Grant: Operating Grant

The burden of the hepatitis C (HCV) and the human immunodeficiency (HIV) viruses among individuals who inject drugs (IDU) remains a major public health challenge. Note that these diseases do not only affect IDUs. For example, the US launched a campaign in 2012 to test "baby boomers" given they have been exposed to HCV in the past; they calculated that 1 in 30 "baby boomers" are unaware of being infected with HCV. Also in the US, it was calculated that 21% of individuals infected with HIV are unaware of their infection. In Canada, especially in British Columbia (BC), the situation is very similar. Unfortunately, there is neither a preventive HCV vaccine nor a preventive vaccine or a cure for HIV. Currently, the treatment for HCV is very complicated, associated with a high occurrence of side-effects and a low cure rate. Among individuals infected with both HCV and HIV, the management of their diseases is further complicated, and they are at a higher risk of mortality. Based on the success of using the "HIV Treatment as Prevention" strategy to decrease the burden and transmission of HIV, we propose to evaluate a parallel "HCV Treatment as Prevention" strategy to decrease the combined burden of HIV and HCV and, secondarily, to decrease the spread of both HIV and HCV. This proposal will develop a methodology to forecast the future of both HCV and HIV epidemics in BC, considering different scenarios of testing, treatment coverage and retention into treatment for both diseases. There is no time to wait for the "perfect regimen" or a vaccine that will prevent HCV and HIV. Many lives will be saved if we act expeditiously taking advantage of the currently used and newly approved drugs. Failure to do so will lead to avoidable healthcare costs and further stress to healthcare systems already struggling to cope with the existing demand.