Province-to-province variability in hepatitis C testing, care, and treatment across Canada

Erin Mandel, Kate Underwood, Chelsea Masterman, Robert A. Kozak, Cheryl H. Dale, Melinda Hassall, Camelia Capraru, Hemant Shah, Harry L.A. Janssen, Jordan J. Feld, Mia J. Biondi*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Scopus)


BACKGROUND: Few countries have implemented the necessary policy changes to reduce the number of steps in the cascade of care to achieve hepatitis C virus (HCV) elimination, including Canada. The aim of this study was to describe and compare legislation, scope of practice, and policy as it relates to the provision of HCV care in each province. METHODS: We reviewed grey literature and regulatory and legislative documents which affect various aspects of the HCV cascade of care. Findings were verified by content experts. RESULTS: HCV RNA reflex testing ensures those that are antibody positive get an HCV RNA test; however only 80% of provinces have reflex test. Point-of-care antibody testing can be offered in most community non–health care settings, yet many types of health care providers are unable to do this independently. Following a positive test, it may not be feasible to complete venipuncture; however only a single province processes HCV RNA dried blood spot cards. In many provinces, training and verification are required for novice prescribers, and in some provinces prescribing continues to be restricted to specialists. Only a single province has task-shifted treatment to a non-physician non–nurse practitioner model, where pharmacists can prescribe treatment. Finally, 80% of provinces require authorization forms, and 30% require proof of investigations for treatment. CONCLUSIONS: No single province is optimizing the use of diagnostic tools and task shifting and decreasing paperwork to expedite treatment initiation. Collaboration between provinces is needed to streamline practice, update policy, and promote equity in HCV diagnosis, care, and treatment.

Original languageEnglish
Pages (from-to)234-248
Number of pages15
JournalCanadian Liver Journal
Issue number2
Publication statusPublished - Jul 2023

Bibliographical note

Funding Information:
FUNDING: This study was funded by the Viral Hepatitis Care Network.

Publisher Copyright:
© Canadian Association for the Study of the Liver, 2023.


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