Background: Canada has committed to eliminating hepatitis C virus (HCV) by 2030. Despite highly effective treatments, screening and treatment uptake remains suboptimal. Immigrants from HCV-endemic countries account for 35% of HCV cases and face distinct barriers to care. This study explored health care providers' perspectives on barriers and facilitators to providing HCV screening and treatment among immigrant populations.
Methods: We conducted a qualitative descriptive study guided by the Theoretical Domains Framework (TDF). Semi-structured interviews were performed with health care providers in two Canadian cities. Transcripts were independently coded by two researchers, and key themes were identified.
Results: Twelve health care providers (7 female, 5 male) were interviewed, including eight family doctors, two infectious disease specialists, one nurse, and one social worker. Participants identified multiple barriers including limited familiarity with immigrants' specific clinical guidelines, low confidence in managing HCV, and difficulty addressing culturally sensitive issues. Providers perceived patient-related barriers, such as stigma, limited awareness, and competing life priorities, as factors that may hinder engagement with HCV care. Language and communication challenges frequently interfered with care. System-level issues, including fragmented services, long wait times, and shortages of family physicians, further constrained access.
Conclusion: This study underscores the complex barriers health care providers face in delivering HCV care to immigrant populations in Canada. While some challenges reflect broader health care system gaps, they are compounded for immigrants by linguistic and cultural differences. Strengthening provider capacity, improving system coordination, and embedding culturally and linguistically responsive approaches are essential to advancing HCV elimination.
Keywords: Theoretical Domains Framework; barriers; health care providers; hepatitis C; immigrants; implementation science; qualitative research.
Hepatitis C is a liver disease that can now be cured in more than 95% of cases with short courses of medication. However, many people with hepatitis C still go undiagnosed or untreated. Canada has promised to eliminate hepatitis C as a public health threat by 2030. About a third of individuals with hepatitis C in Canada are immigrants from countries in which hepatitis C is common. In this study, we wanted to understand the challenges health care providers (HCPs) face when providing hepatitis C testing and treatment to immigrants. We interviewed 12 HCPs including family doctors, specialists, a nurse, and a social worker in two Canadian cities, Ottawa and Montreal. Providers described several obstacles. Many felt unfamiliar with immigrant-specific guidelines or unsure about their role in delivering hepatitis C treatment. Some found it difficult to discuss the disease in culturally sensitive ways. They also perceived that stigma, low awareness, and competing life demands often made it harder for immigrants to prioritize hepatitis C care. Language barriers were a major challenge, with providers frequently relying on family or community members to translate because professional interpretation services were not available. System-level problems, such as shortages of family doctors, long wait times, and fragmented services, added to these difficulties. Our findings show that while many challenges reflect broader problems in Canada's health care system, they are especially difficult for immigrants who must also navigate language and cultural differences. To meet Canada's 2030 elimination goal, we need to support HCPs with clearer guidance and training, expand interpreter services, and create more coordinated, immigrant-friendly care pathways.
© Canadian Association for the Study of the Liver, 2026.