Open letter update: for more accessible hepatitis C screening

April 28, 2025 

In 2021, 9.4 people out of 100,000 in Quebec had hepatitis C, representing 10.7% of all cases in Canada.¹. Nevertheless, a year and a half after the publication of our first open letter in 2023, we are obliged to renew our appeal to the Quebec government. The Comité provincial de concertation en hépatite C (Provincial Hepatitis C Consultation Committee) is calling for greater capacity for action in the area of community screening, as well as the financial support needed to implement this change. 

On Quebec's Hepatitis C Day, April 29, 2025, we're forced to admit that hepatitis C is still not at the heart of the fight against STBBIs, nor is it a priority. 

The need to lighten the workload of nurses is not considered. Yet nurses have been constantly overworked since the covid-19 pandemic. 

Considering that the community environment has amply demonstrated its ability to provide support, link up with care and prevent STIs, including hepatitis C. It is scandalous that a demand such as community screening is always sidelined in conversations about hepatitis C prevention. The WHO is proposing a comprehensive approach to all STBBIs in order to achieve its elimination objectives. And the INESSS has been mandated to issue an opinion on community-based rapid HIV testing. We wonder why HCV rapid tests have been excluded. Yet these two tests have identical procedures. If this INESSS opinion is positive, how long will we have to wait before this finding is transferable to HCV? HCV can be treated and cured in 8 to 12 weeks. 

In October 2024, our call for support was heard by MP Vincent Marissal. He took the time to express his support for our demands by directly addressing the Minister of Health, Christian Dubé, in a letter of support published on December 9, 2024. We have received support from numerous professionals (nurses, doctors, specialists) via our website. To date, no response has been received from the Minister of Health.  

The Quebec government and Santé Québec must take the cause of hepatitis C seriously, and over the long term. We are therefore reiterating our call for collaboration between the relevant authorities and community organizations to pool all our resources and achieve the WHO's goal of eliminating hepatitis C by 2030, which Quebec has never endorsed.  

See the open letter published/forgotten in November 2023:

On the occasion of International Screening Week, which runs from November 20 to 26, 2023, we, the members of the 33 Quebec community organizations that make up the Comité provincial de concertation en hépatite C, in the spirit of the CAPAHC campaign, let's unite our voices to demand that the various levels of government put the fight against hepatitis C and STBBI back at the heart of their priorities.

Given that we are a long way from achieving the World Health Organization's (WHO) objectives in the fight against hepatitis C, that the situation on the ground is constantly worsening, and that the figures for new STBBI diagnoses are alarmingly high, we are calling for an expansion of our capacity for action in terms of community screening, as well as the associated financial resources.

Vers une offre de dépistage communautaire

In 2016, Canada committed to the elimination of viral hepatitis by 2030, according to WHO targets. Today, Quebec is the province lagging furthest behind, with targets set for 2037 in the absence of additional investment. The numbers of declared and probable cases for the Montreal region in 2023 indicate a clear increase in hepatitis C cases compared with previous years over the same period.

Hepatitis C is a chronic infection for which an effective treatment exists. In fact, over 97% of those treated completely rid themselves of the virus, which can cause severe liver damage. With this in mind, one might be forgiven for thinking that eliminating hepatitis C is a problem that has already been solved. The first step towards a cure is access to screening. However, since the COVID-19 pandemic, access to care has become more difficult and the number of screenings has fallen, due in part to the shortage of nurses in our healthcare system.

One of the best ways to increase the number of hepatitis C screenings would be to enable community workers to offer screening using rapid tests. This practice, which decentralizes and simplifies services, is recommended by the WHO and has been successfully implemented in many countries and some Canadian provinces for several years.

We deplore the fact that its use is still reserved for nurses, when all it requires is a drop of blood taken from a fingertip. What's more, thanks to our decades-long relationship of trust with the communities we serve, we're in the best position to raise awareness among those unreached by the healthcare system. What's more, we have all the expertise needed to accompany these people through the screening process. All we need is the authorization to screen and the financial resources.

In this capacity, we challenged the MSSS on April 29 with our “A plea for community screening". To date, we we haven't even received an acknowledgement of receipt..

The community sector in dire need of resources

Since the COVID-19 pandemic, the overdose crisis, the housing crisis, the delays in obtaining physical and mental health care and the growing precariousness faced by a large part of the population have been exacerbated. The reality observed by our teams in the field is worsening month by month. Similarly, the explosion in the number of requests for services and the increasing urgency of these requests are becoming increasingly difficult for organizations to absorb. The chronic under-funding of the community sector is a reality we've been juggling with for several years, and this rise in distress is increasing our powerlessness to help all those in need. We would like to highlight the work that organizations and teams are doing to complement the healthcare system in the prevention of hepatitis C and STBBIs. That's why we're asking that the specialized expertise of organizations working in the fight against hepatitis C and harm reduction be fully recognized by the various levels of government by increasing the funding allocated.

Essential collaboration between the MSSS and community organizations

In conclusion, it's time to start a real dialogue to identify the government's commitments to preventing hepatitis C and improving the living conditions of people living with the disease. It is in this spirit that we ask you, Mr. Minister of Health, to work together to implement concrete actions. Solutions have been identified, following the example of British Columbia and Ontario, which are actively and financially involved in the community fight against hepatitis C. Your support is essential if Quebec is to better position itself in the fight against hepatitis C and STBBIs.

For further information:

The Provincial Hepatitis C Committee is to ensure that community organizations work together to promote awareness and recognition of its recommendations on hepatitis C, and thus encourage increased knowledge, harmonious policies and support for members in their actions. It has 32 member organizations and is coordinated by CAPAHC.

Contact

Marjolaine Pruvost, Project Coordinator
CAPAHC (Centre Associatif Polyvalent d’Aide Hépatite C)
recherche@capahc.com

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References

-“Timing of elimination of hepatitis C virus in Canada’s provinces” Jordan J Feld, Marina B Klein, Yasmine Rahal, Samuel S Lee, Shawn Mohammed, Alexandra King, Daniel Smyth, Yuri Sanchez Gonzalez, Arlene Nugent, and Naveed Z Janjua. Canadian Liver Journal 2022 5:4, 493-506
– https://emis.santemontreal.qc.ca/sante-des-montrealais/maladies-a-declaration-obligatoire/mado-statistiques