Five ways to sustain the hepatitis C elimination efforts in Canada

This June, CATIE and the Canadian Network on Hepatitis C (CanHepC) co-hosted a webinar on sustaining the hepatitis C response before and after the novel coronavirus disease (COVID-19) pandemic. We invited leaders in the hepatitis C field to explore the challenges that the pandemic has posed for hepatitis C elimination efforts, but also the opportunities that could be leveraged.

Here are just five of the ways we can do this:

1. Leverage resources from the COVID-19 public health response

The COVID-19 response has placed a spotlight on the public health response to infectious disease. Significant resources have been allocated to test, trace and prevent COVID-19, and hepatitis C could be integrated into some of these approaches. This may include bundling hepatitis C testing with COVID-19 testing, or using COVID-19 testing as a way to engage marginalized populations in healthcare. The increased capacity of provincial public health laboratories can help us improve diagnosis and surveillance of hepatitis C in Canada.

2. Expanding testing to find new cases of hepatitis C

There has been renewed investment in public health testing, to increase both the capacity and speed at which we can diagnose cases. With the difficulty of providing in-clinic testing during the pandemic, we may also look to alternative technologies such as dried blood spot testing, point-of-care testing or even look into self-testing. These are methods which can be done outside of medical settings, as viable alternatives to traditional testing methods.

3. Simplify the cascade of care

Through COVID-19, it has been increasingly difficult to engage people in healthcare. Hepatitis C treatment in the era of modern direct-acting antiviral treatments is remarkably simple and effective. This allows us to simplify the testing and treatment process, reducing our reliance on specialists, and curing more people. Telemedicine and remote medical appointments have proven to be a viable alternative that can now be leveraged to expand the reach of hepatitis C treatment. Tasks such as point-of-care testing can be done by non-clinical staff such as outreach workers, increasing healthcare worker capacity and our ability to reach marginalized people who do not access traditional medical services as often. We also heard how British Columbia has moved to reflex testing, further removing laboratory steps in the diagnosis process.

4. Innovative hepatitis C programs that include social, cultural and harm reduction supports

Marginalized populations, such as people who use drugs, Indigenous communities and racialized people, have faced even greater hardships during the COVID-19 pandemic. Hepatitis C testing and treatment cannot exist in a vacuum, and must provide appropriate social and harm reduction supports for a person to be cured and prevent re-infection. This may include cultural supports, housing assistance, and a safer supply of drugs. Particularly now, in the midst of the twin epidemics of the overdose crisis and the COVID-19 pandemic, many priority populations are at even greater risk. Governments across Canada have shown they can move quickly to provide income and substance use support during the pandemic, and this must continue to support the most vulnerable in our society.

5. Stay focused and motivated in working towards elimination

Prior to the pandemic, there was promising evidence that Canada was on the right track to reach elimination by 2030, but only if we remained aggressive in prevention, testing and treatment. The COVID-19 pandemic has undoubtedly created a setback in both testing and treatment numbers and policy action. Despite this, policy-makers and service providers must stay motivated and focused. Through our combined efforts, elimination is still a reachable goal in Canada.

To learn more, watch the recording of our recent webinar, Hepatitis C elimination: Sustaining the Canadian response during and after COVID-19.

Christopher Hoy is a Knowledge Specialist in Hepatitis C Community Health Programming at CATIE. He moderated the recent webinar, Hepatitis C elimination: Sustaining the Canadian response during and after COVID-19.