Research Papers

@article{Young2023,

title = {The rate of hepatitis C reinfection in Canadians coinfected with HIV and its implications for national elimination},

author = {Jim Young, Shouao Wang, Charlotte Lanièce Delaunay, Curtis L Cooper, Joseph Cox, M John Gill, Mark Hull, Sharon Walmsley, Alexander Wong , Marina B Klein; Canadian Coinfection Cohort Investigators},

doi = {10.1016/j.drugpo.2023.103981},

year  = {2023},

date = {2023-04-01},

journal = {Int J Drug Policy },

volume = {114},

number = {103981},

pages = {103981},

abstract = {Background: The World Health Organisation (WHO) has set targets for the rate of new infections as a way to measure progress towards the elimination of hepatitis C virus (HCV) as a public health threat. As more people are successfully treated for HCV, a higher proportion of new infections will be reinfections. We consider whether the reinfection rate has changed since the interferon era and what we can infer about national elimination efforts from the current reinfection rate.



Methods: The Canadian Coinfection Cohort is representative of HIV HCV coinfected people in clinical care. We selected cohort participants successfully treated for a primary HCV infection either in the interferon era or in the era of direct acting antivirals (DAAs). Selected participants were followed from 12 weeks after completing a successful treatment until the end of 2019 or until their last measured HCV RNA. We estimated the reinfection rate in each treatment era, overall and in participant subgroups, using proportional hazard models appropriate for interval censored data.



Results: Among 814 successfully treated participants with additional HCV RNA measurements, there were 62 reinfections. The overall reinfection rate was 2.6 (95% confidence interval, CI, 1.2-4.1) /100 person years (PY) in the interferon era and 3.4 (95% CI 2.5-4.4) /100 PY in the DAA era. The rate in those reporting injection drug use (IDU) was much higher: 4.7 (95% CI 1.4-7.9) /100 PY and 7.6 (95% CI 5.3-10) /100 PY in the interferon and DAA eras respectively.



Conclusion: The overall reinfection rate in our cohort is now above the WHO target set for new infections in people who inject drugs. The reinfection rate in those reporting IDU has increased since the interferon era. This suggests Canada is not on track to achieve HCV elimination by 2030.},

keywords = {HCV Elimination, HCV elimination; HCV reinfection; HCV treatment; HIV-HCV coinfection; People who inject drugs, HCV reinfection, HCV treatment, HIV-HCV coinfection, People who inject drugs},

pubstate = {published},

tppubtype = {article}

}

@article{C2022,

title = {Gaps in hepatitis C virus prevention and care for HIV-hepatitis C virus co-infected people who inject drugs in Canada},

author = {C, Laniece Delaunay; M, Maheu-Giroux; G, Marathe; S, Saeed S; V, Martel-Laferriere; C, Cooper; S, Walmsley; J, Cox; A, Wong A; MB, Klein; },

url = {https://www.sciencedirect.com/science/article/pii/S0955395922000470?via%3Dihub},

doi = {10.1016/j.drugpo.2022.103627},

year  = {2022},

date = {2022-02-01},

journal = {International Journal of Drug Policy},

abstract = {Background: People who inject drugs (PWID) living with HIV are a priority population for eliminating hepatitis C virus (HCV) as a public health threat. Maximizing access to HCV prevention and treatment strategies are key steps towards elimination. We aimed to evaluate engagement in harm reduction programs and HCV treatment, and to describe injection practices among HIV-HCV co-infected PWID in Canada from 2003 to 2019.



Methods: We included Canadian Coinfection Cohort study participants who reported injecting drugs between 2003 and 2019 in Quebec, Ontario, Saskatchewan, and British Columbia, Canada. We investigated temporal trends in HCV treatment uptake, efficacy, and effectiveness; injection practices; and engagement in harm reduction programs in three time periods based on HCV treatment availability: 1) interferon/ribavirin (2003-2010); 2) first-generation direct acting antivirals (DAAs) (2011-2013); 3) second-generation DAAs (2014-2019). Harm reduction services assessed included needle and syringe programs (NSP), opioid agonist therapy (OAT), and supervised injection sites (SIS).



Results: Median age of participants (N = 1,077) at cohort entry was 44 years; 69% were males. Province-specific HCV treatment rates increased among HCV RNA-positive PWID, reaching 16 to 31 per 100 person-years in 2014-2019. Treatment efficacy improved from a 50 to 70% range in 2003-2010 to >90% across provinces in 2014-2019. Drug injecting patterns among active PWID varied by province, with an overall decrease in cocaine injection frequency and increasing opioid injections. In the most recent time period (2014-2019), needle/syringe sharing was reported at 8-22% of visits. Gaps remained in engagement in harm reduction programs: NSP use decreased (58-70% of visits), OAT engagement among opioid users was low (8-26% of visits), and participants rarely used SIS (1-15% of visits).



Conclusion: HCV treatment uptake and outcomes have improved among HIV-HCV coinfected PWID. Yet, this population remains exposed to drug-related harms, highlighting the need to tie HCV elimination strategies with enhanced harm reduction programs to improve overall health for this population.},

keywords = {drug injecting patterns, harm reduction, HCV Elimination, HCV treatment, HIV-HCV coinfection, People who inject drugs},

pubstate = {published},

tppubtype = {article}

}

@article{ME2019,

title = {"Another thing to live for": Supporting HCV treatment and cure among Indigenous people impacted by substance use in Canadian cities},

author = {Pearce ME and Jongbloed K and Demeras L and MacDonald H and Christian WM and Sharma R and Pick N and Yoshida EM and Spittal PM and Klein MB},

url = {https://pubmed.ncbi.nlm.nih.gov/31525640/},

doi = {10.1016/j.drugpo.2019.08.003},

year  = {2019},

date = {2019-12-01},

journal = {The International Journal on Drug Policy},

abstract = {Background: Colonization and colonial systems have led to the overrepresentation of Indigenous people impacted by substance use and HCV infection in Canada. It is critical to ensure Indigenous people's equitable access to new direct acting antiviral HCV treatments (DAAs). Identifying culturally-safe, healing-centered approaches that support the wellbeing of Indigenous people living with HCV is an essential step toward this goal. We listened to the stories and perspectives of HCV-affected Indigenous people and HCV treatment providers with the aim of providing pragmatic recommendations for decolonizing HCV care.



Methods: Forty-five semi-structured interviews were carried out with Indigenous participants affected by HCV from the Cedar Project (n = 20, British Columbia (BC)) and the Canadian Coinfection Cohort (n = 25, BC; Ontario (ON); Saskatchewan (SK)). In addition, 10 HCV treatment providers were interviewed (n = 4 BC, n = 4 ON, n = 2 SK). Interpretive description identified themes to inform clinical approaches and public health HCV care. Themes and related recommendations were validated by Indigenous health experts and Indigenous participants prior to coding and re-contextualization.



Results: Taken together, participants' stories and perceptions were interpreted to coalesce into three overarching and interdependent themes representing their recommendations. First: treatment providers must understand and accept colonization as a determinant of health and wellness among HCV-affected Indigenous people, including ongoing cycles of child apprehension and discrimination within the healthcare system. Second: consistently safe attitudes and actions create trust within HCV treatment provider-patient relationships and open opportunities for engagement into care. Third: treatment providers who identify, build, and strengthen circles of care will have greater success engaging HCV-affected Indigenous people who have used drugs into care.



Conclusion: There are several pragmatic ways to integrate Truth and Reconciliation as well as Indigenous concepts of whole-person wellness into the HCV cascade of care. By doing so, HCV treatment providers have an opportunity to create greater equity and support long-term wellness of Indigenous patients.},

keywords = {HCV treatment, Health equity, Indigenous peoples, Wellness},

pubstate = {published},

tppubtype = {article}

}