Grant: Project Grant

Roughly 250,000 Canadians live with chronic hepatitis C virus (HCV) infection, a major cause of liver cirrhosis, cancer, and transplantation that places a significant burden on infected individuals and the health system. People who inject drugs (PWID) are the principal group at risk of this blood-borne infection. Recent advances in curative treatment present an opportunity to drastically reduce HCV transmission in the absence of a vaccine. However, even a universally effective treatment cannot cure people who remain undiagnosed and untreated, and the public health impact of new medications will rely on linking and retaining infected individuals in appropriate healthcare. For PWID, a range of conditions (discrimination, stigma, a lack of insurance or stable housing, and difficulty navigating the health system) can hinder access to necessary services, and many individuals are lost along the 'cascade of care' connecting HCV testing, treatment, and cure. This study seeks to improve our understanding of the accessibility of HCV care and treatment for diverse groups of people with a history of injecting drug use, including Indigenous people and women who inject drugs. In partnership with community-based organisations across Canada, we will recruit current or former PWID and provide on-the-spot hepatitis C testing, with counselling and clinical referral for those testing positive. Participants will complete a short questionnaire to collect information on their background, medical history, and perspectives on barriers to healthcare. We will then request permission to follow their healthcare utilisation and medical outcomes "virtually" through records routinely collected and stored in administrative databases during clinic, hospital, laboratory, and pharmacy visits for the next five years. Altogether, the study aims to identify modifiable barriers and facilitators to care and guide evidence-based public health interventions and policy in the new landscape of HCV therapy.