Grant: Project Grant

The purpose of this application is to evaluate the impact of ongoing health policy changes in hepatitis C (HCV) and addiction care on HCV-related outcomes among people who inject drugs (PWID). We propose to undertake this research in British Columbia (BC), Canada, which is facing a dual epidemic of HCV and opioid addiction. This proposal comes at a time when there is growing international consensus that, given the key role that PWID play in the HCV epidemic, expanding and optimizing access to HCV treatment among this population will be critical to curb the HCV epidemic. Accordingly, we will seek to evaluate the impact of novel HCV treatment roll-out and exposure to opioid addiction treatment (OAT) on engagement along the HCV cascade of care among PWID. We will also aim to characterize how different health care delivery models (e.g., integration of addiction and HCV care) shape these outcomes. To this end, we propose to develop a province-wide, population-level administrative cohort of HCV-positive PWID in BC over the past two decades. The availability of unique personal health numbers confers unique opportunities to build a de-identified and comprehensive demographic, laboratory, and clinical longitudinal HCV-related profile for each member of the cohort. By bringing together a multidisciplinary and experienced team with expertise in epidemiology, substance use, viral hepatitis, health services and clinical sciences, we are well positioned to make use of this exceptional resource to critically inform HCV efforts, with a particular emphasis on PWID. This study will provide important contributions to our understanding of the feasibility and potential of a strategy that aims to reduce HCV-related outcomes. We aim to address several urgent issues surrounding the effective delivery of these highly efficacious and safer HCV medications in Canada, and to inform the development of policies and interventions to address the dual epidemics of HCV and opioid addiction.