Immigrants, newcomers and refugees face specific factors that increase their risk of viral hepatitis transmission. Understanding these factors and learning how to better reach these communities through viral hepatitis services is essential to improving health outcomes among migrants living in Canada. CATIE asked two experts about factors related to viral hepatitis transmission among migrants, the barriers these individuals face in accessing viral hepatitis testing, treatment and care, and how to effectively engage them in clinical and support services.
- Rachel Talavlikar is a primary care physician and medical director at the Calgary Refugee Health Clinic. She is also co-chair of the Canadian Refugee Health Network.
- Sheryl Wolfstadt is a registered nurse and coordinator of hepatology treatment at Bioscript Solutions.
See more in the article: Bridging the gap in viral hepatitis care for immigrants and newcomers in Canada
Rachel Talavlikar, primary care physician and medical director, Calgary Refugee Health Clinic; co-chair, Canadian Refugee Health Network
From your perspective, what are the biggest barriers that refugees face when trying to access care for viral hepatitis in the community? The biggest facilitators?
Refugees face several intersecting barriers when accessing care for viral hepatitis in the community. Language and communication challenges remain one of the most significant hurdles. Many patients speak a different language than their healthcare provider, and without consistent access to professional interpreters, there is a risk of miscommunication around diagnoses, medications and follow-up care. System navigation is another critical barrier — understanding how to access care, what services are covered under the Interim Federal Health Program (IFHP) or provincial [or territorial] plans, and how to follow up can be overwhelming for newcomers. Stigma related to hepatitis B, often rooted in cultural perceptions, can deter patients from seeking care. Social instability — such as housing insecurity, food scarcity or precarious immigration status — can deprioritize health concerns altogether.
On the other hand, key facilitators have emerged through intentional, integrated care design. Continuity with culturally competent, trauma-informed providers builds trust and fosters long-term engagement. Language-concordant care — or care that is in a person’s preferred language, whether through bilingual staff or professional interpreters — greatly enhances communication. Multidisciplinary teams and co-located services (e.g., primary care, social work, mental health) reduce silos and allow for wraparound support. Community partnerships — especially with settlement agencies or cultural organizations — help reduce stigma and provide education in culturally relevant ways. Patient navigation services and flexible scheduling also help bridge gaps by making care more accessible and less intimidating. A patient-centred, culturally safe approach has proven essential in reducing barriers and facilitating long-term engagement in hepatitis care.
What are the most common health and social service referrals you provide that support refugees to engage in viral hepatitis testing and treatment?
In our clinic, we are fortunate to offer on-site screening for viral hepatitis as part of a shared care model embedded within a trauma-informed, refugee-centred primary care setting. This model removes many traditional access barriers by integrating screening and medical care into the same appointment, within a familiar and trusted environment. Once hepatitis is identified, I work closely with a health navigator who plays a vital role in engaging patients. They help explain the diagnosis in culturally appropriate ways, address stigma or fear and reinforce the importance of long-term follow-up.
For patients requiring specialist input, I collaborate directly with hepatology services, reviewing cases to determine whether referral or ongoing shared care is appropriate. When needed, I also coordinate with public health to facilitate family member screening and vaccination — often offering to support contact tracing or multi-person appointments for ease of access.
If a patient requires treatment, I work closely with community pharmacists to support adherence, offer counselling and promote a clear understanding of their medications. Since many refugee patients face coverage challenges, social workers help navigate IFHP, provincial drug plans and compassionate access programs to ensure affordability and continuity of care.
Because stigma, trauma and mental health concerns often accompany a new diagnosis, we integrate mental health supports, including trauma-informed counsellors familiar with refugee experiences. In addition, I may refer patients to settlement agencies, language programs, mental health counsellors or housing supports, depending on their broader context. These referrals are not stand-alone; they are part of an intentional continuum designed to ensure patients feel supported not only clinically, but socially and emotionally as well, which helps to improve both uptake and retention in hepatitis care.
What are some techniques you use to engage refugees in your clinic?
Engaging refugee patients meaningfully in care requires a deliberate, patient-centred approach grounded in cultural humility and trauma-informed practice. Many of our patients have experienced displacement, trauma or disrupted care journeys, so we start by prioritizing relationship-based care — taking time to build trust, maintain continuity and respect the unique lived experiences each patient brings.
Communication is central. We routinely use professional interpreters rather than relying on family members, ensuring confidentiality and accuracy. For health education, we incorporate visual aids, translated materials and plain-language explanations, especially when discussing chronic conditions like hepatitis B. Whenever possible, we also engage family members or community supports (with consent), recognizing the collectivist cultures many of our patients come from. We proactively follow up through phone calls, reminder texts or outreach, especially if a patient misses an appointment or is at risk of falling out of care.
We also integrate cultural practices into care delivery — for example, being mindful of fasting periods, prayer times or beliefs around Western medicine. Maintaining a non-judgmental tone during difficult conversations helps patients feel seen, respected and empowered. Many of our team have lived experience as refugees or speak multiple languages, enhancing the care received. Ultimately, we focus on creating a welcoming, safe space where patients feel like partners in their care journey, not just recipients of services.
One of the most effective engagement tools is our outreach coordinator with lived experience, who plays a key role in bridging cultural, emotional and language gaps. They meet with patients to explain what hepatitis is, what the testing or diagnosis means and why follow-up matters — always in a culturally safe, compassionate manner. This peer-led support model greatly enhances understanding and trust.
Sheryl Wolfstadt, registered nurse, coordinator of hepatology treatment at Bioscript Solutions
What are some of the biggest challenges associated with viral hepatitis screening, testing and engagement in care in immigrant, newcomer and refugee populations?
Some of the biggest challenges I encounter when working with this population include:
- encouraging clients to get tested and helping them to understand why testing is important
- limited availability of family doctors who offer hepatitis testing
- clients not following up with their healthcare provider for their results after testing
- limited understanding of hepatitis C and viral hepatitis, including the consequences if left untreated
- encountering communication and language barriers
- fears of testing positive and needing treatment
- a lack of knowledge on currently available treatment options; some clients have heard that treatment was hard for others in the past and don’t know it’s easier and more effective now
- concerns about the cost of treatment and not being aware of the funding available
- worries about treatment side effects and the impact of treatment on daily life and work
- feelings of shame of having a virus that is contagious and possibly sexually transmitted, and fear they may pass it to others
What are some techniques you use to engage immigrants, newcomers and refugees in your clinical practice?
To engage these clients in accessing care and treatment, I use the following approaches:
- have open and honest conversations about the nature of viral hepatitis and available treatments
- provide educational materials in a language the client understands, or give them to a family member or friend who can help explain the information
- review their screening results with them and explain the potential health impacts of not receiving treatment
- arrange for interpretation support when clients are not fluent in English
- share my contact information and encourage clients to discuss their diagnosis with their family, who can contact me if they have questions
- encourage clients to suggest testing for friends and family, both in Canada and in their home country
- use available tools and resources in the clinic to explain what hepatitis C is, how it is passed and how it can be prevented and treated