Research projects

The Pan-Canadian HCV Prevention Consortium works to address critical gaps in HCV prevention by leveraging existing research infrastructures. Specific aims are to:  

• Conceptualize HCV prevention in relation to risk and protective factors at multiple levels of influence;
• Identify a harmonized framework and set of HCV prevention indicators that reflect key behavioural, social, and structural determinants;
• Facilitate opportunities for multi-database analyses, including to validate proposed indicators;
• Prioritize future data collection needs.  

Ultimately, the Consortium aims to inform modelling for HCV elimination and guide improvements to programming and policies across Canada. 

Project team: 

BC: Eugenia Socias​, Sofia Bartlett​, Kate Salters​, Marion Selfridge​, Tyrone Curtis​
AB​: Elaine Hyshka​, Ginetta Salvalaggio​
SK​: Alexandra King​, Barb Fornssler​
ON​: Dan Werb​, Zoe Greenwald​, Jolene Eeuwes​, Curtis Cooper​
QC​: Julie Bruneau​, Nadine Kronfli​, Sarah Larney​, Joe Cox​, Marina Klein​, Souleymane Diabate​, Adelina Artenie​, Stine Hoj*​, Ingrid Matei,*​ Nanor Minoyan*​ (*coordinating team)

For more information, contact: Nanor Minoyan or Ingrid Matei

Hepatitis C virus (HCV) affects an estimated 58 million people globally, including over 250,000 Canadians. Despite the availability of highly effective curative treatments, hepatitis C continues to cause hundreds of thousands of deaths each year. Diagnosis and treatment reach only a minority of those infected, and without a vaccine, global elimination will remain out of reach.

Developing a vaccine for HCV has been particularly challenging. The only phase 2 vaccine trial to date required significant time and resources and was ultimately unsuccessful. Conducting large-scale trials for every candidate will not be practical. A Controlled Human Infection Model (CHIM) for HCV will offer a more efficient approach by allowing early testing of the most promising vaccine candidates, reducing the risk and cost of vaccine development.

This study will aim to establish a CHIM for hepatitis C in healthy adult volunteers. Participants will be intentionally infected with a carefully screened HCV strain known to be safe and curable. Study participants are infected with hepatitis C through a blood sample that has been confirmed to be free of other diseases. Because acute HCV infection often has no symptoms and can be reliably treated, this model will be implemented safely with appropriate oversight.

After screening and informed consent, eligible participants will be enrolled in the study. The active study period will last approximately 12 weeks, during which participants will undergo regular clinical visits for blood tests, liver scans, and plasmapheresis (a procedure that collects plasma for research). Following this period, participants will receive an 8-week course of direct-acting antivirals (DAAs), which are highly effective and well-tolerated.

To monitor long-term outcomes, participants will attend four follow-up visits in the first year after treatment, followed by yearly visits for an additional five years. Participation will be voluntary, and individuals will be able to withdraw from the study at any time without penalty.

In addition to accelerating vaccine development, the CHIM will allow researchers to study the earliest stages of HCV infection in detail—something that is rarely possible in natural infections. These insights will inform future vaccine design and deepen scientific understanding of the virus and the immune response it triggers.

By providing a faster and more controlled way to evaluate vaccine candidates, this model will play a critical role in global hepatitis C elimination efforts. The study will be conducted under strict ethical, safety, and regulatory oversight to ensure participant well-being and scientific integrity.

Project members:

Coordinating team: Jordan Feld (PI), Nishat Rashid (Study Coordinator), Jiayun Chen (Study Coordinator)

1 Day Sooner: Circe McDonald, Josh Morrison, Julia Murdza

Co-investigators:

University Health Network, University of Toronto: Jordan Feld (Site Lead), Mia Biondi, Adam J. Gehring, David Barth, Alexander Mosa, Bettina Hansen (Statistician)
Li Ka Shing Institute of Virology, University of Alberta: Michael Houghton (Site Lead), Lorne Tyrrell, Vanessa Meier-Stephenson, Jason Acker (Canadian Blood Services)
Kingston Health Science Centre, Queen’s University: Jeannie Callum (Site Lead)
Centre de Recherche Universite de Montreal (CHUM): Naglaa Shoukry (Site Lead), Julie Bruneau
Western University: Charles Weijer (Site Lead – ethicist)

Funders: Canadian Institutes of Health Research (CIHR), Open Philanthropy, Founders Pledge

Project website: https://hcvchallenge.org/

For more information, contact: Nishat Rashid or Jiayun Chen

 

 

More information coming soon

 

Project 1.  Hepatitis C Point-of-Care Testing: Establishing the framework for decentralized hepatitis C point-of-care testing and treatment in Canada – an implementation science-based approach

Hepatitis C virus (HCV) infection poses a significant public health challenge in Canada, where achieving the World Health Organization’s goal of eliminating HCV by 2030 requires a dramatic increase in diagnoses and treatment. While current treatments boast cure rates over 95%, the diagnostic process remains cumbersome and inefficient, often leading to treatment delays and loss to follow-up, particularly among high-risk groups such as people who inject drugs and incarcerated individuals. These groups face unique obstacles, including stigma, discrimination, and limited access to healthcare services. Innovative finger-stick point-of-care tests, which can detect HCV antibodies and RNA within an hour, offer a promising solution by enabling single-visit diagnosis and treatment, thereby increasing testing acceptability and reducing loss to follow-up. 

Objectives: Building on studies supported by the CIHR-funded CanHepC, our overall goal is to generate evidence to inform the scale-up of point-of-care HCV testing and treatment in key settings across three Canadian provinces. Our specific objectives are to:

• Map processes of existing and proposed point-of-care HCV testing and treatment practice
• Identify multilevel barriers and facilitators to implementing point-of-care HCV testing and treatment, with a comparative analysis across provinces and settings
• Co-design implementation strategies, protocols and materials, such as training documents and standard operating procedures, for point-of-care HCV testing and treatment
• Assess the acceptability, feasibility, and costs of implementation strategies, protocols and materials 

Project team: Agatha Jassem, Andrew Mendlowitz, Christina Greenaway, Cole Etherington, Daniel Elakpa, Emma Day, Elisabeth Vesnaver, Guillaume Tremblay, Jason Grebely, Jody Jollimore, Jordan Feld, Julie Bruneau, Justin Presseau, Kate Dunn, Lisa Douglas, Lorraine Fradette, Lucy You, Mark Gilbert, Marina Klein, Melisa Dickie, Mia Biondi, Natalie Taylor, Naveed Janjua, Nashira Popovic, Paul Sandstrom, Sofia Bartlett, Tamara Barnett, Jennifer van Gennip 

For more information, contact: Guillaume Fontaine

 

Project 2. NEXUS: Needle EXchange Uptake Study

The Needle EXchange Uptake Study (NEXUS) is a five-year study (2024-2029) that aims to improve the implementation of the Prison Needle Exchange Program (PNEP) in Canadian federal prisons, with the goal of increasing the number of PNEP participants across nine federal prisons. NEXUS also aims to improve PNEP adoption, implementation, and maintenance by identifying barriers and facilitators to sustainability. 

The study has two main objectives: 

1. Increase PNEP reach: Conduct an implementation trial using an evidence based quality improvement model (NIATx) to improve the existing standard of care at nine federal prisons with PNEP services; and  

2. Identify barriers and facilitators to PNEP sustainability: Determine the factors that impact PNEP maintenance at each prison using mixed-methods strategies among multi-level stakeholders (incarcerated individuals, healthcare staff, correctional officers, and prison leaders). 

The expected outcomes of NEXUS are:  

1. Increased participation in PNEP among people who inject drugs in prison. 

2. Increased quality of PNEP services, which in turn leads to greater adoption and sustainability through collaborative learning; and  

3. A reduction in the transmission of bloodborne viruses (HIV, HBV, and HCV) 

By focusing on the “how” and “why” PNEP services work in the Canadian federal prison system, NEXUS hopes to ensure the sustainability of PNEP for the federal prison population, inform Canada’s expansion efforts to remaining federal and provincial/territorial prisons, generate evidence to inform PNEPs worldwide, and support advocacy efforts globally. 

Project team: Nadine Kronfli, Frederick Altice, Behzad Hajarizadeh, Lise Lafferty, Andrew Lloyd, and Mark Stoové

For more information, contact: Nadine Kronfli

Project 1.  Hepatitis C virus testing, treatment and long-term outcomes, a CANUHC Study 

DAA treatment is associated with reduced all-cause, liver- and drug-related mortality and outcomes. Liver-related deaths with HCV have declined while drug-related deaths are increasing. In fact, PWID with HCV infections are more likely to die from drug-related causes than liver-related causes. The risk of drug-related mortality is higher in HCV patients with IDU, younger age, excessive alcohol intake, and HIV/HBV coinfection.  

The Canadian Network Undertaking against Hepatitis C (CANUHC) is an ongoing national HCV cohort of HCV patients from 17 different sites across Canada, including 3 in Ontario and 2 in Alberta. Most participants have received DAA treatment. Other than containing inter provincial data, a strength of CANUHC is the level of information related to race and socioeconomic determinants of health. No study to date has compared long-term effects of SVR on all-cause, liver- and drug-related mortality and outcomes cross provincially.  

Our goal is to link the Ontario and Alberta CANUHC patients to their respective health administrative databases for the purpose of cross provincial comparison, aims are: 

1. To examine associations between hepatitis C virus testing, treatment and long-term outcomes relative to advanced liver disease among patients with chronic infection.   

2. From this linkage, determine clinical and demographic predictors of long-term outcomes related to HCV. 

3. Examine engagement in testing, care and subsequent treatment among the cohort.  

This initiative aims to generate valuable insights, enhance evidence-based treatment approaches, and support healthcare professionals, policymakers, and government agencies in developing effective programs and support systems for individuals affected by HCV. 

Project team: Haris Imsirovic, Curtis Cooper, Andrew Mendlowitz, Jordan Feld, Abdel Aziz Shaheen, Hongqun Liu, Pam Crotty, Sam Lee

For more information, contact: Haris Imsirovic or Curtis Cooper

 

Project 2. Hepatitis C Treatment During Pregnancy and Postpartum: A Qualitative and Prospective Cohort Study 

Treatment in pregnancy requires consideration to address loss to follow-up postpartum, as prenatal care may be the only time one is engaged with the healthcare system. Interestingly, recent findings have shown that a viral load of ≥6.0 log10 IU/ml may be predictive of vertical transmission, which may suggest that treatment in the prenatal period could decrease transmission. The American Guidelines recommend a case-by-case decision making process for treatment in pregnancy, and providers in Canada and globally are started to initiate HCV treatment in pregnancy as a part of routine care. Large interventional studies are underway, and thus far there have been no major safety concerns, cure rates have been 100%, and no child has acquired HCV to date. As providers are starting to offer treatment in pregnancy, it will be important to gather the data and follow these patients to understand whether there is overall maternal and pediatric benefit to treatment in pregnancy. Similarly, understanding women’s motivation to undergo HCV treatment or choosing not to be treated during pregnancy is critical to developing pathways to link women to care, expediate the HCV care cascade to prevent lost to follow up and essentially prevent vertical transmission in their current pregnancy and in subsequent pregnancies. This work will provide valuable information, expand evidence-based treatment practices, and inform health care providers, policy analysts and governments to create pathways and comprehensive programs for vulnerable pregnant and postpartum women living with HCV. Furthermore, by interviewing pregnant women living with HCV, we hope to better understand the reasons one which choose to be treated or not in pregnancy.

Project team:

CanHepC Members Protocol Development:  Mia Biondi, Curtis Cooper, Jordan Feld, Jennifer Flemming, Alnoor Ramji, Brian Conway, Chris Fraser,  Sofia Bartlett, Carla Coffin, Naveed Zafar Janjua, Gisela Macphail, Valérie Martel-Laferrière, Marie-Louise Vachon 

CanHepC Recruiting Sites: Mia Biondi, Curtis Cooper, Jordan Feld, Jennifer Flemming, Alnoor Ramji, Brian Conway, Chris Fraser 

For more information, contact: Mia Biondi