Time to Hepatitis C Care Engagement and Treatment Outcomes in Canadian Immigrants Have Markedly Improved Over Three Decades.

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.