What does it take to eliminate hepatitis C in a city like Montreal?
What would it take for Montreal to eliminate hepatitis C? The short answer: sustained, collective effort. The reality is that hepatitis C is both preventable and curable, but it continues to affect communities across Montreal. These communities are often those facing the greatest barriers to care. While hepatitis C treatment can be simple, eliminating the virus at a population level is a challenge. It tests how effective health systems can work across sectors and reach those often left behind by traditional systems of care.
The Métropoles sans Hépatite C (MSHC) project was created with an ambitious goal: to make Montreal the first city in North America to eliminate hepatitis C. We aim to do this through community-specific approaches to diagnosis, treatment and prevention. By changing how and where care is delivered, MSHC shows what becomes possible when elimination efforts are grounded in equity and lived experience.
The origins of Métropoles sans Hépatite C
According to the World Health Organization, hepatitis C is eliminated as a public health threat when 90% of people living with the virus are diagnosed and 80% of those who need treatment receive it. This would sharply reduce new infections and HCV-related deaths. These targets are global and national ones, but they can be applied at a local level. However, doing so needs approaches that reflect the realities of specific cities and communities.
MSHC was formed in 2019 as a collaborative initiative led by Dr. Marina Klein (McGill University Health Centre), Dr. Julie Bruneau (Centre hospitalier de l’Université de Montréal), Dr. Christina Greenaway (Jewish General Hospital) and Laurence Mersilian (Centre Associatif Polyvalent d’Aide Hépatite C – CAPAHC). Our goal is to eliminate hepatitis C in Montreal and create a roadmap that other cities can adapt to their local communities. From the outset, the project recognized that elimination would require more than clinical capacity. It would depend on sustained collaboration between healthcare systems, public health departments and community-based organizations.
A community-centred approach to elimination
MSHC is grounded in the meaningful participation of people most affected by hepatitis C and the organizations that serve them. These communities include people who use drugs, people with lived experience of incarceration, immigrants and refugees, Indigenous people, gay, bisexual and other men who have sex with men and people born between the years 1946 to 1964.
Instead of top-down program design, MSHC uses co-design to bring together lived experience, community expertise and professional knowledge. By valuing lived experience as a form of expertise, MSHC aims to shift how elimination initiatives are imagined and implemented. This integrated model encourages shared learning and decision-making. It also ensures that interventions are relevant, accessible and aligned with community priorities and realities.
We would be remiss not to acknowledge the increasingly challenging context faced by Montreal community organizations amid ongoing social crises, including housing instability, food insecurity and a toxic drug supply, compounded by the lasting impacts of the COVID‑19 pandemic. These pressures have contributed to significant staff turn over and burnout, underscoring the importance of pursuing approaches that do not add to the operational burden of community workers. We continue to work closely with our community partners to develop interventions responsive to these realities while advancing hepatitis C micro‑elimination efforts.
What have we done so far?
MSHC began with a qualitative study designed to better understand the barriers to treatment faced by people who inject drugs and people who have recently immigrated. Through interviews and focus groups, participants consistently said competing life priorities and misinformation about treatment were major barriers. Many described feeling that they needed to “get their life together” before considering hepatitis C care.
Participants also said that housing instability, food insecurity, immigration precarity and challenges with substance use affected their sense of readiness. These show how broader structural issues are directly related to the health of marginalized communities. Participants emphasized that peer-led services are essential for starting and staying engaged in care. Key aspects of these include access to accurate health information and supportive connections to trusted people and organizations.
Testing for hepatitis C within community settings
To explore the potential for community workers to deliver rapid point-of-care hepatitis C testing, MSHC supported CAPAHC’s pilot project CADRE-C. Under Québec’s Medical Act, hepatitis C screening is currently limited to licensed healthcare professionals; CADRE-C was designed to explore the feasibility and value of point-of-care testing in community settings. It aims to evaluate the role of trained community workers in expanding access to screening. The project has been implemented as a continuous service in four community organizations and also includes pop-up screening events with other community organizations or cultural events based on how meaningful they are to the key populations. It aims to generate evidence to shape policy and practice, particularly for reaching those who may not engage with traditional healthcare environments.
Increasing access and continuity of care
MSHC also collaborated with the Direction régionale de santé publique de Montréal (DRSP) in an 18-month pilot study to identify those previously diagnosed with hepatitis C and offer pathways for relinking to care. Beginning in 2024, a public health team member contacted people who potentially had hepatitis C and referred them for confirmatory testing and/or treatment. By tracking progress through the cascade of care, the project helped clarify how public health could more effectively support people as they navigate each stage of the continuum.
This collaborative work led to the DRSP revising their hepatitis C care cascade data and providing linkage to care for individuals previously lost to follow-up. Following the end of the study in December of 2025, the DRSP has integrated this hepatitis C relinkage intervention into their scope of work.
Culturally safe approaches to hepatitis C awareness
A central position in the team is the STBBI outreach worker at the Indigenous Health Centre of Tiohtià:ke. The Indigenous Health Centre of Tiohtià:ke is a community‑led, culturally grounded health and wellness hub in Montreal that provides holistic, trauma‑informed care for Indigenous people, addressing critical gaps in a service landscape where many community organizations do not have an explicit mandate for sexually transmitted and blood borne infections. The STBBI outreach worker’s primary focus is building a network amongst Indigenous-led community organizations, as well as encouraging culturally relevant hepatitis C education and awareness. This approach fosters trust, strengthens relationships and is an essential step in building relationships before having discussions of testing or treatment.
What’s coming next?
Building on insights from early MSHC data and understanding the role that housing insecurity can play in preventing people from engaging in hepatitis C care, MSHC will bring testing services to transitional housing. In parallel, MSHC is supporting the second phase of a community pharmacy testing project to better reach communities that already have trusted relationships with their local pharmacy. Together, these approaches increase access by bringing testing and care directly to individuals and communities who may otherwise face challenges accessing hepatitis C care.
What Métropoles sans Hépatite C offers beyond individual projects
Our work through MSHC shows that elimination is not achieved by isolated interventions. It happens through sustained coordination, shared accountability and the willingness to adapt health systems to the people they serve. By linking community-based innovation with public health infrastructure and clinical care, MSHC proves how cities can move from fragmented efforts toward integrated elimination strategies.
Perhaps most importantly, this work shows that hepatitis C elimination is as much about relationships and trust as it is about treatment. When affected communities are engaged as partners rather than targets, elimination becomes more equitable – and more achievable. As MSHC moves forward, we seek to give a practical template for cities to translate global elimination goals into local, people-centred action.
James O’Grady is a research coordinator with the Métropoles sans Hépatite C initiative in Montreal, Canada. He specializes in qualitative research and works closely with affected communities to ensure lived experiences inform program design and policy for hepatitis C elimination.
Isabelle Robichaud is the project manager for Métropoles sans Hépatite C. With years of experience in HIV and hepatitis C research across both clinical and community settings, she brings strong expertise in designing and implementing projects driven by community‑identified priorities. She also maintains a well‑established network of partners across the sector, with a particular focus on collaboration, accessibility and harm‑reduction approaches.