Provincial Variability in HCV Testing, Care, and Treatment Across Canada

Author: Erin Mandel Kate Underwood Chelsea Masterman Robert Kozak Cheryl Dale Melinda Hassall Camelia Capraru Hemant Shah Harry Janssen Jordan Feld Mia Biondi Harry

Theme: Epidemiology & Public Health Research Year: 2022

Background: Few countries have implemented the necessary widespread policy changes to reduce
the number of steps in the cascade of care to achieve 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 Canadian province.
Methods: We reviewed grey literature, regulatory and legislative documents related to essential
aspects of the HCV cascade of care. Findings were verified by content experts.
Results: HCV RNA reflex testing is essential to ensure those that are antibody positive get an HCV
RNA test, however only 80% of provinces reflex test. Point-of-care antibody testing can be offered in
most community non-healthcare settings, yet many types of healthcare 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. Pharmacists and
registered nurses/registered psychiatric nurses can order laboratory investigations in 10% and 40%
of provinces and prescribe a limited list of medications in 80% and 60% of provinces. Pharmacists
can only prescribe direct acting antivirals in a single province. In many provinces, training and
verification processes are required for novice prescribers, and in some provinces prescribing
continues to be restricted to specialists. Finally, 80% of provinces require authorization forms, and
30% require proof of investigations for treatment.
Conclusion: No single Canadian province is fully utilizing diagnostic tools, optimizing task shifting,
and decreasing paperwork to expedite treatment initiation. Collaboration and sharing lessons
between provinces is needed to streamline practice, update policy, and promote efficiencies in HCV
diagnosis, care, and treatment.
Disclosure of Interest Statement: MJB reports receiving research support and consulting fees from
AbbVie, Gilead, and Specialty Rx Solutions. CHD is an employee of McKesson Canada, receives
consulting fees from AbbVie and Gilead. HS reports receiving consulting fees and research support
from AbbVie and Gilead. JJF reports receiving research support and consulting fees from AbbVie and
Gilead. HLAJ reports receiving research support from AbbVie and Gilead. No other competing
interests were declared.

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