Research Areas

The Canadian Network on Hepatitis C

CanHepC is a national collaborative research and training network on hepatitis C virus funded by the Canadian Institutes of Health Research (CIHR) and the Public Health Agency of Canada (PHAC). CanHepC brings together over 100 members including researchers and student trainees from different disciplines (Biomedical, Clinical, Health Services, and Social, Cultural, Environmental, and Population Health) and knowledge-users from across Canada, as well as international partners.

Research program:

Our overarching goal is to improve health outcomes for people living with hepatitis C at all stages of the cascade of care, closing the gap between knowledge and practices while training and building capacity in research. An important part of our work is providing evidence to inform the hepatitis C elimination agenda in Canada and globally.

Our research is organized into two main areas (1) optimizing prevention and treatment programs to eliminate hepatitis C and (2) long-term consequences and health implications of hepatititis C. Read more about each area below.

Cross-cutting platforms:

CanHepC is committed to working in a good way with Indigenous communities. The network's Indigenous platform guides efforts to incorporate Indigenous ways of knowing and doing across network research and training activities. The platform works closely with a Community Guiding Circle comprised of people with lived/ living experience of hepatitis C, Elders, government and policy advisors, clinicians and other stakeholders from across regions. The Indigenous platform has also contributed to shaping CanHepC's vision and scope of work related to Equity, Diversity, Accessibility and Justice (EDIA&J). Find out more about our Indigenous platform and Equity, Diversity, Accessibility and Justice (EDIA&J) platform below.

CanHepC also works in partnership with many organizations involved as knowledge-users to discuss and exchange on new hepatitis C research and programming knowledge. Some of our main knowledge translation and exchange platforms include the Canadian Symposium on Hepatitis C Virus (CSHCV), the Blueprint to inform hepatitis C elimination efforts in Canada, and our Regional Hepatitis C Elimination Roadmap project.

Training program:

Another important goal of CanHepC is to train the next generation of investigators across all disciplines. Over 144 graduate trainees and 97 summer students have gone through the CanHepC Training, Education and Mentorship Program which started in 2003 as the National CIHR Research Training Program in Hepatitis C. Since 2015, the program has continued to expand in accordance with the scientific direction and mission of the network providing a more transdisciplinary approach. As part of this program, CanHepC recruits and provides stipend support and training to graduate, post-doctoral students and fellows. Find out more on our training program here.

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.

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: Joseph CoxAlexandra KingMarina KleinSarah LarneyDaniel 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 FeldMichael HoughtonNaglaa ShoukryAngela 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 BartlettChristina GreenawayJeff KwongBeate SanderWilliam 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 BruneauNadine KronfliChristina 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.

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 ConwayMarina KleinAlnoor RamjiMia BiondiNaveed 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.

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

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 NursesCentre Associatif Polyvalent d'Aide Hépatite CCATIECanadian Liver FoundationCAAN 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:

The Canadian Symposium on Hepatitis C Virus (CSHCV)

The Blueprint to inform hepatitis C elimination efforts in Canada

The Regional Hepatitis C Elimination Roadmap project: CanHepC is currently facilitating the development of regional roadmaps (and a national Indigenous roadmap) to hepatitis C elimination which aims to adapt the Blueprint to address specific issues and barriers pertaining to regions/communities and progress towards elimination.

Indigenous Platform

Lead: Alexandra King; Co-leads: Carrielynn Lund and Renée Masching
The Indigenous Platform supports meaningful Indigenous participation and leadership and interweaves with the EDIA&J 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, inclusion, accessibility and justice, 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, Inclusion, Accessibility & Justice (EDIA&J) Platform

The EDIA&J Platform will focus efforts at two levels of priority: internal network-level (e.g., CanHepC's structure, membership, policies, etc.) and at the broader research ecosystem-level (e.g., the network's influence on broader research environments and academic practices). Network-level EDIA&J objectives 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 the network, including research support, training, and representation in seminars and at our annual symposium; 2) create an inclusive culture in CanHepC where EDIA&J becomes innate by providing EDIA&J training opportunities, developing a code of conduct to promote respectful and inclusive work/ research environments, and developing a network EDIA&J framework and action plan.

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.

Co-Leads: Joyce Wilson & Nadine Kronfli. The co-leads are supported members of the Education Commitee.
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. Read more about the training program, here.