Imagine a virus spreading at the rate of one person per hour in Canada — a blood-borne infection that can lead to cancer, organ failure or death. Imagine that this viral infection could cost our healthcare system $260 million per year, within 10 years.
Posted at 12:00 p.m.
Now imagine that we could eliminate this viral infection without distancing measures, without masks, without telework orders and without cancellation of events. Imagine that we already had the strategies and medications to prevent, diagnose, treat and cure this infection. Imagine that a coalition of experts has already devised an action plan to eliminate this virus as a public health threat in Canada.
In fact, you don’t have to imagine anything, because that’s the reality of hepatitis C.
Both for our health and in terms of the cost to the healthcare system, hepatitis C is one of the worst-burdening viral infections in the country.
On the other hand, it receives surprisingly little attention in public policy priorities. Yet its elimination is one of the simplest and most efficient public health strategies imaginable.
Prevention
Unlike hepatitis A and B, there is still no vaccine against hepatitis C, but there are proven strategies to prevent its transmission. In Canada, one of the main routes of hepatitis C transmission is through sharing drug use equipment. Studies have shown that distributing new equipment to people who use drugs can reduce sharing so that the virus cannot be transmitted.
Harm reduction programs that do just that are unfortunately met with resistance, despite preventing hepatitis C, HIV and overdoses. Regulatory hurdles and political opposition take up the time of front-line responders who could provide life-saving services. With the political support and funding required, these programs could be the cornerstone of our efforts to eliminate hepatitis C, especially in communities less likely to have access to mainstream health services.
The diagnosis
Interestingly, a person can live up to 20 years with hepatitis C without showing any signs or symptoms. It’s a double-edged sword because she might not be detected until it’s too late. Since the potential exposure dates back a long time, the person or their healthcare provider will not necessarily see a risk or a reason to screen.
That’s why liver specialists recommend that everyone born between 1945 and 1975—one of the most common age groups for hepatitis C in Canada—be tested for hepatitis C at least once. .
Doctors also recommend offering testing in other communities for all ages, including immigrants and people new to countries where hepatitis C is common, Aboriginal people, people who inject drugs, gay and bisexual men as well as people with experience of the prison system. Community organizations that already work with these populations are well positioned to educate them about the need for hepatitis C testing, demonstrating cultural competence and taking into account the unique circumstances that create increased risk in these communities.
Treatment and cure
Hepatitis C is the first chronic viral infection for which there is a cure.
After eight to twelve weeks of treatment, the current generation of direct-acting antivirals (DAAs) cure more than 95% of cases. Yet, seven years after the first DAAs were added to public drug formularies in Canada, the initiation of this treatment has stalled.
Simplifying the treatment process has been identified as a key strategy to help people achieve healing. Rather than waiting for an appointment with the hepatologist, primary care providers could be trained and supported to prescribe treatment and monitor its progress. Waiting times for treatment can also be reduced by eliminating elective testing, taking advantage of telehealth services, entrusting treatment to nurses and integrating mobile hepatitis C clinics into the health services offered. to the most affected communities.
Hepatitis C is eliminated…if you want it
By investing in community health services, expanding access to testing and simplifying the process from diagnosis to treatment, imagine for a bit that we could eliminate this viral infection. Considering everything that has been done to control COVID-19 over the past two years, it seems relatively simple and easy to achieve.
What’s stopping us?