Time to Hepatitis C Care Engagement and Treatment Outcomes in Canadian Immigrants Have Markedly Improved Over Three Decades
Bibliographic record
Abstract
We assessed the characteristics and treatment outcomes of hepatitis C virus (HCV)-infected Canadian immigrants evaluated for antiviral therapy with a specific focus on time from arrival to HCV care engagement and the Direct-Acting Antiviral (DAA) era. A retrospective cohort analysis was conducted using medical records from HCV RNA positive patients assessed at The Ottawa Hospital Viral Hepatitis Program between August 1997 and March 2025. Of 2620 patients, 563 (21.5%) were immigrants. Proportions of treatment initiation, completion and SVR were comparable between immigrant and Canadian-born groups. SVR bloodwork completion was higher in the immigrant cohort (93.6% vs. 80.7%, p < 0.001). The overall median time from immigrant arrival in Canada to first HCV clinic assessment was 8 years. This delay in accessing HCV care trended downwards with each 5-year interval from 1990 to 2025 (median years = 23, 18, 12, 7, 3, 2, 1, p < 0.001). More recently immigrated patients demonstrated high proportions of DAA initiation (arrived in Canada 1990-1994: 62.3%; 1995-1999: 80.0%; 2000-2004: 92%; 2005-2009: 80.0%; 2010-2014: 90.7%; 2015-2019: 91.5%; 2020-2025: 89.3%, p < 0.001). Reduced times from immigrant arrival to specialty HCV care engagement and high DAA treatment initiation amongst more recently arrived patients suggest improved success in immigrant progression along the HCV care cascade. This reflects positive developments in Canadian HCV care over the past three decades and reinforces the importance of sustaining efforts towards national HCV elimination.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.003 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".