Integrating HCV and addiction treatment to improve individual and population HCV outcomes among people who inject drugs

Hepatitis C (HCV) remains a significant challenge that affects an estimated 60,000 British Columbians. Many more, in particular, people who inject drugs (PWID), remain highly vulnerable to HCV infection. Recently, there have been dramatic developments in the treatment of HCV with the arrival of direct acting antivirals (DAAs). These drug regimens are highly effective, offering vastly superior cure rates over past HCV treatments. Interferon-free regimens with DAA-based regimens are also simpler and better tolerated. While there is immense optimism regarding future HCV treatment efforts, concerns remain regarding issues of access, treatment adherence, and potential reinfection following treatment. Further, recent evidence from phylogenetic analyses reveal that the core transmitters of HCV within British Columbia tend to be PWID with active addiction and who remain outside of conventional treatment programs.

Accordingly, there is now a pressing need to optimize the delivery of addiction treatment to ensure the success of HCV treatment in order to reduce HCV-associated morbidity and mortality, prevent forward transmission and protect valuable health resources. Vancouver offers an ideal setting in which to undertake research focused on identifying how to best integrate addiction and HCV treatment efforts. The BC Centre for Excellence in HIV/AIDS (BC CfE) is home to two large ongoing US National Institutes of Health-funded prospective cohort studies of PWID with a HCV prevalence of 90%. The BC CfE is also home to a CIHR and NIH-funded addiction clinical trials network, and is leading efforts to deliver DAAs to marginalized populations, including PWID.

Using prospective cohort methods, this postdoctoral program of research will seek to identify barriers to and facilitators of access and adherence to DAAs, as well as risk factors for HCV reinfection, with a focus on the role that addiction treatment plays in shaping HCV outcomes (e.g., sustained virological response). With the advent of safer and more efficacious HCV treatments, as well as the research infrastructure afforded by the BC CfE, I will be uniquely positioned to undertake innovative research with high potential to improve population health outcomes in British Columbia.