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Hepatitis C Virus Infection Outcomes Among Immigrants to Canada: A Retrospective Cohort Analysis
Curtis L Cooper1, Kednapa Thavorn2, Ecaterina Damian3
1The University of Ottawa, Ottawa, ON, Canada.
Insights
Immigrants with Hepatitis C virus (HCV) had better access to fibrosis assessment and similar treatment outcomes compared to Canadian-born patients. Earlier screening and engagement in healthcare at immigration could improve HCV care for immigrants.
Area of Science:
- Hepatology
- Infectious Diseases
- Public Health
Background:
- Hepatitis C virus (HCV) infection is a significant health concern, with immigrant populations contributing to the overall prevalence in developed nations.
- Limited data exists on the healthcare engagement, service access, and treatment outcomes for immigrants receiving Direct Acting Antiviral (DAA) therapies for HCV.
Purpose of the Study:
- To investigate and compare access to diagnostic procedures, HCV treatment initiation, and treatment outcomes (Sustained Virologic Response - SVR) between immigrant and Canadian-born patients with HCV.
- To identify potential delays in care and propose strategies for optimizing HCV management in immigrant populations.
Main Methods:
- A retrospective analysis of 2,335 HCV-infected patients treated at The Ottawa Hospital Viral Hepatitis Clinic (2000-2016).
- Data collected included immigration history, race, socioeconomic status, HCV work-up, treatment details, and outcomes.
- Logistic regression was used to compare HCV fibrosis assessment, treatment, and SVR rates between immigrant and Canadian-born groups.
Main Results:
- Of 2,335 patients, 23% were immigrants, with a median of 16 years from immigration to referral.
- Immigrants showed significantly higher access to fibrosis assessment (FibroScan/liver biopsy) compared to Canadian-born patients (78% vs. 68%, p=0.001).
- SVR rates were comparable between immigrant and Canadian-born patients for both Interferon (IFN) and DAA therapies, with DAA recipients achieving >94% SVR.
Conclusions:
- Immigrant patients with HCV had improved access to fibrosis assessment but similar treatment outcomes compared to Canadian-born individuals.
- Significant delays in accessing HCV care were observed for both groups, representing a missed opportunity for timely treatment and cure.
- Implementing HCV screening and healthcare engagement strategies at the time of immigration is recommended to optimize care and outcomes for immigrant populations.
Introduction And Aim:
HCV-infected immigrants contribute to the total prevalence in Canada and other developed nations. Little is known about engagement in care, access to service, and treatment outcomes in recipients of Direct Acting Antiviral (DAA) HCV therapies among immigrants living with HCV.
Material And Methods:
HCV patients assessed at The Ottawa Hospital Viral Hepatitis Clinic between 2000-2016 were identified. Immigration history, race, socioeconomic status, HCV work-up, treatment and outcome data were evaluated. HCV fibrosis assessment, treatment and sustained virologic response (SVR) were compared using logistic regression.
Results:
2,335 HCV-infected patients were analyzed with 91% (2114) having data on immigration (23% immigrants). A median 16 years (Quartiles: 5, 29) passed from immigration to referral. Access to diagnostic procedures (Fibroscan/liver biopsy) was greater among immigrants compared to Canadian-born (78% vs. 68%, p = 0.001) and immigrants had an odds ratio of 1.72 (95% CI: 1.18-2.51) of receiving a FibroScan compared to Canadians after adjustment for demographic characteristics, HCV risk factors, and socioeconomic status. No differences in SVR were found between immigrants for IFN recipients. Among DAA recipients, rates of SVR were > 94% among all patients, 93% in Canadian-born and 98% among immigrants (p = 0.14).
Conclusion:
Nearly 80% of immigrants in this setting had access to fibrosis assessment which was higher than Canadian-born patients. Under half of both groups had initiated HCV therapy. Delays in accessing HCV care represent a missed opportunity to engage, treat and cure HCV patients. HCV screening and health care engagement at the time of immigration would optimize HCV care and therapeutic outcomes.
