Approaches to hepatitis C testing in Canada

Key points

In Canada, two broad approaches to hepatitis C testing are used: risk-based testing and one-time testing.
Risk-based testing is the main approach to hepatitis testing in Canada. It involves conducting tests for people who have an increased chance of being exposed to hepatitis C.
One-time testing is an approach to expand hepatitis C testing to reach the large proportion of people with chronic hepatitis C who are undiagnosed in Canada.

In Canada, two broad approaches to hepatitis C testing are used: risk-based testing and one-time testing.

Risk-based testing

Risk-based testing is the main approach to hepatitis testing in Canada. It involves conducting tests for people who have an increased chance of being exposed to hepatitis C, either because they have certain behavioural, clinical or demographic characteristics that put them at ongoing risk for hepatitis C, or because they may have been exposed to hepatitis C in the past.

The priority populations that are disproportionately affected by hepatitis C in Canada include:

people who use drugs
Indigenous peoples (First Nations, Inuit, Métis)
people with experience in the prison system
immigrants and newcomers from countries where hepatitis C is common
gay, bisexual and other men who have sex with men (gbMSM)

It is important to understand that while certain populations have higher rates of hepatitis C overall, this does not mean that being a member of one of these populations is a “risk factor” for getting hepatitis C in and of itself.

Regular, ongoing testing is recommended for people who have ongoing risks for exposure to hepatitis C.

As examples, risk-based testing can be integrated into existing services, such as supervised injection or overdose prevention sites, offered to people who are currently incarcerated or added to other forms of routine testing, such as for people who are on HIV pre-exposure prophylaxis (PrEP).

One-time testing

One-time testing is an approach to expand hepatitis C testing to reach the large proportion of people with chronic hepatitis C who are undiagnosed in Canada. This form of testing also addresses barriers, such as limited knowledge about hepatitis C among healthcare providers and patients, and by systematically offering a hepatitis C test to everyone within a given group it helps to address hepatitis C stigma.

Birth cohort: 1945–1975

There is evidence that there is a high prevalence of hepatitis C among people born between 1945 and 1975. Testing and linkage to care can be life saving in this birth cohort, which also has the highest rates of hepatitis-related liver failure and liver cancer.

One-time hepatitis C testing of everyone in this birth cohort has been recommended by the Canadian Association for the Study of the Liver and the Blueprint to Inform Hepatitis C Elimination Efforts in Canada, but uptake has been limited.

Newcomers to Canada

One-time testing may also be used to find undiagnosed hepatitis C infection in newcomers to Canada from countries where hepatitis C is common. Some individuals may have been exposed through unsafe medical and dental practices in their home countries but are not aware of their risk for hepatitis C.

Resources for service providers