Montreal without HCV: Innovative care trajectories to improve diagnosis and treatment of HCV in first-line and community settings


In 2016, Canada signed on to the World Health Organization’s global health sector strategy on viral hepatitis which defines elimination as a 90% reduction in new infections and a 65 % reduction in HCV-related deaths by 2030. Only 9 countries are on track to reach these objectives. Canada is not. Approximately 250 000 Canadians are living with HCV but fewer than 20% have been treated. Direct acting antivirals have transformed the management of HCV curing over 95% who receive treatment making the elimination of HCV a realizable goal.

We propose a novel simplified care trajectory based in the community that will increase patient engagement along all steps of the care cascade. By reducing important delays between diagnosis and treatment, we will not only reduce the number of patients lost to follow-up, but also reduce new infections, improve health outcomes and enhance quality of life. To maximize the impact of this innovation, we will first focus on two priority populations for HCV elimination: people who inject drugs and immigrants. Our approach will be tested in three different settings (CLSC, a medical clinic for drug users and a family practice clinic).

This project is a first step in a wider vision aimed at making Montreal the first city in North America to eliminate HCV. The results will inform our approach to scaling up HCV elimination efforts first in Greater Montreal, then to other cities and beyond to remote and rural regions of Quebec.