Maryam Alavi

Project Title: 

The epidemiology of advanced liver disease among people with hepatitis C in Australia, Scotland and Canada

Host Organisation: 

Glasgow Caledonian University, School of Health and Life Sciences

Short biography

Maryam’s training and research is based in the field of epidemiology, with a specific focus on clinical epidemiology. In 2014, she completed her PhD at the Kirby Institute, University of New South Wales in Sydney, where now she is a Research Associate. Since 2015, she has been working on her postdoctoral research in Glasgow; an international project studying the epidemiology of advanced liver disease among people with hepatitis C virus infection. She completed her fellowship in August 2017 and is now leading a research pilot project funded by Iran's National Insitute for Medical Research Development, evaluating the impact of hepatitis C point-of-care testing and non-invasive liver disease screening (provided in opioid substitution treatment clinics) on improving diagnosis, linkage to hepatitis C care, and treatment uptake among Iranian people who inject drugs.

Brief description of research project

Worldwide, hepatitis C is associated with considerable liver disease-related morbidity and mortality. Fortunately, interferon-free direct-acting antiviral therapies with the potential to reverse hepatitis C-related liver disease progression are now available. The prospect of increased access to interferon-free direct-acting antiviral (DAA) therapies instigated the World Health Organization (WHO) to set ambitious targets for elimination of hepatitis C as a major public health threat by 2030. In Australia, Canada, and Scotland access to the highly effective new therapies has been provided since 2014, although the breadth of access has been different. Subsequently, hepatitis C treatment uptake has increased across the three settings, putting these countries on track to be among the first in the world to achieve the WHO 2030 targets. However, uncertainties remain on the population-level impact of enhanced therapeutic interventions, including the impact on risk of primary liver cancer re-occurrence and primary liver cancer survival rates. Evaluating the success of hepatitis C treatment programs depends on having solid baseline data and the ability to monitor population-level liver disease diagnosis trends, risk factors, and prognosis over time.

Australia, Canada, and Scotland are among the few settings with established surveillance systems that enable monitoring people with hepatitis C by linkage between diagnosis, hospitalisation, and mortality databases. My research in this area is focused on understanding the burden of hepatitis C-related liver disease, and evaluating the impact of improved antiviral therapies, using data linkage.  Findings from my research have shown the burden of hepatitis C-related liver disease has been rising in Australia, Canada, and Scotland. Liver disease prevention and management efforts have had a minimal impact on this rising disease burden during the era of interferon-containing hepatitis C therapies. Further, health risk behaviours including high alcohol consumption have significantly contributed to morbidity and mortality among people with hepatitis C. Moving forward, the extent to which health risk behaviours such as alcohol use would compromise the individual and population level benefits of DAA therapies needs to be closely monitored. Where appropriate, effective public health strategies against hepatitis C must combine DAA treatment uptake promotion and management of health risk behaviours. Findings from my research demonstrate the value of administrative datasets for health surveillance and evaluation of the impact of health policies. Over the coming years, use of administrative databases for surveillance will remain a valuable tool for ongoing evaluation and comparison of the impact of new DAA therapies. This research will be particularly important for sustainable development of international policies against the hepatitis C epidemic, given differences in the epidemiology of hepatitis C and hepatitis C public health strategies across Australia, Canada, and Scotland.