A road map to viral hepatitis elimination in BC by 2030

Issue: BCMJ, vol. 66, No. 2, March 2024, Pages 58,63 BC Centre for Disease Control
By: Sofia R. Bartlett, PhD Deb Schmitz Joel Harnest Janice Duddy, MES Mona Lee, MPH

Hepatitis B virus (HBV) infection can be prevented with an effective vaccine, and chronic infection can be managed with antiviral medications. While there is no vaccine against hepatitis C virus (HCV), chronic HCV infection can be treated with direct acting antivirals. Treatment with direct acting antivirals cures more than 95% of people with chronic HCV infection and is associated with significant reductions in both liver-related[1] and non-liver-related[2] mortality. Despite the availability of effective prevention and treatment, viral hepatitis remains a persistent public health issue in Canada[3] as well as globally.[4] As a result of social, economic, and migration factors, British Columbia experiences a disproportionate burden from viral hepatitis compared with the rest of Canada.[5]

To reduce the impact of viral hepatitis, the Canadian government, in alignment with global efforts spearheaded by the World Health Organization,[6] aims to eliminate both hepatitis viruses as a public health threat by 2030. To support this goal, the Public Health Agency of Canada set targets[7] for the proportion of people living with chronic HBV or HCV infection in Canada to be diagnosed and treated by 2025 and 2030.

As each province and territory in Canada is responsible for health care planning and delivery, strategies for viral hepatitis elimination are tailored to each region. In July 2023, the BC Ministry of Health announced actions to develop a road map to viral hepatitis elimination in BC.[8] The road map development is being led by the BCCDC and the BC Hepatitis Network, with funding support from the BC Ministry of Health and the Canadian Network on Hepatitis C. Together, they are conducting a series of province-wide consultations and engagements to help inform the road map.

The BC viral hepatitis elimination road map development aligns with efforts supported by the Canadian Network on Hepatitis C Roadmap Project[9] and is overseen by a multipartner steering committee, with representatives from the government, health care, research, and community sectors.[10] In mid-2023, a project team was formed, including staff from BCCDC Clinical Prevention Services,[11] the BC Hepatitis Network,[12] and independent consultants. In the summer of 2023, five working groups were formed, each including people with lived experience of HBV or HCV infection, along with clinicians, researchers, and other service providers, fostering collaboration and expertise from diverse perspectives.

These working groups helped design and implement the consultations and engagements that launched in November 2023. The objective is to gain comprehensive insights into the status of viral hepatitis and related services in the province. A survey of service providers was conducted, along with interviews and focus groups across the province to engage diverse perspectives and experiences. Data are also being used from published scientific literature, public health surveillance, previous strategies and consultations, and ongoing research studies.

Once the information gathering is completed, working groups will craft recommendations based on the best available evidence and what is learned about the current state of viral hepatitis in BC. Recommendations will be aimed at ensuring the right tools and adequate resources are available to care providers and communities to support them in eliminating viral hepatitis as a public health threat by 2030. The BC road map tailors recommendations for targets and goals for eliminating viral hepatitis to BC, including a focus on health equity and Indigenous self-determination.

Learn more at https://hepfreebc.ca. Clinicians and other parties wishing to provide input into the road map or participate in a working group to help craft recommendations can use the contact form to email the project team (https://hepfreebc.ca/contact/).
—Sofia R. Bartlett, PhD
Scientific Director (Interim), Clinical Prevention Services, BCCDC
—Deb Schmitz
Executive Director, BC Hepatitis Network
—Joel Harnest
Community Engagement Specialist, BC Hepatitis Network
—Janice Duddy, MES
Principal Consultant, Janice Duddy Consulting
—Mona Lee, MPH
Consultant, Janice Duddy Consulting

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This article is the opinion of the BC Centre for Disease Control and has not been peer reviewed by the BCMJ Editorial Board.

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References

1.    Hamill V, Wong S, Benselin J, et al. Mortality rates among patients successfully treated for hepatitis C in the era of interferon-free antivirals: Population based cohort study. BMJ 2023;382:e074001.

2.    Jeong D, Wong S, Karim ME, et al. Treatment of HCV with direct-acting antivirals on reducing mortality related to extrahepatic manifestations: A large population-based study in British Columbia, Canada. Lancet Reg Health Am 2024;29:100658.

3.    Nanwa N, Kwong JC, Feld JJ, et al. The mean attributable health care costs associated with hepatitis B virus in Ontario, Canada: A matched cohort study. Can Liver J 2022;5:339-361.

4.    Cox AL, El-Sayed MH, Kao JH, et al. Progress towards elimination goals for viral hepatitis. Nat Rev Gastroenterol Hepatol 2020;17:533-542.

5.    Popovic N, Williams A, Périnet S, et al. National Hepatitis C estimates: Incidence, prevalence, undiagnosed proportion and treatment, Canada, 2019. Can Commun Dis Rep 2022;48:540-549.

6.    World Health Organization. Elimination of hepatitis by 2030. Accessed 19 January 2024. www.who.int/multi-media/details/elimination-of-hepatitis-by-2030.

7.    Public Health Agency of Canada. Reducing the health impact of sexually transmitted and blood-borne infections in Canada by 2030: A pan-Canadian STBBI framework for action. Accessed 19 January 2024. www.canada.ca/en/public-health/services/infectious-diseases/sexual-health-sexually-transmitted-infections/reports-publications/sexually-transmitted-blood-borne-infections-action-framework.html.

8.    Government of BC. Province takes action to eliminate hepatitis C [news release]. 30 July 2023. Accessed 19 January 2024. https://news.gov.bc.ca/releases/2023HLTH0104-001243.

9.    Canadian Network on Hepatitis C. Roadmap project. Accessed 19 January 2024. www.canhepc.ca/en/elimination/roadmap-project.

10.    Hepatitis Elimination Roadmap British Columbia. People. Accessed 19 January 2024. https://hepfreebc.ca/people.

11.    British Columbia Centre for Disease Control. Clinical prevention services. Accessed 19 January 2024. www.bccdc.ca/our-services/service-areas/clinical-prevention-services.

12.    BC Hepatitis Network. Staff directory. Accessed 19 January 2024. https://bchep.org/about-us/staff-directory/.

Sofia R. Bartlett, PhD, Deb Schmitz, Joel Harnest, Janice Duddy, MES, Mona Lee, MPH. A road map to viral hepatitis elimination in BC by 2030. BCMJ, Vol. 66, No. 2, March, 2024, Page(s) 58,63 - BC Centre for Disease Control.


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