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Evidence-based guidelines and other tools synthesize research literature, the consensus of experts in the field and practice-based evidence into recommendations that frontline service providers can use to inform their programs and services. In previous issues of Prevention in Focus we reviewed Canadian HIV guidelines and Canadian harm reduction guidelines and manuals. This article will highlight guidelines and strategies to address hepatitis C in Canada.


There are two national sources for hepatitis C testing guidelines in Canada.

The Canadian Task Force on Preventive Health Care developed Recommendations on hepatitis C screening for adults in 2017.  However, the Canadian Liver Foundation, Action Hepatitis Canada and several Canadian liver experts criticized the task force’s screening recommendations when they were released as they did not recommend broad-based screening for adults who are not at high risk for exposure to hepatitis C.

The Canadian Association for the Study of the Liver (CASL) released guidelines for the management of hepatitis C in 2018 that included hepatitis C screening recommendations. The CASL guidelines recommend testing for people at increased risk of infection as well as one-time testing for all people born from 1945 to 1975. CASL cited the low testing rate and high prevalence of hepatitis C in the 1945 to 1975 birth cohort as reasons for the recommendation. The inclusion of testing both for those at increased risk of infection and by birth cohort addresses the concerns raised with the 2017 task force recommendations.

Provincial testing guidelines are informed by the national guidelines. The 2021 Viral hepatitis testing guidelines from the BC Ministry of Health also include a consideration for one-time testing of people born from 1945 to 1975. However, recommendations in some other provinces, such as 2022 recommendations from Quebec and Alberta, do not include testing on the basis of birth cohort.

Post-exposure risk assessment

The guidelines listed here have been developed by provincial and territorial governments. They cover transmission risk assessment following a potential 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 post-exposure management and prophylaxis: HIV, hepatitis B, hepatitis C and sexually transmitted infections  (2019) – Government of Alberta

Blood and body fluid exposure management (2018) – Yukon Health and Social Services

Guide pour la prophylaxie et le suivi après une exposition au VIH, au VHB et au VHC  (2019) – Ministry of Health and Social Services of Quebec (in French only)

Guidelines for the management of exposures to blood and body fluids (2013, with revisions in 2019 and 2020) – Government of Saskatchewan

Blood and body fluid exposure guideline (2019) – Department of Health and Wellness, Prince Edward Island

Post-exposure prophylaxis for HIV, HBV and HCV: Integrated protocol for managing exposures to blood and body fluids in Manitoba (2019) – 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. Updated in 2021, the Best practice recommendations for Canadian programs that provide harm reduction supplies to people who use drugs and are at risk for HIV, HCV, and other harms provide guidance for harm reduction programs on the distribution and disposal of safer drug use equipment.

Treatment and care

The following guidelines address the treatment and care of people with hepatitis C. They include guidelines for people with hepatitis C and people with hepatitis C and HIV coinfection.

The management of chronic hepatitis C: 2018 guideline update from the Canadian Association for the Study of the Liver

CIHR Canadian HIV Trials Network Coinfection and Concurrent Diseases Core Research Group: 2016 updated Canadian HIV/hepatitis C adult guidelines for management and treatment

For additional guidance on hepatitis C treatment and care, international guidelines can also provide information for Canadian service providers.

HCV guidance: Recommendations for testing, managing, and treating hepatitis C (2021) – Infectious Diseases Society of America, American Association for the Study of Liver Diseases

EASL recommendations on treatment of hepatitis C: Final update of the series (2020) – European Association for the Study of the Liver

Guidelines for the care and treatment of persons diagnosed with chronic hepatitis C virus infection (2018) – World Health Organization

Public health management

Communicable disease manuals provide recommended public health practices for the prevention and control of communicable diseases in a province or territory. The manuals include viral infections like hepatitis C and can provide guidance on case definition, testing, follow-up and management after diagnosis and reporting practices when it’s required to notify public health of new cases.

Communicable disease control: Hepatitis C (2021) BC Centre for Disease Control (BCCDC)

Alberta public health disease management guidelines: Hepatitis C (acute case) and Hepatitis C (chronic case) (2021) Alberta Health

Communicable disease control manual: Blood and body fluid pathogens: Hepatitis C (2014) Saskatchewan Ministry of Health

Communicable disease management protocol: Hepatitis C (2020) Manitoba Health, Seniors and Active Living

Appendix 1: Case definitions and disease-specific information: Disease: hepatitis C (2022) Ontario Ministry of Health

Nova Scotia communicable diseases manual: Hepatitis C (2014) Nova Scotia Department of Health and Wellness

Newfoundland and Labrador disease control manual: Section 5: Sexually transmitted infections and blood-borne pathogens (2016) Newfoundland and Labrador Department of Health and Community Services

Hepatitis C (2016) Yukon Department of Health and Social Services

NWT communicable disease manual: Viral hepatitis (2007) and Hepatitis C (case definition) (2013) Northwest Territories Health and Social Services

Nunavut communicable disease and surveillance manual (2018) Nunavut Department of Health

Maladies à déclaration obligatoire (MADO) et signalements en santé publique (2019) – Ministry of Health and Social Services of Quebec (in French only)

Hepatitis C elimination

The World Health Organization has developed global health strategies for the elimination of viral hepatitis, HIV and sexually transmitted infections as public health threats by 2030. Originally released in 2016, the current strategies cover the period from 2022 to 2030.

Canada has signed on to the global health strategies and the federal government has released a framework and action plan to inform the Canadian response to sexually transmitted and blood-borne infections:

Reducing the health impact of sexually transmitted and blood-borne infections in Canada by 2030: A pan-Canadian STBBI framework for action (2018)

Accelerating our response: Government of Canada five-year action plan on sexually transmitted and blood-borne infections (2019)

The Canadian Network on Hepatitis C (CanHepC) also developed the Blueprint to inform hepatitis C elimination efforts in Canada in 2019. The blueprint provides recommended activities and targets to help provinces and territories meet the global hepatitis elimination goal. CanHepC is also supporting the development of regional roadmaps across the country.

For more hepatitis C guidelines and manuals, visit the CATIE website.

About the author(s)

Erica Lee is CATIE’s manager of website content and evaluation. 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).