Grant: CIHR Fellowship

Hepatitis C (HCV) remains a significant global health problem that affects estimated 130-150 million individuals worldwide. Recent developments in HCV therapeutics have made HCV curable in most cases. HCV cure is associated not only with substantial reductions in HCV-related mortality, morbidity and associated healthcare costs, but also has a secondary prevention benefit, by virtually eliminating the risk of HCV transmission. While there is immense optimism regarding future HCV treatment efforts, concerns remain regarding issues of access, treatment adherence, and potential reinfection following treatment. In Canada, and most developed countries, people who inject drugs (PWID) represent the core of the HCV epidemic, accounting for most prevalent and incident HCV infections. However, treatment uptake rates among this population have been consistently low, which likely reflects a combination of individual and social-structural barriers to health services. Despite the high efficacy of newer HCV therapies, their impact on the HCV epidemic will be limited as long as PWID do not access HCV treatment. Accordingly, there is now a pressing need to identify how to best integrate HCV treatment with addiction treatment and other harm reduction strategies, in order to reduce HCV- associated morbidity and mortality, prevent forward transmission and protect valuable health resources. Due to leading efforts in innovative addiction treatment approaches and recent scale-up of HCV treatment coverage, Vancouver offers an ideal setting to conduct this research. Through prospective cohort methods this post-doctoral program of research will seek to identify barriers and facilitators to access and adherence to HCV treatment, as well as risk factors for HCV reinfection among PWID, with a focus on the role that addiction treatment plays in shaping HCV outcomes. The evidence generated from this study has high potential to guide future HCV and addiction efforts in Canada, and elsewhere.