Evaluation of the Hepatitis C Prevention, Support and Research Program 1999/2000 – 2005/2006

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3. Evolution of the Hepatitis C Prevention, Support and Research Program

The Hepatitis C Prevention, Support and Research Program, introduced in June 1999 in response to the Commission of Inquiry on the Blood System in Canada (Krever Commission) was a $50 million, 5-year time-limited program spanning 1999/2000 - 2003/2004.

The Program consisted of four main components including:

• research and surveillance;
• prevention and community-based support;
• care and awareness; and
• management, policy, evaluation and public involvement.

The Program was national in scope and shared responsibility in its delivery with the regional offices of Health Canada, subsequently the Public Health Agency of Canada (PHAC). A National/Regional Hepatitis C Program Network was established to undertake this shared responsibility soon after the Program's inception.

The Program's four goals were:

1. Contribute to the prevention of HCV;
2. Support persons infected with/affected by HCV;
3. Provide a stronger evidence base for policy and programming decisions; and
4. Strengthen partners' capacity to address HCV in Canada.

The Program was extended twice, each time for one year (2004/2005 and 2005/2006) for approximately $10 million each year. A one-year extension of the Program to March 31, 2005 was approved in Budget 2004 to allow continuation of the Program's work while the PHAC was being established. An additional extension to March 31, 2006 was approved in Budget 2005 enabling the Program to operate while the PHAC developed an integrated framework for addressing infectious diseases.

Provinces and Territories (P/Ts) welcomed federal leadership in building an enhanced hepatitis C knowledge base, and on collaboration in the development and implementation of best practice models of care. The Hepatitis C Program was developed in consultation with P/T governments, persons infected/affected and at-risk of hepatitis C, researchers, Aboriginal people and NGOs. Based on consultations during the winter of 2002-2003, these same groups agreed that the Program should maintain its main components of Program Management, Research, Prevention, Care and Treatment, and Community based support and continue work in these areas, in addition to setting longer-term strategic directions.

As a result of the evolution of the Program, and the results of the mid-term evaluation and an informal five-year program review, the final extension years were designed to address:

• Prevention efforts for the populations most at risk of infection;
• General awareness of HCV and targeted social marketing initiatives;
• Care, treatment, support and quality of life issues for Canadians already infected;
• The “hidden” epidemic (those who do not know they are infected);
• Enhanced research capacity including social and behavioural research;
• Enhanced surveillance;
• Community-based capacity to appropriately respond to diverse needs at the local level; and
• A comprehensive long-term conceptual framework to support a more integrated and holistic approach to HCV, other infectious diseases, and health and social determinants more broadly.

3.1 Program Reach - Target Population

The Program's plans, particularly for the two one-year extensions, sought to strengthen federal leadership in broad areas. These included: capacity building for care professionals, researchers, and community organizations; increased focus on research, surveillance, evaluation and strategic planning/consultations with stakeholders, government partners and provincial/territorial governments; ensure an effective and efficient response to address populations most at risk (Aboriginal peoples, street youth, inmates and injection drug users) including the “hidden” epidemic (those who do not know they are infected); the general public in the area of general awareness/social marketing; and, those infected/affected in need of care, treatment and support.

This was accomplished through nationally and regionally funded grants and contributions that incorporated surveillance data, previous evaluative processes, consultations and progress report recommendations. The Program addressed multiple health determinants and disease challenges of diverse populations - demanding a coordinated strategy promoting a multi-disciplinary approach, linkages and partnerships across systems and sectors.

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