Today, Thursday May 11th, marks the second annual Canadian Viral Hepatitis Elimination Day. With a global focus on access to testing and equitable access to care, viral hepatitis could be eradicated in modern society.
Dating back to 2016, World Health Organization (WHO) issued the first Global Health Sector Strategy on Viral Hepatitis with a goal of eliminating viral hepatitis as a public health threat by 2030. Canada was one of 194 countries that committed to support this global goal.
Report: Progress Toward Viral Hepatitis Elimination
Today, Action Hepatitis Canada (AHC) released its 2023 report Progress Toward Viral Hepatitis Elimination in Canada. Although the report does not consider all the targets set in the various strategies and blueprints, several key metrics are included for Canada and the individual provinces and territories including Planning, HCV Testing, HCV Treatment, HCV Prevention, HCV Testing-to-Treatment Link, and HBV Preventions.
The targets being considered to eliminate viral hepatitis as a public health threat by 2030 include:
- 90% reduction in new cases of chronic HBV and HCV infections
- 65% reduction in HBV and HCV deaths
- 90% of HBV and HCV infections are diagnosed
- 80% of HBV patients receiving treatment and HCV patients achieving sustained virological response (SVR)
- 300 needles/syringes distributed per PWID
Priority populations for HCV or viral hepatitis continue to be:
- People who are incarcerated (PWAI)
- People who use drugs (PWUD)
- Indigenous people
- Gay, Bisexual, and other Men Who Have Sex with Men (bgMSM)
- Newcomers and Immigrants from Countries with High Prevalence Rates of HCV
- People born between 1945-1975
With provinces and territories responsible for the provision of healthcare within their own borders, we will focus on the progress with British Columbia. When it comes to viral hepatitis testing, BC is fairing pretty well in terms of HCV testing and HCV access to treatment.
When it comes to hepatitis B (HBV) on the other hand, the results are not as good. In fact, across the country, not a single province and territory is on track for either HBV testing or access to a universal HBV vaccine although it is noted that further data is needed to form a complete picture. The report goes on to recommend the implementation of both “HBV vaccinations at birth for all babies and universal HBV screen and vaccination for adults.” It is reported that “the majority of cases of HBV are among newcomers and immigrants from countries where HBV is prevalent.”
Like all other provinces and territories with the exception of Saskatchewan and Alberta, it is recommended that BC implement universal HCV prenatal testing.
In terms of viral hepatitis screening, treatment, and retention in care after release from a corrections facility, BC is certainly a leader in Canada. Although no province has implemented Needle Syringe Programs as disease prevention, in all five other categories considered, BC has provincial policies in place currently including access to HCV testing and treatment equal to that available in the community and access to Opioid Agonist Therapy (OAT) for both initiation and maintenance.
Public Health Agency of Canada (PHAC) Perspectives
The Public Health Agency of Canada (PHAC) recently released a Hepatitis C in Canada: 2020 surveillance data update, based on surveillance data reported by provincial and territorial health authorities from 2011 to 2020. The update notes that hepatitis C (HCV) rates rose from 2011 to 2018 in Canada and then showed a downward trend into 2019. However, it is evident by the numbers that HCV continues to be a very large public health concern across the country.
According to the reported data, as of 2020, British Columbia’s HCV rate was the second highest province with 27.8 cases per 100,000 people constituting 21.3% of overall reported cases in Canada.
In 2020, the highest reported cases for acute HCV rate were people aged 30 to 39 years, with 58.7% of those being male.
The surveillance data provided also clearly indicated that HCV “disproportionately affects certain populations and communities in Canada, including people who inject drugs; people who are incarcerated; First Nations, Inuit, and Métis people; gay, bisexual, and other men who have sex with men; immigrant populations; and the 1945-1975 birth cohort”.
BC Provincial Government Action on Viral Hepatitis
In 2007, the BC government released Healthy Pathways Forward: A Strategic Integrated Approach to Viral Hepatitis in British Columbia to serve as a provincial blueprint to complement, guide and support community and health authority efforts to address viral hepatitis in BC. This was developed by the Ministry of Health in collaboration with the BCCDC, regional health authorities, community partners, clinicians, and people with lived and living experience of viral hepatitis. In 2010, the Healthy Pathways Forward Progress Report was released to serve as an update of the progress the province had made in meeting the four goals discussed in the original Healthy Pathways Forward. Since 2015 the Ministry of Health began a process to refresh its strategic policy related to viral hepatitis by participating in the development of BC’s Roadmap to Viral Hepatitis, but a second progress report has not yet been released.
People Who Use Substances Speak Up
Also in recognition of Canadian Viral Hepatitis Elimination Day, the International Network on Health and Hepatitis in Substance Users (INHSU) in partnership with CATIE , launched three new ‘Connecting with Care’ films, which highlight innovative models of hepatitis C care from regions across Canada including one that focused on the Victoria CoolAid Society in Victoria, BC and their approach to healthcare and hepatitis C. The video and transcript can be found here.
Call to Federal Government Action
In anticipation of Canadian Viral Hepatitis Elimination Day, Action Hepatitis Canada released the five key things the federal government could do right now to work toward our elimination goal, including:
More information can be found at Action Hepatitis Canada and by searching the hashtags #CanHepDay23 and #HepCantWait on social media platforms.
Questions? Contact Jennifer Demchuk, Research and Evaluation Manager