Co-Infection Cohort

A) Q1

B) Q2

C) Q3

D) Q4

...and Q3 has the least!

15 Years of Excellence: 2003 to 2018

How was the Canadian Co-Infection Cohort created?

Question 6

Typically, which quarter of the year has the most traffic in terms of completed questionnaires?

The idea was generated after Dr. Marina Klein completed her M.Sc project using retrospective data from the Montreal Chest Institute. The data showed that people living with HIV and HCV were experiencing increased rates of liver disease outcomes despite effective HIV treatment.

Dr. Danielle Rouleau, a research investigator at the Centre hospitalier de l’Université de Montréal (CHUM), strongly supported the need for follow-up of HIV and Hepatitis C co-infected patients and together they developed a protocol for the pilot study.

The pilot study was granted funding from the Réseau SIDA-Fonds de recherche santé to create a Quebec cohort of HIV/HCV co-infection. Over the years, with the help of other research collaborators and funding agencies, the provincial cohort grew into a national one representing 18 sites across 6 provinces.

Question 5

What is the total number of research blood samples collected from 2003 to 2022?

A) 97,873

B) 74,137

C) 86,255

D) 109,272

The Canadian Co-infection Cohort

// Celebrating 15 Years of Excellence

Recruitment & Treatment Initiations

Welcome,

Please enjoy this presentation taking you through the history of the Canadian Co-infection Cohort, highlighting its achievements and milestones.

- Dr. Marina Klein and the Canadian Co-infection Cohort team

Sub-studies

What we have accomplished over the years....

Educational, Training & Publications

But how did we get here?

Let's take a ride down memory lane to see how the cohort has grown in size over the years!

Question 4

What is the total amount of visits a single participant has ever had in our cohort?

A) 43

B) 40

C) 34

D) 27

Question 3

What is the age of the oldest person in the cohort?

A) 82

B) 79

C) 88

D) 74

@ site B

Question 2

Between 2003 and 2017, which year contained the most amount of completed and scanned questionnaires?

A) 2015

B) 2010

C) 2016

D) 2006

1539 completed questionnaires!

Recruitment & Treatment Initiation

Question 1

Prior to REDCap and Inform, what was the total number of pages scanned into the COCO database?

Thanks for playing!

How did you score?

We hope you have enjoyed this presentation of the Cohort!

A) 152,368

B) 194,201

C) 98,923

D) 302,624

Now, let's have some FUN answering questions and learning some fun facts along the way!

HCV Elimination

Here we go...

The CCC currently has 2105 participants across Canada and among them 678 are active

Since 2016, the aim of the cohort has been to monitor the scale up and impacts of direct-acting antiviral (DAA) medication for hepatitis C treatment.

As of 2019, among the 944 active CCC participants:

• 795 patients are HCV RNA –
• 145 patients are HCV RNA +

Contact Us

www.cocostudy.ca

@cocostudy

Follow-us!

cocostudy222@gmail.com

Funded by:

Community Partners:

Presentation created using Prezi software by Costas Pexos

• The food insecurity sub-study sought to understand the relationships between food security and behavioural and clinical factors related to HIV-HCV co-infection, health-related quality of life (HRQOL), and health and treatment outcomes, among co-infected patients participating in HIV care in Canada.

• The sub-study enrolled 725 participants of the CCC and the results revealed that 65% of participants (468 of 725) did not have adequate access to food due to a lack of money. They were 8 times more likely to be unable to get enough food than the general Canadian adult population. Additionally, over half were missing meals and sometimes going days without food which is categorized as experiencing severe food insecurity.

• An info-card (pictured) was created as a knowledge transfer tool to provide participants with the results of this study. The card encourages participants to tell their health care providers if they feel that they are experiencing food insecurity, as there may be services available to help them access food.

Food insecurity in people living with HIV and hepatitis C in Canada

CTN 264 Food Insecurity Sub-Study:

Sub-studies

• Study results have also been published in several scientific journals including AIDS and Behavior, Drug and Alcohol Dependence and HIV Medicine, as well as the CATIE website.

• Two PhD trainees (Epidemiology, McGill University), Taylor McLinden and Wusiman Aibibula, were instrumental to the study's success in advancing analyses and communicating related results.

Food insecurity in people living with HIV and hepatitis C in Canada

CTN 264 Food Insecurity Sub-Study:

Sub-studies

Study recruitment sites:

• Oak Tree Clinic, Vancouver, BC
• Vancouver Infectious Diseases Research and Care Centre Society, Vancouver, BC
• MUHC Chronic Viral Diseases Clinic, Montreal, QC
• BC Centre for Excellence in HIV/AIDS, Vancouver, BC
• Regina Qu'Appelle Health Region, Regina, SK
• Hamilton Health Sciences, McMaster University Medical Center Health Sciences, Hamilton, ON
• CHUQ – CHUL, Quebec City, QC
• Toronto General Hospital, Infectious Disease Division, Toronto, ON

• The FibroScan sub-study used the FibroScan test as a method of determining liver fibrosis progression in chronic HIV and HCV co-infection.

• The FibroScan is a test used for evaluating changes in the liver. It is able to measure hepatic fibrosis in a non-invasive and painless manner, with no risks for the patient.

• The sub-study has since been implemented into the main study and FibroScans are part of regular research activities.

Sub-studies

Novel Approaches to Studying Liver Fibrosis-Transient Elastography (FibroScan)

FibroScan Sub-Study:

• Dr. Margo Pearce's Indigenous sub-study aimed to understand how to better support Indigenous peoples' access to hepatitis C care and treatment.

• A total of 45 participants were interviewed from the Cedar Project and the CCC studies in Vancouver, Prince George, Sudbury, and Regina. Additionally, 10 hepatitis C treatment providers were also interviewed.

• Three overarching themes emerged from the data:

1. Understand colonization as a social determinant of health and wellness among Indigenous people living with HCV.

2. Treat us with respect: create and maintain trust within the doctor-patient relationship.

3. Identify, build, and strengthen circles of care

• Analyses of these interviews were presented by Dr. Pearce and Kate Jongbloed at the Canadian Association for HIV Research (CAHR) in 2018 and 2019.

• The manuscript was published in the International Journal of Drug Policy.

Dr. Margo Pearce

Indigenous Sub-Study:

Validation of a simple model for predicting liver fibrosis in HIV/hepatitis C virus-coinfected patients

Cohort Profile: The Canadian HIV–Hepatitis C Co-infection Cohort Study

Impact of hepatitis C viral replication on CD4+ T-lymphocyte progression in HIV–HCV coinfection before and after antiretroviral therapy

How Generalizable Are the Results From Trials of Direct Antiviral Agents to People Coinfected With HIV/HCV in the Real World?

Evaluating Liver Fibrosis Progression and the Impact of Antiretroviral Therapy in HIV and Hepatitis C Coinfection Using a Noninvasive Marker

Marijuana Smoking Does Not Accelerate Progression of Liver Disease in HIV–Hepatitis C Coinfection: A Longitudinal Cohort Analysis

Is Antiretroviral Therapy Causing Long-Term Liver Damage? A Comparative Analysis of HIV-Mono-Infected and HIV/Hepatitis C Co-Infected Cohorts

Recognizing and responding to barriers to HCV treatment among Indigenous people who use drugs in Canadian cities

"I would like to thank all the study coordinators and staff at each study site for their support in this work"

Clinical Infectious Diseases, 2016

Clinical Infectious Diseases, 2013

All articles will be available on the upcoming new website!

Sub-studies

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2007

Plos one, 2009

(continued)

Top 10 Cited Papers

AIDS, 2010

International Journal of Epidemiology, 2009

• As HIV and HIV/HCV co-infection disproportionately affect marginalized groups, COVID-19 may have presented unique challenges that are likely to include: HIV treatment and care interruptions (e.g. cancellation of medical appointments), delays in HCV treatment initiation, lack of access to telehealth services, changes to substance use patterns, and the double effect of confinement on aging people for whom loneliness and isolation is often part of their everyday reality.

• The aim of the sub-study is to measure the impact of COVID-19 from a clinical, psychosocial, and economic perspective to understand how the pandemic has impacted routine HIV and HCV care including laboratory monitoring, medication management, and overall well-being.

• Electronic questionnaires are used to collect data at participating sites and the spectrum of COVID-19 infections will be investigated by determining the frequency and severity of symptomatic disease and by storing plasma to enable future batch testing of COVID-19 antibodies.

4.

5.

6.

7.

8.

9.

10.

HIV Medicine, 2005

COVID-19 Sub-Study

The impact of COVID-19 on persons with HIV in Canada: Data from the HIV/HCV co-infection) and HIV aging cohorts

European Journal of Immunology, 2010

JAIDS Journal of Acquired Immune Deficiency Syndromes, 2003

HCV-specific T cells in HCV/HIV co-infection show elevated frequencies of dual Tim-3/PD-1 expression that correlate with liver disease progression

Sub-studies

The Impact of Hepatitis C Virus Coinfection on HIV Progression Before and After Highly Active Antiretroviral Therapy

Sexually Transmitted Infections, 2012

Top 10 Cited Papers

Incidence of acute hepatitis C virus infection among men who have sex with men with and without HIV infection: a systematic review

24 trainees since 2006...

Trainees

CCC papers: 76

CCC papers with students as first authors: 39

Conferences, abstracts, and presentations: 162

Manuscripts have been published in top journals with high impact factors such as

• AIDS
• International Journal of Epidemiology
• Clinical Infectious Diseases

&

Acknowledgments,

Thank you's

Dr. Robert W Platt, Professor of Department of Epidemiology, Biostatistics and Occupational Health and Senior Scientist of the Child Health and Human Development Program at the RI-MUHC. He has supervised one PhD student of the COCO study.

Dr. Joseph Cox, Associate Professor of Department of Epidemiology, Biostatistics and Occupational Health and Investigator at the MUHC. He is the Principal Investigator for CTN 264-Food Insecurity Sub-Study in which he has supervised two PhD students and Co-Investigator of the COCO study.

Dr. Erica Moodie, Associate Professor of Biostatistics at McGill University, Biostatistics Graduate Program Director and McGill Health Statistics Training Network Director. She has played a key leadership role in growing the number of trainees working on the COCO study.

Dr. James Young, Adjunct Professor in the Department of Epidemiology, Biostatistics and Occupational Health (EBOH) at McGill University. He has worked on contract on a number of analyses for the Canadian Co-Infection Cohort applying Bayesian methods and assisting our trainees with their study analysis.

To the McGill Department of Epidemiology, Biostatistics and Occupational Health

Dr. Mathieu Maheu-Giroux, Assistant Professor in the Department of Epidemiology, Biostatistics and Occupational Health. He is currently co-supervising one PhD student of the COCO study.

Dr. Dimitra Panagiotoglou, Assistant Professor in the Department of Epidemiology, Biostatistics and Occupational Health. She is currently co-supervising one of our PhD students.

We thank as well....

Sahar Saeed, Alex Schnubb, Jennifer Kocilowicz, Hansi Peiris and Isabelle Robichaud for coordinating and overseeing all sites of the Canadian Co-Infection Cohort

Lesley Galanger, who coined the title "The Coco Study"

Bruce Hinds and his students, creators of the study logo

2012

CCC Coordinating Centre / CVIS (Montréal)

Teams at Site C and K over the years...

Goodbye to Paper

....and as of December 31st, 2021:

217 Baseline, 3759 Follow-up and 452 DAA questionnaires have been successfully submitted

Bye bye paper and pen...

Hello keyboards and tablets

In 2018, we switched to electronic data capture systems REDCap and Inform.

2014

...and in

2018

"The CCC Coordinating Centre would like to thank all of the investigators, coordinators, students and patients who support the work of our study throughout these 19 years. We could not do this important work without your commitment!"

Site F - Regina Qu'Appelle Health Region, Regina General Hospital

8 July

PI: Dr. Alex Wong

Team: Sarah Craddock, Alexander Cameron, Claire Allen, Jones Kalyniuk

2017

Sukayna Chatoo, Chantal Morrisseau, Laurie Gokool

2014

A message from the CHUM Research Team

[Names reflect current CTN222 site staff]

26 March

Site X - SHARE University of Saskatchewan, Saskatoon

PI: Dr. Stephen Sanche

Sub PI's: Dr. . Kris Stewart, Dr. Siddharth Kogilwaimath, Dr. Shaqil Peermohamed, Dr. Beverly Wudel

Team:

2013

[Names reflect current CTN222 site staff]

A message from Warmond at Site T (Toronto General)

<< Ce projet de recherche est un de nos projets d’étude qui nous tient à cœur depuis longtemps. La clientèle recrutée et suivie au cours de ces années représente un réel défi pour l’adhérence aux visites. Les participants sont reconnaissants à leur façon et apprécient l’attention lors des visites. Les questionnaires du protocole permettent une rencontre et une collaboration de l’équipe de recherche avec les participants. Ils favorisent leurs suivis, mobilisent et soutiennent les liens entretenus auprès de l’équipe de recherche, de la clinique de l’UHRESS et des différents intervenants (TS, pharmaciens, psychiatres, psychologues).

Nous tenons à remercier chacuns et chacunes qui ont contribué au succès de cette cohorte.

Nous adressons un sincère remerciement à Dre Marina Klein et à son équipe de coordination du CUSM pour le bon travail effectué, la collaboration et le soutien apporté depuis le début. >>

29 February

PI: Dr. Marie-Louise Vachon

Sub-PI: Dr. Sylvie Trottier

Team: Isabelle Chabot, Marie-Christine Samson

Site Q - CHU de Québec - Université Laval

2012

[Names reflect current CTN222 site staff]

L to R: Angela Cicci, Adri D'Aquilla, Rosemary Clarke, Dr. David Wong, Dr. Sharon Walmsley, Bryan Boyachuk, Warmond Chan

Site R - Sunnybrook Health Sciences Center

4 February

PI: Dr. Anita Rachlis

Team: Cathy McDowell, Anja McNeil

Site U -Vancouver Aboriginal Health Society, St-Paul’s Hospital

31 March

PI: Dr. Mark Hull

Team: Lindila Awendila

Claire Dufour, Martine Paradis, Kathleen Gingras, Jacinthe Lessard et Sonia Roy

23 September

Site A - Oak Tree Clinic

PI: Dr. Neora Pick

Sub-PI: Dr. Melanie Murray

Team: Arezou Azampanah

2009

"Here is a photo of our group and a photo of me drowned in some of the binders of copied questionnaires. We have 20+ binders!

With the launch of InForm and RedCap, we are thankful that we will no longer drown in paper! They could not have come any sooner!

We are happy to have experienced the evolution of HCV treatment with our participants, from the days of peg-interferon and ribavirin when some of our participants had to undergo blood transfusions, to the first generation protease inhibitors that had to be consumed with a high amount of fat, and to the new DAAs that just needs to be taken as one pill once a day for two to three months but with one pill costing more than a bottle of champagne or hotel stay at the Four Seasons. This journey was like seeing a happy ending with them, that there is a cure for HCV. Like that cure, most of them ask about and hope for a HIV cure. Hopefully, it will be in the lifespan of the cohort. Fingers crossed!

Above all, thank you to you and your team for giving us and our participants the opportunity to contribute to your work."

[Names reflect current CTN222 site staff]

Site Q (CHU Québec)

Site E - BC Centre for Excellence in HIV/AIDS

2 July

PI: Dr. Mark Hull

Sub-PI: Dr. Marianne Harris

Team: Bruce Ganase

6 August

Site M - Hamilton Health Sciences

PI: Dr. Shariq Haider

Sub-PI's: Dr. Seth Glassman, Dr. Philippe El-Helou, Dr. Fiona Small, Dr. Marek Smieja, Dr. Kevin Woodward

Team: Mariana Rusler, Saba Poursasan

...in 2003

2008

[Names reflect current CTN222 site staff]

"The CHUQ – CHUL team’s lab standards have evolved in the last 15 years! Even if a few persons have changed, most of us remain part of this team that is committed to the success of your project. Happy Anniversary!"

7 February

Site H - QEII Health Science Center

PI: Dr. Lisa Barrett

Sub-PI's: Dr. Shelly McNeil, Dr. Ian Davis, Dr. Lynn Johnston

Team: Barbara Goodall

"The Food Insecurity (CTN 264) team would like to thank site coordinators and participants for their involvement in this sub-study."

Wusiman Aibibula, Dr. Joe Cox, Taylor McLinden @CAHR 2016

PI: Tammy Bourque

Team: Linda Mansfield-Smith

Site S - Health Sciences North - The HAVEN Program

24 June

...and in 2018

2008

[Names reflect current CTN222 site staff]

Claire Dufour, Geneviève Corneau, Kathleen Gingras, Jacinthe Lessard et Françoise Legault

...and bigger!

PI: Dr. Pierre Côté

Team: Bryan Dobson

Site L - Clinique Médicale du Quartier Latin

31 July

Anne-Marie Hamelin & Wusiman Aibibula

Site B - Vancouver Infectious Diseases Research and Care Centre

14 November

PI: Dr. Brian Conway

Sub-PI: Dr. David Truong

Team: Mindy Mok

Site J - Windsor Regional Hospital, Metropolitain Campus

PI: Dr. Corinna Quan

Sub-PI:

Team: Gail Howlett

Carmine Rossi

2007

[Names reflect current CTN222 site staff]

Getting bigger...

Site G - Southern Alberta Clinic, Alberta Health Services

The Food Insecurity Sub-Study Team

PI: Dr. John M Gill

Team: Brenda Beckthold

Nadine Kronfli

19 June

Nasheed Moqueet

Site W - The Ottawa Hospital - General Campus

PI: Dr. Curtis Cooper

Team: Nana Frimpong

6 July

Gayatri Marathe

Site T - University Health Network - Toronto General Hospital

Sean Yaphe

PI: Dr. Sharon Walmsley

Sub-PI: Dr. David Wong

Team: Bryan Boyachuk, Angela Cicci, Rosemary Clarke, Adri D'Aquilla

25 July

Carolina Festa

2007

Adam Palayew

Laurence Brunet

[Names reflect current CTN222 site staff]

Sahar Saeed

Charlotte Lanièce

Site K - Montreal General Hospital Immune Defficiency Treatment Center/Chronic Viral Illness Service (CVIS)

Man Wah Yeung

20 April

PI: Dr. Joseph Cox

Team: Blake Linthwaite

Mazen Habayeb

Adefowope Odueyungbo

2004

[Names reflect current CTN222 site staff]

Where it all began...

Site C - Montreal Chest Institute Immunodeficiency Service/Chronic Viral Illness Service (CVIS)

Students/Trainees over the years

PI: Dr. Marina Klein

Team: Chantal Burelle, Costas Pexos, Shouao (Stan) Wang, Isabelle Robichaud, Alexandra Looky

25 April

Site N - Centre hospitalier de l'Université de Montréal - Unité hospitalière de recherche, d’enseignement et de soins sur le sida (UHRESS)

5 June

PI: Dr. Valérie Martel-Laferrière

Sub-PI: Dr. Danielle Rouleau

Team: Chantal Morrisseau, Laurie Gokool, Pascale Arlotto

2003

Ye-Von Lee, Arezou Azampanah

[Names reflect current CTN222 site staff]

Neora Pick, Anna Marquez

"Marina was very happy to add us on board in 2008 when there was a need for more women to be included in the cohort. 10 years later, we have included 112 women representing 112/518 (ratio of women of site A/women of the whole cohort) in the cohort. We are proud of this significant gender contribution to this HIV and hepatitis C Cohort.

Marina has adapted the questionnaire to the changing dynamic of treatment of HCV very well. It has now provided relevant data on the cohort which is now “only” mono-infected with HIV.

We are very proud and honoured to be part of this very important work, one of the largest HIV/HCV cohorts in the world!"

Sincerely,

The Oak Tree Team

Site A - Oak Tree Team (Vancouver)

Hansi Peiris

Chantal Burelle

Alexandra Looky

Stan Wang

Costas Pexos

Rhyan Pineda, Eshel Espaldon, Reynan Espaldon

Administrative

Data Management Team

Lab Team

PI's and Staff