More testing needed to identify, treat British Columbians living with viral hepatitis: infectious diseases expert

Screening for hepatitis C is simple and a result can be returned in 20 minutes.

Seven years after Canada pledged to eliminate viral hepatitis by 2030, a new report is shedding light on how each province—including British Columbia—is faring when it comes to reaching that target.

Action Hepatitis Canada is set to release its findings to the public on Thursday, which is the second annual Canadian Viral Hepatitis Elimination Day (CanHepDay).

The report is focused on two types of liver infections—Hepatitis B (HBV) and Hepatitis C (HCV)—that can cause liver damage, cancer and even death when untreated.

Back in 2016, Canada adopted the World Health Organization’s strategy to eliminate viral hepatitis as a public health threat by 2030, meaning provincial and territorial governments had to come up with individual plans to meet that national target.

While the report by AHC shows British Columbia is progressing towards Canada’s goal, the findings highlight room for improvements in the province's plan.

B.C.'s PROGRESS AND CHALLENGES

B.C. is on track to reach its HCV elimination targets, but is lagging behind its HBV goals, according to the report.

AHC estimates that 28,607 people in the province live with HCV, but the number of HBV cases is unknown.

Dr. Brian Conway, medical director of the Vancouver Infectious Diseases Centre, told CTV News that the number of people who are infected but undiagnosed is likely in the tens of thousands.

Between January 2021 and November 2022, Conway estimates his team treated 300 people for hepatitis in the Downtown Eastside alone.

HCV is curable through oral treatment, with daily pills for between eight and 12 weeks, while HBV is a vaccine-preventable infection.

People who inject drugs account for 85 per cent of all new hepatitis C infections, according to the AHC report, which is partially why Conway says B.C.’s efforts should include improving access to testing and treatment on the Downtown Eastside.

“This is existing in the context of an ongoing opioid overdoes crisis. You’ve got a population that’s disengaged in care and for whom the main priority, from a health care perspective, is staying alive and from a social perspective, having access to dignified housing,” Conway said.

“So if we say, ‘We’re going to help you get into addiction care and stay in it, and get you into housing, all while addressing hep C—which isn’t affecting your health now but certainly can moving forward,' we need to present it in that context,” he added. “If I or others go into the inner city and say, ‘Your main problem is hepatitis C,’ our credibility is very low.”

Rather than risk-based screening, Conway would like to see B.C. screen the entire population once in their lifetime.

“To improve how we treat more people, we need to find these individuals. We need to test more broadly, in more ways, in more locations so that everyone who thinks they may have hepatitis C will have access to the test,” said Conway.

In addition to people who inject drugs, priority populations outlined in the AHC report include people who are incarcerated; Indigenous people; gay, bisexual and other men who have sex with men; newcomers and immigrants from countries with high rates of HCV; and people born between 1945 and 1975.

The report by AHC commends B.C. for making hepatitis testing and treatment available in corrections facilities across the province.

To progress further towards the goal of eliminating viral hepatitis, the report recommends the implementation of the BC Roadmap to Viral Hepatitis Elimination, which is currently in development.

In addition, the report suggests B.C. remove testing requirements and implement universal HCV prenatal testing.

To address HBV, the report recommends B.C. vaccinate all babies for the virus at birth and cover HBV screenings and vaccinations for adults.

To reach its HCV target, the province needs to treat 1,788 people annually for the next seven years.

“We have the tools at our disposal to achieve that important goal, we just have to work together in a co-ordinated fashion,” said Conway. “(Hepatitis) needs to be recognized as an infection that is quite prevalent and it’s cost-effective to provide this treatment to anyone with an active infection."