THETA team and the collaborating partners from ICES, Ontario First Nations HIV Aids Education Circle  (OFNHAEC), Public Health Ontario, University Health Network, University of Toronto, University of Waterloo, St. Michaels Hospital and the Department of Indigenous Services Canada, have been awarded a three year project grant from the Canadian Institutes of Health Research (CIHR).

The core idea for this project and the collaborative relationship with the OFNHAEC has been formulated in part as a result of the work and research interests of Andrew Mendlowitz, PhD(c).


Hepatitis C viral (HCV) infection has the highest health burden among infectious diseases in Ontario. No research has fully addressed the burden of HCV among First Nations people in Ontario. Research that helps us understand the burden of HCV among the First Nations population can help communities influence policy and/or community action, and improve health and well-being.
This study will bring together researchers and the Ontario First Nations communities to evaluate the burden of HCV infection. This study has 4 parts:

1) we will use healthcare administrative data governed by the First Nations in Ontario and HCV testing records from Public Health Ontario Laboratories data to examine the extent of HCV infection within the First Nations population in Ontario. These results will be interpreted with members of the Ontario First Nations communities to understand the contextual roots underlying HCV infection;

2) we will describe patterns of health care for HCV, based on records of patient interactions with the healthcare system. This will identify any potential barriers to access and/or gaps in service delivery;

3) we will measure the cost to the Ontario health care system for HCV infection and determine the effects of clinical and demographic variables on health care costs. This will help make decisions regarding community treatment and prevention programs;

4) we will measure the cost to the Ontario health care system for HCV infection and determine the effects of clinical and demographic variables on health care costs. This will help make decisions regarding community treatment and prevention programs.

This will be a First Nations-led, strength-focused project. OFNHAEC’s partnership will ensure that First Nations representatives are involved throughout the project to contextualize the roots of the HCV epidemic and ensure that the findings reflect the voice of First Nations communities. This study will also help to develop a standard on how to properly engage and build capacity with First Nations representatives and communities when performing research using healthcare administrative data.


Murray Krahn, MD MSc (Nominated PA) will be responsible for the overall execution of the study. He is the founding director of THETA (, a Tier 1 Canada Research Chair, ICES, Scientist, and an internationally recognized outcomes researcher with expertise in hepatitis C outcomes and costs.

Jennifer Walker, PhD (co-PA) is a Tier 2 Canada Research Chair in Indigenous Health and the Indigenous Health Lead facilitating the use and understanding of Indigenous data at the Institute for Clinical Evaluative Studies (ICES).

Andrew Mendlowitz, MBiotech (co-A) will guide data analyses and work with OFNHAEC on the project. He is a PhD candidate at THETA and the University of Toronto and a Doctoral Fellow with the Canadian Network for Hepatitis C (CanHepC). His research focus is on estimating the health and economic burden of the Hepatitis C virus (HCV) in First Nations populations in Ontario. His work formed the basis of this project grant and has helped forge the relationship between the research team and the Ontario First nations HIV AIDS Education Circle (OFNHAEC).

Ontario First Nations Partners:

Lyndia Jones (collaborator) is the Independent First Nations (IFN) Health Director and a Representative of Ontario First Nations HIV AIDS Education Circle (OFNHAEC)

Gwen Medicine (collaborator) was an educator in the Nishnawbe Aski Nation communities for over 20 years.

Irene Peters (collaborator) has served on various Elders Advisory boards. Both are knowledgeable in HIV, HCV and STBBI diseases.

Public Health Ontario contributors:

Beate Sander, PhD (co-A) is a scientist at THETA, ICES, and Public Health Ontario, and Associate Professor at the University of Toronto. She has experience in costing methods using health administrative data.

Michelle Murti, MD (co-A) is a Public Health Physician and PHO Scientist with expertise in communicable diseases including HCV.

Vanessa Allen, MD (co-A) is the Chief of Medical Microbiology at PHO, and an experienced infectious diseases researcher.

Wanrudee Isaranuwatchai, PhD (co-A) is the Director of CLEAR at St. Michaels Hospital, with expertise in person-level data analysis and administrative databases.

Jordan Feld, MD (co-A) is a hepatologist at the University Health Network and is a national policy leader in HCV (CanHepC co-lead of the National Blueprint for HCV Elimination).

William Wong, PhD (co-A), Assistant Professor at the University of Waterloo, developed an influential disease progression model for HCV. We will use this model and back-calculation methods to estimate the undiagnosed burden of HCV.

Nicholas Mitsakakis, PhD (co-A), a highly experienced biostatistician, will provide statistical support.

Thomas Wong (collaborator), Chief Medical Officer and Executive Director of the Department of Indigenous Services Canada, as a collaborator and knowledge user for the results of the study, for policy decision-making and service planning around hepatitis C.

CIHR Page: Grant Details

Posted on July 15, 2019