Research areas and platforms: from Discovery to Implementation

CanHepC's research program is organised around two specific research areas of focus each with underlining themes as well as cross-cutting platforms including our training program. Each research area, theme and platforms are supported and build on CanHepC’s existing infrastructure of cohorts, data linkage platforms and biobanks, and are led by one of CanHepC’s Principal Investigator as well as co-leads.
 

Research Area 1: Optimising prevention and treatment programs to eliminate hepatitis C

Eliminating hepatitis C hinges upon the development of effective programs to understand and optimise the cascade of care and prevent new infections (and re-infections). Despite the existence of interventions to prevent hepatitis C transmission, new infections continue to occur. We lack the data needed to understand why current interventions are not successful, and guide improvements to programming and policies. Research Area 1 will contribute to the optimization of prevention and treatment programs focusing on 3 specific themes:

Theme 1. Hepatitis C prevention determinants

Theme 1.1. Behavioural, social and structural determinants
Lead: Julie Bruneau, co-leads: Michel Alary, Joseph Cox, Alexandra King, Marina Klein, Sarah Larney, Daniel Werb.
The objectives of this theme are: 1) develop programme theories of expected social and structural policy/intervention effects and a corresponding suite of hepatitis C prevention indicators; and 2) obtain measures of those indicators to describe the hepatitis C prevention landscape in Canada, inform and calibrate hepatitis C elimination modelling, and guide future implementation science studies.

Theme 1.2. Correlates of protective immunity in priority populations
co-leads: Jordan Feld, Michael Houghton, Naglaa Shoukry, Angela Crawley.
A prophylactic vaccine against hepatitis C remains a research priority to achieve elimination, significant effort is required to understand the correlates of protective immunity in priority populations in order to inform vaccine development. The objective of this theme is to support projects that can enhance vaccine development like novel approaches to enhance immunogenicity and efficacy of vaccines.

Theme 2. Monitoring the cascade of care, and assessing progress towards hepatitis C elimination

Lead: Naveed Zafar Janjua; co-leads: Sofia Bartlett, Christina Greenaway, Jeff Kwong, Beate Sander, William Wong.
The objectives of this theme are: 1) estimate the undiagnosed proportions of various priority populations and evaluate the impact of birth cohort screening; 2) identify measures and indicators of cascade of care overall and for priority populations; and 3) inform prevention, care and treatment interventions through modeling studies.

Theme 3. Implementation science to optimise the cascade of care for priority populations

Leads: Justin Presseau & Guillaume Fontaine; co-leads: Julie Bruneau, Nadine Kronfli, Christina Greenaway.
Implementation of effective approaches to engage undiagnosed populations is a key challenge to achieving hepatitis C elimination. The objectives of this theme are: 1) explore how barriers and enablers vary across priority populations and in different areas of the cascade of care, 2) explore the impact of provincial context on observed barriers and enablers, and 3) co-design interventions, tools and models of care that address identified barriers.

Research Area 2: Long-term consequences and health implications of hepatitis C infection, re-infection and treatment

Remarkable advances in antiviral treatment have turned hepatitis C into a curable disease with rates of sustained viral response consistently over 95%. However, clinical trials and even observational cohort studies are designed to document antiviral efficacy, safety and short-term clinical improvement, with little ability to assess longer term outcomes and what happens to people after cure.

Lead: Curtis Cooper, co-leads: Brian Conway, Marina Klein, Alnoor Ramji, Mia Biondi, Naveed Zafar Janjua.
In continuity with research area 1, the objectives under research area 2 are to: A) understand liver-related and non-liver-related outcomes in the Canadian population using cohorts of people with cirrhosis coupled with administrative datasets; B) identify the frequency of testing to detect hepatitis C re-infection post cure in priority populations; and C) understand the cascade of care in pregnant women with hepatitis C.

 

Cross-cutting program and platforms

CanHepC’s program includes cross-cutting platforms (including the Training program) that inform, support and synergises with our research areas of focus described above:

Training, Education, and Mentorship Program

Co-Leads: Joyce Wilson & Nadine Kronfli, the co-leads are supported members of the Education Commitee.
The training program supports and is aligned with CanHepC’s research areas providing a transdisciplinary approach, training students across the hepatitis C biomedical, clinical, health systems services and population health fields of research. The objective of CanHepC’s Hepatitis C Training, Education and Mentorship Program is to train the next generation of investigators across all CIHR pillars. As part of this program CanHepC recruits and provides stipend support to graduate, post-doctoral students and fellows. The program also includes different training and mentorship activities, an education curriculum complete with a hepatitis C course, webinars and journal club as well as trainee elective and exchange program to promote research collaboration, visibility and knowledge translation. In addition, the program also aims to strengthen training opportunities for practitioners in Canada such as the Hepatitis C in Primary Care & Drug and Alcohol Settings workshops a collaboration with the International Network on Health and Hepatitis in Substance Users.

Knowledge Translation and Exchange (KTE) Platforms

Principal Knowledge User: Melisa Dickie; CanHepC's Knowledge Users are listed on our members page.
Since 2015, CanHepC has worked in partnership with national and regional member organizations, engaging frontline workers, community organizations working with different priority populations, policy makers and other stakeholders including people with lived/living experience of hepatitis C from across Canada to discuss and exchange on new hepatitis C research and programming knowledge. Several of these organizations (Canadian Association of Hepatology Nurses, Centre Associatif Polyvalent d'Aide Hépatite C, CATIE, Canadian Liver Foundation, CAAN Communities, Alliances & Networks and more) have direct knowledge exchange mandates and are involved as knowledge users in the network. Building on this engagement, the objectives of our KTE platforms are to increase the translation and uptake of knowledge and implementation of evidence to inform practices, policies and programs. Our KTE platforms include:

Indigenous Platform

Lead: Alexandra King; Co-leads: Renée Masching, Carrielynn Lund
A new Indigenous Platform will build on meaningful Indigenous participation and leadership and will interweave with the EDI Platform (see below) where objectives are aligned. The objectives of the Indigenous Platform are to: 1) ensure Indigenous research governance principles are included in CanHepC’s cohorts and project; 2) build engagement ensuring CanHepC’s commitment to cultural safety, equity, diversity and inclusion, as well as thoughtful and reflexive consideration of Network language, processes and structures to remove all sources of unconscious bias; 3) articulate a formal community accountability framework supporting low-barrier participation, that is reflective and responsive to Indigenous community needs related to research in collaboration with Indigenous community, researchers, Elders and people with lived/living experience.

Equity, Diversity and Inclusion (EDI) Platform

A new EDI Platform will address systemic barriers and unconscious biases existing in our scientific research and research community. The objectives of the EDI Platform are to: 1) remove barriers that limit full participation of talented individuals in CanHepC through policies that ensure fair and equitable access to opportunities provided by CanHepC, including research support, training, and presentation in seminars and at our annual symposium; 2) create an inclusive culture in CanHepC where EDI becomes innate through education that focus on EDI philosophy, practices, and lived experiences, and a code of conduct to promote respectful work environments inclusive of Indigenous components (developed with the Indigenous Platform).