Hepatitis C causes more loss of life years than any other infectious disease in Canada. Canada is committed to eliminate hepatitis C as a public health concern by 2030. Cunningham’s research is aimed at supporting the elimination effort in British Columbia (BC) by improving health equity through making hepatitis C care more accessible. Hepatitis C leads to liver damage, including liver cancer, in many people with untreated hepatitis C.
While all testing and treatment for hepatitis C is covered by BC’s PharmaCare, many people are reluctant to get tested for the virus. A 2020 BC Centre for Disease Control survey showed that 87% of stakeholders cited stigma as a barrier to testing.
Cunningham’s research supported by the PSI award engages members of hepatitis C priority populations — people who would benefit most from prioritized testing and treatment — to collaborate on materials to advise present and future healthcare professionals. “The right to be treated with dignity is essential to health equity,” said Cunningham. “Many healthcare providers don’t seem to be receiving enough guidance to make them comfortable or confident when their patient is a member of some of the hepatitis C priority populations. My thesis project brings patients’ clear voices into education, providing insight into patient experience, and giving learners advice based on real encounters.”
“I am so grateful to Dr Viviane Lima for supporting me in taking this approach, and to PSI and its supporters at UBC for creating this initiative, and selecting my research to support,” said Cunningham.
BC-CfE is home to other hepatitis C research projects, including Per-SVR (PrEseRvation of Sustained Virologic Response – pronounced “persevere”), which Cunningham will work with. This work on elimination of hepatitis C is part of the Targeted Disease Elimination strategy which has already proven effective at curbing the HIV epidemic in BC. The strategy for hepatitis C has a key difference from that for HIV, as hepatitis C can be cured in most patients. Engaging all possible patients in curative healthcare is essential to their individual health, and to ending the hepatitis C epidemic in Canada as well.
Cunningham’s research bridges the work of different teams at BC-CfE. She works with Dr Lima’s EMBARC team on administrative data, with Dr Kate Salter’s Per-SVR team to collect healthcare providers’ perspectives, and will do independent research to collect patients’ perspectives. “Collaborating with different teams and community members gives a deeper understanding, which can be turned to when searching for ways to reduce perceived stigma in healthcare and persistent inequity,” said Cunningham. “Whenever I can, I draw on both quantitative and qualitative research. Quantitative data gives more precise measurement of a problem, and qualitative data lets you map pathways to solutions. Then quantitative analysis tells you how those solutions performed.”