Blueprint to Inform Hepatitis C Elimination Efforts in Canada: What do service providers need to know?


Blueprint to Inform Hepatitis C Elimination Efforts in Canada: What do service providers need to know?

Virus targets
Hepatitis C
WHO region
Region of the Americas
Geographic level

Canadian Network on Hepatitis C

Year of HCV Elimination Goal

Executive Summary

Although preventable and curable, hepatitis C virus (HCV) infection has been described as Canada’s “most burdensome infectious illness” since it causes more years of life lost than any other infectious disease in the country.Without urgent actions, HCV will continue to spread, and Canada will face increasing rates of HCV-related illness and death in the coming years, with a corresponding surge in healthcare costs.

There is no vaccine for HCV, and new infections continue to occur at an alarming rate. HCV disproportionally affects a number of populations in Canada, including people who inject drugs (among whom up to 85% of new infections occur), Indigenous peoples, people with experience in Canada’s federal and provincial prisons, immigrants and newcomers from countries where there are high rates of HCV, and gay and bisexual men who have sex with men (gbMSM). 

Addressing HCV in Canada will require specific efforts in these groups that are often left behind by mainstream programs for HCV care. People in these Priority populations may need tailored interventions to ensure that they have equitable access to high quality HCV services. Many people who are at risk for, or living with HCV face stigma and discrimination, which discourage them from seeking prevention, testing, treatment and care, as well as other essential social services. De-stigmatizing HCV is crucial for successful delivery of services that will reach people who need them most.

Increasing access to HCV testing in Canada is essential, so that people who are living with HCV can be diagnosed and linked to care and treatment. HCV causes few symptoms in most people until liver damage is very advanced, which may explain why over 40% of the estimated 250,000 people living with HCV in Canada are unaware of their infection.

Canada is facing twin HCV epidemics - one of new infections, primarily among young people who inject drugs (PWID), and one of long-standing HCV infections among people born between 1945 and 1975. People born between 1945 and 1975 account for over 60% of HCV infections in Canada. As they age, rates of liver failure, liver cancer and death among this birth cohort are expected to rise rapidly. In addition to the human toll, the increasing rate of complications from HCV will be very costly to thehealthcare system.

Fortunately, unlike other chronic viral infections, HCV is curable. Remarkable progress has led to development of highly effective new treatments, direct-acting antivirals (DAAs), which cure over 95% of people with 8 to 12 weeks of once-daily pills that have few or no side effects. Cure stops HCV progression, reduces the risk for liver-related morbidity and mortality, all-cause mortality, and improves quality of life. 

HCV treatment has an added public health benefit: prevention. By curing people living with HCV, onward transmission to others is prevented. 17-19 Treatment is not the only preventative approach. Evidence-based harm-reduction strategies such as high-coverage needle syringe programs and opioid agonist therapy can reduce the risk of HCV transmission along with other proven benefits that reduce the devastating toll of opioid overdoses in Canada. 

Now that HCV can be easily cured, momentum around global and national strategies to eliminate HCV has been building. In 2016, Canada endorsed the United Nations Sustainable Development Goals and the World Health Organization (WHO) Global Health Sector Strategy (GHSS) for viral hepatitis and adopted its targets – including eliminating HCV as a public health threat by 2030.

In 2018, the Public Health Agency of Canada (PHAC) launched the Pan-Canadian Framework for Action to Reduce the Impact of Sexually Transmitted and Blood-borne Infections (STBBI) - which includes HCV, and is aligned with WHO timelines and targets. This framework is based on a syndemic approach to disease, which considers how different illnesses worsen each other – and how inequities and social, economic, environmental and other circumstances increase their harm. It calls for an approach grounded in cultural relevance, human rights and health equity, and the recognition that services must reflect “…different cultures, genders, orientations, and abilities… and address a range of psychological, emotional, cultural, physical health, and practical needs.” 

The Blueprint to inform hepatitis C elimination efforts in Canada was created to complement the Pan-Canadian STBBI Framework for Action with tangible steps built around its pillars, linked to objectives and time-bound, measurable targets. It is divided into four sections: Priority populations, Prevention, Testing and diagnosis, Care and treatment, each including key objectives for developing the infrastructure and tools needed to achieve targets. There are many ways to achieve the same goals, and major differences across the country in terms of the HCV burden and healthcare delivery, so each section includes Suggested activities
with recommended Good practices that highlight evidence-based HCV interventions. A Research agenda is also included to address key knowledge gaps related to HCV prevention, testing, care and treatment.

The Blueprint is designed to offer options that can be tailored to different contexts, cultures, populations and areas, and to ensure equity across its objectives and targets for all Priority populations. Ultimately, the goal of this Blueprint is to provide provinces, territories and the federal government with a menu of options for developing action plans relevant to their unique situations, to collectively lead to the elimination of HCV as a public health threat in Canada.

07 May 2020