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Ending hepatitis C

Interdisciplinary research finds key to curbing rate of HCV in N.L.


By Chad Pelley

Interdisciplinary research to help lower Newfoundland and Labrador’s rate of hepatitis C to fall more in line with other Canadian provinces.

Drs. Whitten and Daley standing in front of large windows in MUN MEd School
From left are Dr. Cindy Whitten, Faculty of Humanities and Social Sciences, and Dr. Peter Daley, Faculty of Medicine.
Photo: Rich Blenkinsopp

It’s work that Dr. Peter Daley, Faculty of Medicine, and Dr. Cindy Whitten, Department of Sociology, Faculty of Humanities and Social Sciences, say is in part inspired by the World Health Organization’s goal to eliminate the hepatitis C virus (HCV) by 2030.

Dr. Daley is an infectious disease physician; Dr. Whitten is a clinical research scientist. They are also both employees of Eastern Health.

Dr. Whitten says that among all infectious diseases, the hepatitis C virus is associated with the highest number of life years lost in Canada, and the Canadian Network on Hepatitis C reports that it is the leading cause of liver disease and liver transplantation in the country.

But there is hope that the disease can not only be alleviated but eliminated in Newfoundland and Labrador.

The Canadian Network on Hepatitis C recently released a Blueprint to Inform Hepatitis C Elimination in Canada that states “progress in the HCV field represents one of the major medical breakthroughs of our time.”

Key to success in N.L.

The blueprint identifies people who are incarcerated as a priority group for increased access to HCV care.

Drs. Whitten and Daley are focusing their efforts on this group.

Dr. Whitten says that incarceration is associated with sexually transmitted and blood borne infections (STBBIs), including HCV, because people with substance use disorder are often incarcerated.

“Universal testing in correctional facilities is a best practice, which other provinces adhere to,” she said. “But, given the low rate of testing in our province, the prevalence of STBBIs in our correctional facilities, including HCV, was unknown.”

The pair recently completed a retrospective observational study on STBBIs in Newfoundland and Labrador’s correctional system.

They found that in comparison to other provinces, Newfoundland and Labrador’s testing for high risk populations, such as the incarcerated population, remains low.

This low rate is a contributing factor to the province’s relatively higher rate of HCV, say the researchers.

Drs. Daley and Whitten are advocating for increased testing of all populations, especially those at high risk, to facilitate the identification and treatment of positive cases, so as to prevent its transmission.

This is especially important because there are no vaccines for the infectious disease.

Harm reduction needed

HCV transmission is also common within corrections facilities due to lack of harm reduction measures.

“Best practices and evidence-based approaches, such as opioid agonist therapy and needle exchange programs, have also been shown to reduce the prevalence of STBBIs,” said Dr. Whitten. “While Newfoundland and Labrador has opioid agonist therapy in our correctional system, there is no needle exchange program.”

The researchers’ goal is to have their suggestions and the findings from their ongoing research decrease morbidities associated with STBBIs, especially for patients within correctional facilities.

“HCV treatment using direct-acting antiviral drugs leads to a cure in 95 per cent of people.” — Dr. Cindy Whitten

By curing inmates of hepatitis C, they will spread less the virus less in our correctional system, and in our community upon release.

“HCV treatment using direct-acting antiviral drugs leads to a cure in 95 per cent of people, with 8–12 weeks of once-daily pills that have few or no side effects,” said Dr. Whitten. “By curing cases as we identify them, we reduce the risk for liver-related morbidity, all-cause mortality and improve quality of life.”

The researchers have a suite of studies underway to help them in their mission.

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