Hepatitis C Treatment Outcomes Among Immigrants: A CANUHC Cohort Analysis

Immigrants to Canada are disproportionately affected by hepatitis C virus (HCV) infection. Little is known about treatment outcomes among immigrants at the national level or how outcomes vary across Canadian provinces.

We used data from the Canadian Network Undertaking against Hepatitis C (CANUHC), a prospective cohort enrolling HCV RNA-positive patients from 17 sites across 6 Canadian provinces between 2015 and 2025. Sociodemographic data, clinical characteristics, immigration details, time to first consult, and treatment outcomes were evaluated. Treatment outcomes included direct-acting antiviral (DAA) initiation, sustained virological response (SVR) bloodwork completion, and SVR achievement.

Of 2521 patients, 427 (16.9%) were immigrants to Canada. Immigrants had higher educational attainment (60.8% vs 28.2% college/university, P < .001), higher employment (47.1% vs 28.0%, P < .001), and lower proportions with a history of injection drug use (25.8% vs 75.3%, P < .001), incarceration (12.9% vs 49.1%, P < .001), or recreational drug use (43.5% vs 91.8%, P < .001). Immigrants demonstrated excellent DAA treatment outcomes with higher crude rates of DAA initiation (95.6% vs 92.2%, P = .02), posttreatment SVR bloodwork completion (81.6% vs 70.5%, P < .001), and SVR (100% vs 98.6%, P = .03). However, after adjustment for age, sex, race, and key socioeconomic measures, immigration status was not independently associated with these outcomes. The mean time from immigration to specialist assessment was 24.9 years (standard deviation, 18.6 years). The delay in accessing care trended downward with each 5-year interval from 1990 to the present (median years, 26, 22, 16, 12, 7, and 2; P < .001).

Immigrants in the CANUHC cohort achieved excellent DAA treatment outcomes comparable to or exceeding those of Canadian-born patients. When engaged in care, immigrants can successfully complete the HCV treatment cascade.