Your reference for hepatitis C in Quebec

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Globally

Recognizing viral hepatitis as a public health issue requires addressing different aspects such as strategies, action plans and allocating sufficient funding to ensure its elimination. It should be noted that since 2010, July 28th has been recognized as World Hepatitis Day. This event is meant to raise awareness and promote the prevention of viral hepatitis as well as access to screening, treatment and care.

Towards Ending Viral Hepatitis – Global Health Sector Strategy on Viral Hepatitis, 2016-2021 In 2016, the WHO launched the first global strategy concerning viral hepatitis Towards Ending Viral Hepatitis – Global Health Sector Strategy on Viral Hepatitis, 2016-2021. It addresses the issues associated with hepatitis while also recognizing the global public health burden. Its objective is elimination of hepatitis by 2030 as a public health threat.

This strategies depends on:

  • Universal health coverage: to allow all individuals to benefit from health services they require with sufficient quality and without being exposed to financial difficulty.
  • The continuum of hepatitis services: that includes preventing and diagnosing infection, linking people to health services, through to providing treatment and chronic care.
  • A public health approach: that is concerned with preventing infection and disease, promoting health, and prolonging life among the population as a whole.

This strategy identified 2020 targets for the elimination of viral hepatitis in 2030 and defined the strategic plans with which to proceed.1

Global health sector strategies on, respectively, HIV, viral hepatitis and sexually transmitted infections for the period 2022-2030.2 In 2022, the WHO launched Global health sector strategies on, respectively, HIV, viral hepatitis and sexually transmitted infections for the period 2022-2030. These integrated strategies seek to eliminate HIV/AIDS and end hepatitis and STI pandemics by 2030. Concerning viral hepatitis, this new strategy takes into consideration lessons learned from the 2016-2021 plan where targets were not achieved.

Targets to achieve

These new strategies identify targets to achieve by 2025 and 2030 in order to eliminate HIV, viral hepatitis and STIs. Concerning hepatitis C, the targets are as follows:

  • Reduce the number of new hepatitis C infections from 1.575 million (in 2020) to 350 000 (in 2030);
  • Reduce the annual number of deaths due to hepatitis C from 290 000 (in 2020) to 140 000 (in 2030);
  • Increase the diagnosis percentage of people living with hepatitis C from 30% (in 2020) to 90% (in 2030);
  • Increase the percentage of people diagnosed and cured of hepatitis C from 30% (in 2020) to 80% (in 2030).

Strategic orientations

Concerning viral hepatitis, the main strategic directions are:

  • Raising greater public and political awareness;
  • Secure funding;
  • Produce data to be used for decision-making and planning;
  • Improved access to screening and treatment;
  • Promote models of simplified service delivery, such as decentralized screening and treatment for hepatitis B and C;
  • Reinforce community participation, notably proposing adapted models of service delivery

In order to guarantee the tracing of indicators and a proper implementation of these strategies, the WHO plans to hold itself and participating countries accountable. A mid-term review is planned for 2026.

In Canada

Government level

On June 16, 2016, the federal government of Canada committed to eliminate hepatitis C by 2030, combat viral hepatitis and adopt the WHO’s Global Health Sector Strategy on Viral Hepatitis along with 193 other states.
Despite this political commitment, the federal government engages with health governance via the following authority:

  • Criminal laws intended to protect physical health and public security by controlling possible dangers posed by products and substances such as tobacco or certain medications;
  • The power to fund research and promote health and general awareness about health issues.44

Federal powers are limited in their ability to combat hepatitis.

In 2018, the government, via the Public Health Agency of Canada (PHAC), published Reducing the health impact of sexually transmitted and blood-borne infections (STBBIs) in Canada by 2030: A pan-Canadian STBBI framework for action. This framework promoted an integrated approach to “reduce the impact of STBBI in Canada and to contribute to the global efforts to end AIDS, viral hepatitis, and sexually transmitted infections as major health concerns."5

In July, 2019, the PHAC also published the Accelerating our response: Government of Canada five-year action plan on sexually transmitted and blood-borne infections. This report “sets out the Government of Canada’s priorities as we advance the Pan-Canadian Framework for Action,” and its objective is to “celerate prevention, diagnosis and treatment to reduce the health impacts of sexually transmitted-and blood-borne infections (STBBI) in Canada by 2030.” A revision of this action plan is currently underway in 2023, though its deadlines and objectives remain unchanged.

The Community Action Fund (CAF) for HIV and Hepatitis C is one of the means by which the government of Canada finances the fight against STBBIs. The yearly funding for the CAF is $26.4 million.7 This amount has not changed in 15 years. Community organizations working to combat STBBIs denounce the underfunding of the PHAC as well as the complex process that organizations must undergo in order to access this funding.

Scientific level

In Canada, the scientific community is also highly mobilized in the fight against hepatitis C. In May, 2019, the Canadian Network on Hepatitis C published the Blueprint to inform hepatitis C elimination efforts in Canada. The goal of this document is to establish the roadmap for a public health response that will meet HCV elimination goals in Canada by 2030.

Community level

On the community level, Action Hepatitis Canada (AHC) has been ensuring the concentration of organizations dedicated to the fight against hepatitis B and C since the 2000s. Its work aims to promote prevention of hepatitis B and C, expand access to care and treatment, increase research and innovation, develop public health awareness, improve skill sets for health professionals, and support community groups and initiatives.

In its 2021 report, Progress Toward Viral Hepatitis Elimination Canada, the AHC compiled advances in the fight against hepatitis C and provided tools necessary to ensure accountability of different levels of government. This report indicates, for example, that seven out of ten provinces are on track to meeting their elimination goals. Sufficient data is unavailable to evaluate the situation in Canada’s three territories. The three provinces not on track to meet elimination targets are Ontario, Manitoba and Quebec. In 2022, AHC, CanHepC, CanHepB, the Canadian Liver Foundation and the Canadian Association for the Study of the Liver were able to convince the Canadian parliament to declare May 11 as the annual Canadian Viral Hepatitis Elimination Day.

In Quebec

Contrary to the federal level, the provincial government has the majority of power and responsibility for health care, which includes:

  • Establishing hospital networks and organize their respective administrations;
  • Ensuring adequate hygiene and public health for the population;
  • Establishing an obligatory health insurance plan, notably regarding costs related to health (hospitalization fees, medical fees and medication).13

In 2017, the Ministère de la Santé et des Services Sociaux (MSSS) of Quebec published the Programme national de santé published – Joindre, dépister et détecter, traiter – Intégrer la prévention des ITSS dans les plans d’action régionaux de santé publique. This document covers the period of 2015-2025 and proposes an “integrated approach, rather than per individual infections, which allows for targeting common factors between them and tackling sexual health and substance consumption.14 This plan is financed by diverse public health measures, managed by the Directions Régionales de Santé Publique (DRSP). Barring any changes, the current government priority list in Quebec does not include the fight against STBBIs and HCV.

Community level

Contrary to the federal level, the provincial government has the majority of power and responsibility for health care, which includes:

  • Establishing hospital networks and organize their respective administrations;
  • Ensuring adequate hygiene and public health for the population;
  • Establishing an obligatory health insurance plan, notably regarding costs related to health (hospitalization fees, medical fees and medication).13

In 2017, the Ministère de la Santé et des Services Sociaux (MSSS) of Quebec published the Programme national de santé published – Joindre, dépister et détecter, traiter – Intégrer la prévention des ITSS dans les plans d’action régionaux de santé publique. This document covers the period of 2015-2025 and proposes an “integrated approach, rather than per individual infections, which allows for targeting common factors between them and tackling sexual health and substance consumption.14 This plan is financed by diverse public health measures, managed by the Directions Régionales de Santé Publique (DRSP). Barring any changes, the current government priority list in Quebec does not include the fight against STBBIs and HCV.

Community level

Contrary to the federal level, the provincial government has the majority of power and responsibility for health care, which includes:

  • Establishing hospital networks and organize their respective administrations;
  • Ensuring adequate hygiene and public health for the population;
  • Establishing an obligatory health insurance plan, notably regarding costs related to health (hospitalization fees, medical fees and medication).13

In 2017, the Ministère de la Santé et des Services Sociaux (MSSS) of Quebec published the Programme national de santé published – Joindre, dépister et détecter, traiter – Intégrer la prévention des ITSS dans les plans d’action régionaux de santé publique. This document covers the period of 2015-2025 and proposes an “integrated approach, rather than per individual infections, which allows for targeting common factors between them and tackling sexual health and substance consumption.14 This plan is financed by diverse public health measures, managed by the Directions Régionales de Santé Publique (DRSP). Barring any changes, the current government priority list in Quebec does not include the fight against STBBIs and HCV.

Community level

In Quebec, community organizations work together in combating hepatitis C through the Comité provincial de concertation en hépatite CThis committee aims to ensure that community organizations collaborate in recognizing and following recommendations regarding hepatitis C. The committee also seeks to promote knowledge, harmonize policies and support its members in their actions. Its philosophy is to focus on the people most at risk or living with hepatitis C within a framework of autonomization and harm reduction. 32 organizations or member groups make up this committee.

It is important to underland that since 2016, April 29th has been designated the Journée nationale de sensibilisation à l’hépatite C (National Day for Hepatitis C Awareness) in Quebec. This designation seeks to improve hepatitis C prevention, accelerate diagnosis and expand care for people living with the virus. The efforts of Laurence Mersilian, director of CAPAHC, led to the vote passing unanimously to the National Assembly in 2015.15

The roadmap for eliminating hepatitis C in Quebec fits into a pan-Canadian initiative facilitated by the CanHepC research network. Inspired by traces identified in guidelines published in 2019, roadmaps are developed for different regions of the country as well as a national roadmap specific to indigenous communities. As such, adapted strategies will be offered to respond to the varied realities of hepatitis C.

Concept of Micro-elimination

In the fight against hepatitis C, the micro-elimination approach is used frequently. It consists of a strategy for meeting national elimination goals via initiatives targeting specific communities such as people who inject drugs, incarcerated populations or immigrants and newcomers. This approach aims to increase prevention, screening, diagnosis, linkage to care and access to treatment.

Micro-elimination is a pragmatic, people-centered approach with realistic goals. This allows for meeting elimination goals within shorter deadlines, adapting different approaches that take into account the perspectives of front-line workers and affected populations. It has been demonstrated that micro-elimination reduces the risk of reinfection in key population segments. Additionally, it provides the opportunity to try and test new models of care and services on a smaller scale.16