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

 

 

 

Project 1. The perspectives of Canadian healthcare providers on hepatitis C care and services during the COVID-19 pandemic: a qualitative study

The COVID-19 pandemic significantly disrupted healthcare services, including hepatitis C (HCV) care. This project explored how healthcare providers across Canada experienced and adapted to these disruptions, and identified solutions to improve HCV care during future public health emergencies. We conducted 11 small group interviews with 18 healthcare providers (HCPs) from Alberta, British Columbia, Ontario, and Saskatchewan. Participants included 11 registered nurses, 3 physicians, 1 nurse practitioner, and 3 support providers (harm reduction, community coordinator, and psychosocial support). We also surveyed 49 HCPs, primarily from British Columbia, about their pandemic experiences.

Our analysis revealed disruptions across all stages of the HCV care cascade. Laboratory services were redirected to COVID-19 testing, appointment-based systems created barriers for marginalized populations, and staff were redeployed to pandemic response. HCC surveillance was particularly affected, with providers noting that pre-pandemic challenges were "further exacerbated" during COVID-19, leading to some patients presenting with "advanced HCC" after missed screenings. Despite these obstacles, HCPs demonstrated remarkable adaptability. They implemented telehealth services, conducted on-site blood collection, expanded mobile outreach, and strengthened community partnerships. As one support provider noted, "Mobile outreach became a really big necessary thing during the pandemic." Several pandemic-induced changes were identified as worth maintaining, including simplified treatment approval processes, expanded testing options, and telehealth integration. HCPs emphasized the importance of a comprehensive approach to HCV care, advocating for "streamlined service delivery" and care provided "where the patients are." As telehealth becomes increasingly important in healthcare delivery, addressing digital exclusion will be crucial to ensure equitable access for all patients, especially those from marginalized populations.

Project team members: Dahn Jeong, Mawuena Binka, Georgine Cua, Terri Buller-Taylor, Sofia R. Bartlett, Richard L. Morrow, Naveed Z. Janjua

Funders: Canadian Institutes of Health Research; British Columbia Centre for Disease Control; University of British Columbia

For more information, contact: Naveed Z. Janjua

Project 2. Impact of the COVID-19 Pandemic on Hepatitis C Treatment Initiation in British Columbia, Canada: An Interrupted Time Series Study

This project evaluated the impact of the COVID-19 pandemic and related policies on hepatitis C treatment initiation in British Columbia (BC), Canada. Hepatitis C treatment initiation peaked in spring 2018 and was declining prior to the COVID-19 pandemic in BC. The COVID-19 pandemic was associated with a decrease in treatment initiation for hepatitis C, compared to the expected trend in treatment, but this effect was temporary. However, the impact of the pandemic on treatment for hepatitis C was greater for people born from 1965 to 1974 and people who inject drugs, compared to others.

Project team members: Richard L. Morrow, Mawuena Binka, Julia Li, Mike Irvine, Sofia R. Bartlett, Stanley Wong, Dahn Jeong, Jean Damascene Makuza, Jason Wong, Amanda Yu, Mel Krajden, Naveed Zafar Janjua

Funders: The British Columbia COVID-19 Cohort (BCC19C) was established and is maintained through operational support from Data Analytics, Reporting and Evaluation (DARE), and BC Centre for Disease Control (BCCDC) at the Provincial Health Services Authority. This study was funded by the Canadian Institutes of Health Research.

For more information, contact: Naveed Z. Janjua

Project 3: Disparities in hepatocellular carcinoma screening, its detection rates, and survival among individuals with hepatitis B or C in Canada

Hepatocellular carcinoma (HCC) is one of the leading causes of death from cancer worldwide and in Canada. People infected with hepatitis B (HBV) or hepatitis C (HCV) are at higher risk of developing HCC. Screening for liver cancer using ultrasounds can help detect the cancer early and improve survival. However, there is limited information about how often people with HBV or HCV are being screened for HCC, especially across different groups of people. This study looked at whether there are any differences in HCC screening, diagnosis, and survival outcomes for people with viral hepatitis in British Columbia, Canada. We used data from the BC Hepatitis Testers Cohort, which includes people who were tested for HBV, HCV, or HIV and links that information to health care visits, cancer diagnoses, and deaths. We included individuals diagnosed with HBV or HCV between 1990 and 2020, focusing on those at higher risk for HCC. This included people with cirrhosis, people also infected with HIV, African people with HBV aged 20 and older, women with HBV over age 50, and men with HBV over age 40. We looked who got screened using ultrasound, who developed HCC, and who died. Out of over 117,000 people with chronic HBV or HCV, around 31,000 were considered at risk for liver cancer. Most of the people in the study were men (70%) and born between 1945 and 1964 (about 66%).

The study found that more than half of people at risk were screened at least once during follow-up. Screening rates were highest among those with chronic HBV mono-infection (81.8%), followed by those with both HBV and HCV (59.9%), and lowest in those with only HCV (53.5%). HCC was found in 10.8% of those who had been screened, with the highest rate (24.4%) among those with both HCV mono-infection. Among those who developed HCC, the death rate was high about 406 deaths per 1,000 person-years, and even higher for those with HCV alone (about 516 deaths per 1,000 person-years). Certain groups were more likely to be screened, including people with diabetes, people born between 1945 and 1964, and people of East Asian backgrounds. On the other hand, men and people with a history of injection drug use were less likely to be screened. People who were East Asian, male, or born between 1945 and 1975 were more likely to be detected with HCC, but those with diabetes or a history of injection drug use were less likely to be detected with HCC. Even among people who regularly visited the health system, differences in screening rates were found. Some groups, like those with diabetes or born in certain time periods, had a lower risk of dying from any cause.

In conclusion, this study shows that not everyone at risk of liver cancer is being screened equally. Differences based on sex, age, ethnic background, and drug use are still present, even with access to health care. More efforts are needed to improve screening and follow-up, especially for high-risk groups. Future research should explore why some groups are less likely to be screened and how to close those gaps.

Project team members: Jean Damascene Makuza, Stanley Wong, Dahn Jeong, Richard Morrow, Sofia Bartlett, Héctor Alexander Velásquez García, Prince Adu, Ji Hyun Choi, Amanda Yu, Alnoor Ramji, Eric Yoshida, Mel Krajden, Naveed Janjua

Funders: BCCDC, CIHR, CanHepC

For more information, contact: Naveed Z. Janjua

Project 4. Ethnic disparities in extrahepatic manifestations among people with HCV infection: a population-based study in British Columbia

Chronic hepatitis C virus (HCV) infection can cause health problems beyond the liver, known as extrahepatic manifestations (EHMs). Our study examined whether different ethnic groups experience these complications differently, using data from over 41,000 individuals in British Columbia tested for HCV between 1990-2015. We found significant ethnic disparities in EHMs, particularly among individuals with untreated HCV. South Asian and East Asian populations experienced higher rates of kidney diseases, diabetes, stroke, and cardiovascular conditions compared to other ethnicities. After accounting for various factors, South Asians had the highest risk of kidney diseases and diabetes, while East Asians showed lower risks of cardiovascular events and neurocognitive disorders. Importantly, successful HCV treatment appeared to reduce most of these ethnic disparities. Among individuals who completed treatment, differences in EHM risk between ethnic groups largely disappeared, except for diabetes, which remained elevated among South Asians regardless of treatment status. Our results emphasize the importance of ensuring equitable access to HCV testing and treatment for all ethnic groups. Healthcare providers should consider enhanced monitoring for kidney complications and diabetes among Asian patients with HCV, especially South Asians. Given Asian populations have a disproportionate burden of HCV, targeted HCV screening, testing, treatment and follow-up strategies should be prioritized to ensure timely diagnosis and linkage to care among this population.

Project team members: Dahn Jeong, Stanley Wong, Héctor A Velásquez García, Prince A Adu, Jean D Makuza, Sofia R Bartlett, Alnoor Ramji, Eric M Yoshida, Richard L Morrow, Amee R Manges, Mohammad E Karim, Amanda Yu, Georgine Cua, Mel Krajden, Naveed Z Janjua

Funders: BCCDC, CIHR, CanHepC

For more information, contact: Naveed Z. Janjua

Project 5. Workshop: 2025 HCV Care Cascade Methods Workshop

The cascade of care for the hepatitis C virus (HCV) describes how many individuals advance through different stages of care for HCV, such as diagnosis, treatment, and testing for response to treatment. This provides information to researchers and the health system to help evaluate health care and services provided to individuals with HCV and to guide potential improvements to policy and services. Developing consistent definitions to use for stages of the HCV care cascade in different provinces may help promote best practices and support teams conducting HCV care cascades. On March 1, 2025, a workshop on HCV care cascade methods was held at the Canadian Liver Meeting in Quebec City. This included researchers and stakeholders from five provinces (BC, Alberta, Saskatchewan, Ontario, and Quebec), as well as representatives from national organizations. At the workshop, participants discussed data sources, how best to define stages of the HCV care cascade, methods, populations, and challenges. The project aims to develop and report on consistent definitions for HCV care cascade stages and related measures which can be applied in Canadian jurisdictions.

Project team members: Naveed Janjua, Dahn Jeong, Zoe Greenwald , Christina Greenaway , Andrew Mendlowitz, Richard Morrow, Beate Sander, William Wong

For more information, contact: Naveed Z. Janjua

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 

Funder: Canadian Institutes of Health Research (CIHR)

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

Funder: Canadian Institutes of Health Research (CIHR)

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