Virtual Cascade of Care Cohort study

Approximately 250,000 people in Canada live with chronic hepatitis C virus (HCV) infection, a major cause of liver-related morbidity and mortality.^[1,2]

People who inject drugs (PWID) are the principal group at risk.

• >60% have been exposed to the virus, as indicated by presence of anti-HCV antibodies^[3,4]
• Injection drug use estimated to contribute >60% of total HCV disease burden^[5].

Advances in treatment suggest HCV could be eliminated as a public health threat by 2030^[6]

• However, high prevalence and low treatment uptake in PWID suggest this will require greatly increased engagement in health services^[7]
• Although HCV antibody screening is broadly accessible this typically occurs in settings with no systematic linkage to care strategy^[8]

Objectives

The Virtual Cascade of Care Cohort study (VCCC) aims to:

• Document and analyze the entire HCV cascade of care for current/former PWID (from community to post-treatment).
• Identify modifiable determinants of access to HCV care/treatment.
• Examine the long-term impact of HCV care/treatment on liver and non-liver comorbidities.

Target Population

The target population includes people who have ever injected drugs and are vulnerable to unmet healthcare needs.

Inclusion criteria:

• Ever injected drugs.
• Recent drug or heavy alcohol use (past six months).
• Intend to remain in province of recruitment for 5 years.
• HCV-negative (including previously treated) individuals are eligible to participate.

Methodology

Recruitment will take place in community-based harm reduction and addiction services with no linkage to HCV care.

During a single study visit (baseline):

• A 10-minute questionnaire – modelled on the candidacy framework
• Rapid HCV antibody testing – results returned in 20 minutes
• Dried Blood Spot collection for RNA detection & genotyping
  – banked at CHUM, research purposes only
• Informed consent to access records held in federal & provincial health administrative databases
  – 5 years retrospective, 5 years prospective

Locations

The VCCC study has already begun in Montreal, Sherbrooke and Shawinigan, Quebec. There are three locations in Saskatchewan: La Ronge, Prince Albert and Saskatoon. The Saskatchewan part of the study, overseen by the Indigenous Wellness Research Group at the University of Saskatchewan, commenced in La Ronge in November 2019. More sites are needed to complete the pilot study and relationships with communities and community organizations are being developed.

Funding

National funding for a larger scale project and are moving from the pilot to the main study. The communities/sites are still to be determined. There has also been a change to the protocol from the pilot, such as following participants for 10 years before and after, rather than five.

This study is supported by the CanHepC through funding provided by the Canadian Institutes of Health Research (CIHR) and the Public Health Agency of Canada (PHAC).

For more information on VCCC in Saskatchewan, contact:

Kehinde Ametepee – k.ametepee@usask.ca