virus to others, preventing transmission between individuals. Curing individuals living with hepatitis C can also lower the amount of virus circulating in the community, which reduces the chance of someone coming into contact with the virus. This contributes to reduced transmission in the community overall.

Reasons for someone to get a hepatitis C test

Testing is the only way for a person to know if they have hepatitis C. There are many reasons someone may request a hepatitis C test or have one recommended to them, such as the following:

routine testing, such as:
- universal testing for all adults in Canada
- prenatal testing for all pregnant people
possible past or recent exposure to the hepatitis C virus, including:
- coming into contact with someone else's blood
- participating in an activity that can pass hepatitis C from one person to another, even if it was just one time
- living in or receiving medical care in a country where hepatitis C is common
- receiving a blood transfusion or organ transplant in Canada before 1992
symptoms or test results that may indicate a hepatitis C infection or liver damage, including:
- symptoms consistent with advanced liver disease (e.g., jaundice [yellowing of the skin and whites of the eyes], fluid buildup [ascites or edema] and blood in stool or vomit) or, more rarely, acute hepatitis C infection (e.g., fatigue, tenderness or an aching feeling on the right side of the abdomen, jaundice)
- abnormal liver enzyme levels (i.e., alanine aminotransferase [ALT] and aspartate aminotransferase [AST]) identified during routine bloodwork (high liver enzyme levels can indicate current liver damage, which may be caused by a hepatitis infection)

Barriers to testing

There are barriers that a person can experience that make it difficult for them to access hepatitis C testing. These barriers can occur at different levels, including at the client level, the service provider level and the system level.

For a person receiving a test (the client), barriers to testing may include concerns that the test result will not remain confidential, or fear that a positive result could lead to social repercussions such as stigma and discrimination. Some individuals may also not seek testing because they have limited knowledge about hepatitis C, including how it is transmitted or whether they may have been exposed.

Service providers may also pose barriers to testing. For instance, they might not have knowledge about hepatitis C testing (e.g., who should get tested, when to offer a test), they might feel uncomfortable talking to clients about past or current risk behaviours, or they might have competing priorities (e.g., not enough time).

Barriers to hepatitis C testing also include system-level barriers, which arise from how healthcare services are organized and delivered. These barriers can make it more difficult for people to access testing and increase the likelihood that a person will be lost to follow-up before receiving their test result. For example, a person may need to attend multiple appointments to receive a diagnosis. Other system-level barriers include long wait times, limited operating hours and limited language options, all of which can reduce access to timely testing and results.

Addressing these barriers can improve access to testing for people who may not otherwise seek care. One-time testing is an approach that can help to overcome barriers to testing at multiple levels.

Resources for service providers