Ontario is unlikely to meet Canada’s targets for eliminating hepatitis C as a public-health threat by 2030 if it continues its current testing and treatment model, a recent study by the University of Waterloo reveals.
The study focused on hepatitis C cases in Ontario, using data starting in 2006, to predict the outcomes of current screening and treatment strategies. It then compared how these outcomes measure up with the World Health Organization’s targets that Canada committed to achieving by 2030.
It examined the progress of the province and the country as a whole under the WHO’s strategy for reducing, screening and treating hepatitis C. The study contrasted the current approach with three potential strategies: aggressive treatment; aggressive screening and treatment; and enhanced harm reduction.
“If you really want to achieve the new-cases target, the harm-reduction strategies need to be there,” said William W.L. Wong, an associate professor at the University of Waterloo’s School of Pharmacy.
He explained that without these strategies, such as education about hepatitis C, people’s behaviours won’t change and can lead to new infections.
Hepatitis C is an infection of the liver caused by a viral infection. It is one of five strains of hepatitis, all of which cause liver inflammation.
Two strains, hepatitis B and C, are the most common causes of more dangerous liver diseases, such as cancer and cirrhosis, which is severe scarring in the liver. Hepatitis B is typically contracted through bodily fluids whereas hepatitis C is only through blood-to-blood contact.
Currently, the qualifications for recommended hepatitis C screening fall into two categories: risk-based and clinical indication.
The risk-based approach recommends testing for individuals with risk factors such as using shared drug-injection equipment, exposure to non-sterile medical equipment, engaging in sexual behaviour where blood is present, or being from a region with a high prevalence of hepatitis C.
The clinical-indication approach recommends testing for individuals who are diagnosed with hepatitis B or human immunodeficiency virus, HIV.
While there is a vaccine for hepatitis B, there isn’t one for hepatitis C, which can be treated with direct-acting antiviral (DAA) medication. DAA targets the virus to “eradicate” it from the body, according to the Canadian Liver Foundation.
The study’s analysis of Ontario shows that current screening and treatment approaches will fall short of Canada’s commitment to the WHO targets by 2030. This includes reducing new hepatitis C infections by 80 per cent, related deaths by 65 per cent and treating 80 per cent of these cases.
The study’s comparison found that the enhanced harm-reduction strategies can reduce new cases by 57.6 per cent. The current strategy of screening and treating as needed would reduce new cases by only 11.1 per cent.
“Most of the developed countries, including Canada, only focus on screening and treatment,” Mr. Wong said. “Sometimes they may overlook the harm reduction.” He explained that harm-reduction strategies include education about the spread of hepatitis C and needle-exchange programs.
In response to the study, Anna Maddison, a spokesperson for the Public Health Agency of Canada, said the country remains committed to meeting these goals.
“We have more prevention, testing and treatment tools than ever before, but much work remains to be done,” she said.
Ms. Maddison said in February that the government launched an action plan on sexually transmitted and blood-borne infections, which includes hepatitis C.
This plan includes 16 recommendations for actions by the federal government, which mentions using harm-reduction strategies such as comprehensive sexual-health education.
According to the WHO’s 2016 report on a strategy toward ending viral hepatitis, efforts to find a vaccine for hepatitis C have been reduced as a result of the development of effective treatments, such as DAA.
“This trend needs to be reversed,” the report said, explaining that the development of a hepatitis C vaccine would be a “powerful addition” to the treatment, prevention and intervention of the virus.
This study by the University of Waterloo only focuses on hepatitis C because the research team did an analysis of hepatitis B in 2022. It found that Ontario is also falling short of the WHO’s targets for the prevention and screening of hepatitis B.