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.
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. On this page 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.
Ideally, it is best to offer information and counselling at the time of testing and diagnosis. This will help the person to 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.
Going through the testing process for hepatitis C, being open to pre- and post-test counselling and being able to positively act on information provided through the counselling is difficult for many people. Each of these steps can require a degree of stability, access to resources, social support, self-esteem and other factors, which make them less accessible for some people.
When offering counselling, it is important to individualize both the information and how it is presented to the person on the receiving end. Be aware of issues such as:
- Is the client overwhelmed by the information? Does he or she want more information or less?
- What extra support could help the client follow up with the next phase of testing and counselling? How can he or she connect with organizations that provide this support?
- What extra support could help the client follow up on recommendations discussed during a counselling session? How can he or she connect with organizations that provide this support?
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 infections. Recommending testing for HIV or other infections may be appropriate.
- Explain that testing is voluntary and confidential (anonymous hepatitis C testing is not available).
- Ask the person how they think they would respond to having hepatitis C. This can identify misinformation they might have and better prepare them for test results.
- 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 behaviours 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 HCV infection.
- 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 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 the risk of HCV infection, including the possibility of getting re-infected (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.
- Reassure and support the person in realizing that hepatitis C is a serious but manageable disease.
- Review harm reduction principles and prevention so the person knows how to minimize the chances of transmitting HCV to others, how to prevent becoming infected with a different genotype of HCV and how to avoid other infections such as HIV or hepatitis B.
- Tell the person that more testing will be done to monitor the infection.
- Review treatment options and discuss treatment readiness.
- Talk about maintaining liver health and other healthy living options, including disclosure.
- Discuss and encourage a plan for medical follow-up and a plan for managing potential ongoing emotional reactions, including options for support. Be prepared with referrals, including reading materials, support services and treating physicians in the person’s community, if available.