The Role of CTN+ in Combating HIV and STBBIs in Canada

Globally and in Canada, new cases of HIV and other sexually transmitted and blood-borne infections (STBBIs) have been rising steadily. Although significant progress has been made in developing effective therapies to combat HIV, a cure and vaccine remain elusive. Coinfections also pose unique challenges in terms of diagnosis, treatment and prevention.

Thanks to a five-year, $25-million investment from the Canadian Institutes of Health Research (CIHR), the Pan-Canadian HIV/AIDS Clinical Trials Network (CTN) will expand to address these challenges. Originally established in 1990 as a cornerstone of the federal AIDS Strategy, the CTN will broaden its focus to include all sexually transmitted and blood-borne infections (STBBIs), and will become known as CTN+. Under the leadership of National Director Dr. Marina Klein at the Research Institute of the McGill University Health Centre (RI-MUHC) in Montreal, the network will undertake clinical trials to find new ways to prevent, treat and manage HIV and other STBBIs, prioritizing a community-based approach to ensure relevant solutions for Canada’s most at-risk populations. It will also invest in developing the next generation of Canadian researchers, to increase the country’s capacity to conduct clinical trials and improve the health and wellbeing of people living with and affected by STBBIs.

“The CIHR Canadian HIV Trials Network has fostered collaborative science nationally and globally for more than three decades. It has enabled important research advances and facilitated access to the latest treatments,” says Dr. Klein, Senior Scientist in the Infectious Diseases and Immunity in Global Health Program at the RI-MUHC and Professor in the Department of Medicine at McGill University. “I am proud to help shape the future of the Network as it expands to focus on other important infections that affect the lives of Canadians. It will be an honour to continue building on the CTN’s success with our colleagues and community partners across Canada and to guide the next generation of innovators and researchers in working towards eliminating HIV and STBBIs as public health threats.”

The CIHR Pan-Canadian Network for HIV/AIDS and STBBI Clinical Trials Research (CTN+) will expand upon the research framework of the CTN, decentralizing to become a country-wide network that facilitates the design, conduct and dissemination of equitable, community-informed, scientifically rigorous, and timely research across disciplines, infections, and key populations in both HIV and other STBBIs.

A network for today’s challenges

HIV remains an important health threat across the world and in Canada. According to the CIHR, in 2022, globally:

• 39 million people were living with HIV

• 630,000 died from HIV/AIDS

• 1.3 million people were newly infected

• an estimated 58 million people were living with chronic hepatitis C and 296 million with hepatitis B

In Canada, the challenges in treatment and prevention of STBBI vary by region. Clinical trial infrastructure is concentrated in the biggest cities, creating barriers to participation for rural, remote and isolated communities and resulting in poorer health outcomes for populations disproportionately affected by STBBI.

By renewing, diversifying and restructuring, CTN+ will address the current landscape of HIV and STBBIs and enhance Canada’s capacity to respond rapidly to emerging infectious diseases that may prominently impact vulnerable populations. To do this, Dr. Klein will lead a diverse network with five regional teams, four specialized think tanks and a community-centred knowledge mobilization hub. These regional teams, which will include researchers, community members and Indigenous representation, will champion the knowledge needs of those in their respective communities.

Continuing the legacy of community engagement 

Recognizing the importance of engaging community throughout the research process, CTN+ will build from a legacy of meaningful community involvement, with community perspectives incorporated throughout the leadership and operation of the Network. 

“Community involvement has always been a priority at the CTN, with CTN+ we are increasing community involvement in all aspects from clinical trial research, from trial representation and trial design to knowledge sharing” says Muluba Habanyama, also a Community Co-Lead and Co-Principal Knowledge User. “Community leadership is paramount in shaping the future of research conducted by the CTN+ to ensure ’nothing about us, without us.’” 

“I am very excited for CTN+’s renewed vision of involving the HIV and STBBI community in clinical trial research,” adds Enrico Mandarino, Co-Lead of the new Community Leadership Team and Co-Principal Knowledge User on the funding application. “I look forward to bringing my experience as a member of CTN’s Community Advisory Committee to provide stronger emphasis on leadership, oversight, and guidance from the community on setting the research priorities and mentoring for CTN+.” 

Acknowledging the power of research and knowledge mobilization to improve health equity across the country, as well as the need to uphold Indigenous rights and move toward truth and reconciliation, the Network will also embed Indigenous knowledge users in leadership positions and integrate Indigenous perspectives into its core operations and processes.

“As someone who has spent the past 24 years working in the field of Indigenous women’s health with a focus on HIV, I see the critical need to further build capacity within Indigenous communities for research conducted by communities, rather than the historical relationship of outside researchers conducting work on communities,” says Carrie Martin, the Network’s Indigenous Principal Knowledge User. “Health inequities experienced by Indigenous Peoples in Canada include the disproportionate impact of HIV and other STBBIs. These inequities are directly linked to systemic racism and colonial policies.”

“We are delighted and honoured to welcome the CTN+ to the RI-MUHC. Marina Klein has been a leader in research and care for HIV and hepatitis C coinfection for many years, and I warmly congratulate her for this nomination as National Director of the pan-Canadian interdisciplinary CTN+ network. I am confident that this network will enhance Canada’s capacity to address HIV and STBBI from prevention to cure,” says Dr. Rhian Touyz, Executive Director and Chief Scientific Officer of the RI-MUHC.

As the Canada Research Chair in Clinical and Epidemiologic Studies of Chronic Viral Infections in Vulnerable Populations, Dr. Klein is known for leading one of the largest cohorts focused on HIV and hepatitis C virus (HCV) coinfection in the world, documenting the impact of new HCV therapies on health outcomes, designing and testing tailored approaches to increase access to diagnosis and treatment, building capacity for research with Indigenous communities, and using evidence to advocate for policy change.