Hep C testing can empower people by giving them information they can use to stay healthy. Individuals who find out they are living with hepatitis C can make decisions about how to prevent transmission, how to stay healthy, and whether or not to access treatment. People whose test results show they are not infected can identify risk factors and learn to keep themselves safe from infection. The goal of providing information before and after testing is to inform the person about hepatitis C and to provide support—no matter what the test results might be.
Ideally, it is best to offer information and counselling at the time of testing and diagnosis. This will help the person prepare for the possibility of a positive result, give informed consent and learn about referrals to support and healthcare services in his or her community, which may be necessary to help an individual deal with a positive diagnosis.
Hepatitis C is a reportable disease across Canada, although case definitions for reporting differ from province to province. Currently, testing positive for HCV antibodies is the case definition for reporting of HCV in Ontario. Some public health units may use the reportable information to contact people to gather more information or to recommend further testing. This information is confidential, as is all medical information; anonymous testing for Hep C is not available in Canada.
The goal of providing information before and after testing is to inform the person about hepatitis C and to provide support—no matter what the test results might be.
Testing for hepatitis C is complex and involves multiple steps before a diagnosis of active infection can be made. It is important to encourage people to return for their test results at all stages of testing.
Currently, there are no formal pre- and post-test counselling guidelines for hepatitis C testing in Canada. Here is a list of some of the information that people may find helpful in understanding the testing process, in particular before and after HCV antibody testing and before and after RNA testing:
Counselling before HCV-antibody testing (anti-HCV)
- Review any prior history of hepatitis C testing, counselling and knowledge level of the disease.
- Review what HCV is including modes of transmission (blood-to-blood contact).
- Review the relationship HCV has to other factors such as addictions, HIV, and sexually transmitted diseases.
- Explain that testing is voluntary and confidential (although anonymous hepatitis C testing is not available).
- Provide details on the type of testing to be done and what the results of both the antibody test and RNA test will mean.
- Explain that results should be expected within two to four weeks and delays do not necessarily indicate a positive test.
- Review risk-reduction behaviors associated with hepatitis C and other blood-borne diseases (including HIV and hepatitis B).
- Reassure and refer the person for emotional support while he or she waits for the results.
- Discuss vaccination for hepatitis A and B, if appropriate, and that there is no vaccine for hepatitis C.
- Explain to the individual that there are treatment options available for hepatitis C.
Counselling after a negative HCV-antibody test
- Negative antibody test results mean the person was not exposed to hepatitis C and is not infected. However, discuss the window period (2 weeks to 6 months). If there were risk activities within the window period, recommend repeat antibody testing 6 months after risk activities.
- If the individual is immune compromised, recommend HCV RNA testing to rule out the possibility of a false negative test result.
- Emphasize that a negative test result does not mean the person is immune to future infection.
- Provide information on how to reduce risk.
- Encourage people to continue to access healthcare and other supports as needed.
Counselling after a positive antibody test (and before the RNA test)
- A positive antibody test result means there is a possibility that the person has an active infection. Explain that he or she was exposed in the past and that the RNA test is required to assess if he or she has an active infection with the hepatitis C virus.
- Explore options for support that the person can access, both personally and through organizations or agencies, while he or she waits for the results and also if the RNA test comes back positive. Include a reminder about HCV treatment options.
- Cover information on how he or she will have test positive for antibodies on future tests but that antibodies do not provide immunity to future HCV infection.
- Discuss harm reduction strategies.
After a negative RNA test (RNA not detected)
- If the RNA test results show no detectable virus, explain to the person that he or she has cleared the virus and is not infected.
- Recommend repeat testing to be done in six months to be sure there is no active infection.
- Review how the person can reduce risk of HCV infection, including the possibility of getting re-infected as HCV antibodies do not provide immunity to the virus.
- Encourage the person to continue to access health services.
After a positive RNA test (RNA detected)
- A positive RNA test result indicates that the person has an active hepatitis C virus infection.
- Review harm-reduction principles and prevention so the person knows about ways to minimize the chances of transmitting HCV to others, to prevent becoming infected with a different genotype of HCV and to avoid other infections like HIV or hepatitis B.
- Discuss with the person more testing will be done to monitor the infection.
- Review treatment options and discuss treatment readiness. Be prepared with referrals including reading materials, support services and treating physicians in the person’s community, if possible.
- Talk about maintaining liver health and other healthy living options, including disclosure.
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