Evaluating the hepatitis C care cascade in Newfoundland and Labrador: Progress toward elimination

Background: Care cascades are useful tools for tracking progress toward public health goals, including the World Health Organization's target of hepatitis C elimination by 2030. This study outlines the hepatitis C care cascade in Newfoundland and Labrador (NL) from 2018 to 2024 and assesses trends in access to testing and treatment. Methods: Provincial administrative health data on hepatitis C testing and treatment dispensing were analyzed. We calculated descriptive statistics for the full study period and compared two time intervals, with additional year-by-year analyses to examine trends. Results: From 2018 to 2024, the annual incidence of hepatitis C antibody positivity was 67.3 per 100,000 population. The diagnosis rate was 71%, and 25.6% of diagnosed individuals initiated treatment. Among those testing positive, the mean age was 40 years, 61% were male, and 31.5% were born between 1945 and 1975. Compared with 2018–2021, access to confirmatory RNA testing and treatment initiation improved in 2022–2024. Yearly trends showed steady increases in testing and treatment uptake, along with shorter time to treatment; by 2023, most individuals began treatment within 1 year of diagnosis. Conclusions: While access to testing and treatment improved over time, NL has not yet met hepatitis C elimination targets. Targeted interventions for higher-risk populations are needed to accelerate progress.