Holding government accountable.

Canada's Promise
In May 2016, Canada signed on to the World Health Organization (WHO)’s first ever Global Viral Hepatitis Strategy, with the goal of eliminating viral hepatitis as a public health threat by 2030.

Yet the federal government has been clear that the provinces and territories will be accountable to their citizens to meet this target, not the federal government. This progress report is a tool to use in providing that accountability.
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Six Metrics To Measure Our Progress

In designing the progress report, we selected six metrics based on the availability of data, as well as the centrality of the target to the overall elimination goals.

We updated the metrics for the 2025 report to align with updates to the WHO targets.

Metric 1: Decrease in new cases of hepatitis B and C
One of the global targets for viral hepatitis elimination is a maximum rate of new cases of chronic viral hepatitis: 11 per 100,000 for HBV by 2025, and two by 2030, and a rate of 13 per 100,000 for HCV by 2025, and five by 2030.

Metric 2: Elimination plan or strategy in place
Each jurisdiction must create and implement its own strategy toward viral hepatitis elimination.

Metric 3: Testing for hepatitis B, C, and D
  • Hepatitis C RNA or antigen reflex testing implemented?
  • Hepatitis C prenatal testing implemented?
  • Hepatitis B universal one-time screening for all adults implemented?
  • Hepatitis D reflex testing implemented?

Metric 4: Access to hepatitis B and C treatment following diagnosis
  • One-day hepatitis C treatment start possible with direct-acting antivirals?
  • First-line recommended hepatitis B treatments available without barriers?

Metric 5: Annual hepatitis C treatment prescribing counts

Metric 6: Prevention measures
  • Is the distribution of new drug use equipment publicly funded, and does the community perceive the funded distribution meets the needs of the community?
  • Hepatitis B birth dose vaccine implemented?
  • Hepatitis B universal adult vaccination recommended and publicly funded?

Health Equity & Viral Hepatitis

As a coalition of community-based organizations, AHC approaches viral hepatitis using a social justice and health equity lens. Viral hepatitis affects a number of populations that have been historically marginalized by mainstream healthcare, creating hurdles to equitable prevention, testing and treatment services.

​These barriers to achieving viral hepatitis elimination will remain if we do not work in true partnership with Indigenous communities to embed their priorities into health services creating culturally safe healthcare, and address inequities in healthcare access for people living in remote and rural areas, as well as for those structurally excluded from mainstream healthcare and society more broadly.

TL;DR

  • Canada is on track with most WHO 2025 interim targets as measured, except for prevention of new infections.
  • Significant progress has been made or is underway in removing barriers to viral hepatitis treatment.
  • Seven of the ten provinces are on track to meet HCV elimination goals.
  • Three are not, including two of the most populous provinces.
  • We do not have the right P/T data for HBV to determine if progress toward elimination goals is on track. 
  • We do not have enough data to determine the status of the NT and NU.

Key Takeaways
  1. Provinces and prisons need to get serious about prevention
  2. Testing policy needs to catch up with testing technology
  3. Federal action is needed to support linkage to treatment
  4. Federal accountability is needed to achieve elimination

Report Contents

  • Context
  • WHO Targets
  • Who is Disproportionately Impacted? (Priority Populations)
  • Metrics
  • TLDR - key takeaways
  • Bright Spots
  • National Progress
  • Federal Role and Recommendations
  • Reports for each P/T
  • Corrections: Federal and Provincial Reports
  • Emerging Priority Population: Women
  • Emerging Trends in Testing
  • Monitoring and Evaluation Methodology
  • References

OUR ASKS: ​Recommended Next Steps


​Federal
  • Develop targets for viral hepatitis as part of the national STBBI Action Plan, using a health equity lens, to measure progress in elimination of viral hepatitis.
  • ​Provide multi-year funding to community-based organizations supporting priority populations for STBBI prevention and linkage-to-care programming in all Canadian jurisdictions.
  • Update HCV screening guidelines and create HBV screening guidelines to provide rights- and evidence-based guidance.
  • Prioritize HBV birth dose vaccination recommendations.
  • Fund and increase efforts to collect updated HBV and HCV prevalence estimates for all Canadian provinces and territories.


​Provincial/Territorial
  • Develop and implement provincial/territorial elimination plans that includes targets, in consultation with priority populations and using a health equity lens, where not already in place.
  • Remove treatment reimbursement barriers, including hepatitis C reinfections, where not already in place.
  • Ensure drug use equipment distribution matches the needs of the community in type, amount, and accessibility. Monitor and report this data.
  • Implement universal HCV prenatal screening, alongside existing universal HIV and HBV prenatal screening, where not already in place.
  • Fund point-of-care testing technologies, integrate them into data collection systems, and accept results for treatment reimbursement, where not already in place.
  • Provide HBV vaccination for all babies at birth, and implement policies that recommend and fund adult HBV vaccinations for those who are not already vaccinated.

Corrections
  • Shift healthcare responsibility to Ministry of Health in provincials and territories where this has not yet been done.
  • Offer HCV and HBV testing and treatment in all provincial and territorial correctional facilities, and report on the # and proportion of people being tested and starting treatment.
  • Increase access to prevention measures including needle syringe programs, opioid agonist therapy, and overdose prevention sites to all federal and provincial corrections facilities.
  • Offer HBV vaccination to all people who are incarcerated and corrections staff, as recommended by NACI.

Limitations & Data Gaps

Prevalence Data

  • It was difficult to determine what the annual HCV treatment initiation target for each P/T should be, as there are few recently published sub-national prevalence estimates.
  • Similarly for HBV, we are unable to measure progress on elimination targets without prevalence estimates at the P/T level. 
  • HCV and HBV prevalence estimates should be updated urgently for all provinces and territories.
  • Treatment data for most P/Ts is not only not available to Action Hepatitis Canada and researchers for free, it is also not provided to PHAC or to most P/T public health teams. The data that is available for HCV is expensive and is modelled, and credible data for HBV treatment does not seem to be available, even for purchase. 
  • Reliable, accessible data on treatment numbers for both HCV and HBV are needed to monitor progress toward the 2030 elimination target.

Health Equity Data

  • The care cascades that are available, both nationally and provincially, do not use an intersectional approach, nor are there metrics provided to measure our frameworks from a health equity perspective. 
  • More work needs to be done in this area to help us all measure barriers for priority populations and more specifically, where those priority populations intersect.
How will we know if we have eliminated viral hepatitis in 2030 without accurate data?
We plan to update this report every two years until 2030.

​If you have suggestions on how to improve this report in the future, or if you are undertaking research that will help address the data gaps identified in this report, please email [email protected].