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The population level care cascade for hepatitis C in British Columbia, Canada as of 2018: Impact of direct acting antivirals.

  • Bartlett, Sofia R1, 2, 3
  • Yu, Amanda1
  • Chapinal, Nuria1
  • Rossi, Carmine1, 2
  • Butt, Zahid1, 4
  • Wong, Stanley1
  • Darvishian, Maryam1, 4
  • Gilbert, Mark1, 4
  • Wong, Jason1, 4
  • Binka, Mawuena1, 2
  • Alvarez, Maria1
  • Tyndall, Mark1, 4
  • Krajden, Mel1, 2
  • Janjua, Naveed Z1, 4
  • 1 British Columbia Centre for Disease Control (BCCDC), Vancouver, BC, Canada. , (Canada)
  • 2 Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada. , (Canada)
  • 3 Kirby Institute, University of New South Wales Australia, Sydney, NSW, Australia. , (Australia)
  • 4 School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada. , (Canada)
Published Article
Liver international : official journal of the International Association for the Study of the Liver
Publication Date
Dec 01, 2019
DOI: 10.1111/liv.14227
PMID: 31444846


Population-level monitoring of hepatitis C virus (HCV) infected people across cascades of care identifies gaps in access and engagement in care and treatment. We characterized the population-level care cascade for HCV in British Columbia (BC), Canada before and after introduction of Direct Acting Antiviral (DAA) treatment. BC Hepatitis Testers Cohort (BC-HTC) includes 1.7 million individuals tested for HCV, HIV, reported cases of hepatitis B, and active tuberculosis in BC from 1990 to 2018 linked to medical visits, hospitalizations, cancers, prescription drugs and mortality data. We defined six HCV care cascade stages: (a) antibody diagnosed; (b) RNA tested; (c) RNA positive; (d) genotyped; (e) initiated treatment; and (f) achieved sustained virologic response (SVR). We estimated 61 127 people were HCV antibody positive in BC in 2018 (undiagnosed: 7686, 13%; diagnosed: 53 441, 87%). Of those diagnosed, 83% (44 507) had HCV RNA testing, and of those RNA positive, 90% (28 716) were genotyped. Of those genotyped, 61% (17 441) received therapy, with 90% (15 672) reaching SVR. Individuals from older birth cohorts had lower progression to HCV RNA testing. While people who currently inject drugs had the highest proportional progression to RNA testing, this group had the lowest proportional treatment uptake. Although gaps in HCV RNA and genotype testing after antibody diagnosis exist, the largest gap in the care cascade is treatment initiation, despite introduction of DAA treatment and removal of treatment eligibility restrictions. Further interventions are required to ensure testing and treatment is equitably accessible in BC. © 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

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