Treatment Access

Fair Access to HCV Treatment in British Columbia

Broadly, we define issues related to fair access to hepatitis C treatment in British Columbia as such:

1. The current treatment guidelines in British Columbia are outdated.  In fact, one of the determining criteria, elevated ALT levels over time, has proven a poor indicator of liver disease from the virus.  The Canadian Association for the Study of the Liver (CASL) consensus guidelines (2007) recommends that all patients be considered for treatment, regardless of the “apparent state of liver disease” and that the earlier a person is treated the better the outcome, i.e. a reduction of the presence of the virus to ‘undetectable’ consistent over time.
2. Current treatment access is controlled by Pharmacare Special Authority via approval from a government-appointed committee.   Specialists with experience completing the Special Authority forms are more likely to gain approval for their patients than family practitioners or specialists without that experience.
3. Evidence demonstrates that stigma within the health care profession affects decision-making when the patient has hepatitis C.  The stigma is more pronounced when the patient is a person who uses drugs, particularly by injection or inhalation but it also affects patients with hepatitis C who have no history of drug use or do not currently use drugs. One of the effects of this stigma is a poorer access to treatment.
4. As a community-based organization with a mandate to work with stakeholders to ensure best possible health outcomes for people living with hepatitis C, we need to understand the policy development and decision-making processes and who is currently in charge of that process so that we can begin to engage with policy and decision makers.
5. We wonder if this current situation violates the Canadian constitution by denying access to health care to a group of people who experience sometimes severe disability and in some cases early death from the disease.

In this initiative we are:

• Documenting information on consensus and treatment guidelines for Canada and BC and providing analysis of differences
• Gathering HCV- and drug-user-related stigma research
• Researching Canadian constitutional rights, i.e. ‘security of the person’ and BC Human Rights law in relation to hepatitis C treatment access in BC
• Produce a report containing all of the above information, analyses and recommendation(s) for action