Could our pandemic response help us eliminate hepatitis C?

CATIE, Canada’s source for HIV and hepatitis C information

By Laurie Edmiston

Every World Hepatitis Day (July 28), I make the case to anyone who will listen: hepatitis C is a dreadful virus that can cause severe liver damage and even death, but it is preventable, curable, and there is no reason why we can’t eliminate it from Canada. In fact, our government committed in 2016 to do just that, but we’re nowhere near that goal.

Could the novel coronavirus disease (COVID-19) change our prospects?

We already know how hepatitis C can be eliminated. Giving medication to people with hepatitis C can cure more than 95 per cent of cases. Outreach and testing programs can help us identify the people who need this medication. And harm reduction programs like needle exchanges and supervised injection sites can stop hepatitis C infections before they happen, saving lives and healthcare resources.

But there has been a frustrating gap between what research tells us can be done and what policy-makers have actually been doing.

Australia, France, Japan, South Korea and the United Kingdom have all implemented robust strategies to prevent, test and treat hepatitis C, and they are now on track to eliminate the infection as a public health threat by 2030. Italy and Spain, despite their challenges navigating the COVID-19 pandemic, are also on track with hepatitis C. Canada, despite our first-class healthcare system, lags behind all of them.

This is depressing news for someone whose job it is to help our country eliminate hepatitis C. But the COVID-19 pandemic, and our public health response to it, has created some openings that could be leveraged to help us reach that goal.

Our testing infrastructure is improving

Diagnostic labs have seen an influx of resources to keep up with the demand for coronavirus tests. And it’s not just about money. Machinery, staff and notification practices have been beefed up and refined, and at least some of these improvements will last long after the COVID-19 pandemic.

This boost to our diagnostic capacity may also present an opportunity for hepatitis C. Following the pandemic, the same machines, labs and staff that have been scaled up to diagnose COVID-19 can be redeployed for hepatitis C diagnosis. And many of these resources could be shared with community-based health services, where pilot projects have found that hepatitis C testing can be performed accurately, rapidly and conveniently.

Integrating COVID-19 and hepatitis C testing

Hepatitis C affects many different groups of Canadians, but homeless and street-involved people are more vulnerable. While the stigma and the long incubation period of hepatitis C already present enough of a challenge for diagnosis, it is even more challenging when a person does not access healthcare services regularly, or faces more pressing dilemmas on a daily basis – such as where they are going to sleep.

Peer outreach and testing is one strategy developed to confront this challenge. Rather than waiting for homeless and other marginalized people to come to a clinic, the clinic employs their peers as lay service providers. They conduct the testing themselves, in the environments where they live.

The prospect of COVID-19 spreading in shelters and encampments where homeless people live has triggered a public health response like we have never seen for such a marginalized population in Canada. Peer testing is now being employed to offer COVID-19 testing in these environments, and some service providers are leveraging this opportunity to test for hepatitis C at the same time.

Demonstrating the importance of health for all

There’s nothing like a pandemic to demonstrate the interconnected nature of public health. We are only as healthy as the most vulnerable members of society, and disregarding the health of others will have consequences for us all.

COVID-19 has brought into focus why public health is a public good: the risks of poor health and the benefits of good health are experienced by us all, whether we are sick or not.

This has bolstered demands to ensure healthcare access for all newcomers, paid time off work for people who are sick, and immediate housing for people who are homeless. My hope is that this greater understanding is another change that will stay with us beyond the COVID-19 pandemic.

Eliminating hepatitis C, and achieving greater health for everyone, is not just the right thing to do – it’s smart public health strategy that benefits us all.

Laurie Edmiston is the executive director of CATIE, Canada’s source for HIV and hepatitis C information.

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