General and inexpensive saliva-based viral RNA testing by direct imaging

In the absence of a vaccine and/or effective treatment, rapid and robust testing is vital not only to reduce the transmission and spread of SARS-CoV-2, but also for paving the way to safely reopen borders and reinstating the world economy. Most Covid-19 tests are performed using nasopharyngeal swabs that are sent to a hospital or public health laboratory to be processed for RT-PCR analysis using expensive equipment by technically trained staff. The specificity of such amplification-based tests makes them superior to many other detection tests. However, the occurrence of false-negative results due to the low levels of viral RNA found in such samples, as exemplified by recent problems with Spartan Cube1, suggests that avoiding nucleic acid amplification entirely and switching to the direct detection of viral RNA could be highly advantageous for SARS-CoV-2 detection.

Funded by the CIHR Rapid Research Opportunity and MSFHR, Dr. Peter Unrau is leading a team of researchers to develop a new saliva-based viral testing strategy for use in the current Covid-19 pandemic. Dr. Unrau (professor in RNA biochemistry) and co-investigator Dr. Forde (professor in biological physics) will coordinate a research team at Simon Fraser University. They will work in collaboration with David Rueda, a professor in single-molecule imaging at Imperial College London.

This COVID-19 research will allow the development of a fast, inexpensive and sensitive viral RNA test that, in principle, could be used for point of care testing at home. The proposed SARS-CoV-2 RNA single-molecule imaging test will be highly specific, will rely on simple well-understood chemistry, and will include an inexpensive imaging device that connects to a cell phone. An additional benefit of this device is that test procedures can easily be adapted for the screening of other RNA pathogens in the future.

Funding Competition: CIHR Operating Grant: COVID-19 Rapid Research Funding Opportunity – Diagnostics

Funders: CIHR; MSFHR

A resident/family-centered, team-based quality improvement collaborative approach to comprehensive pandemic preparedness in long-term care homes

Dr. Akber Mithani’s team is one of two BC research teams being co-funded by MSFHR and the BC Ministry of Health, and supported by the BC Patient Safety & Quality Council, as part of the Implementation Science Teams – Strengthening Pandemic Preparedness in Long-Term Care Initiative led by the Canadian Foundation for Healthcare Improvement (CFHI) and the Canadian Patient Safety Institute.

Practices that show promise to improve response to the COVID-19 pandemic in long-term care homes need to be quickly implemented. These practices relate to outbreak preparation, prevention and response; COVID-19 and non-COVID-19 care; staffing; and presence of family.  

Our research team will study the experiences of long-term care teams as they conduct projects to implement promising practices to address gaps in their pandemic response. The teams will include residents, family, staff and management in six long-term care homes across Fraser Health. They will use a shared approach involving quality improvement training, engagement support, and the use of an online app to share learning between homes.

Key questions to be answered are:

  1. How can an online shared approach be used by team members within long-term care homes to improve pandemic response?
  2. How can this approach help in knowledge sharing across long-term care homes to promote best practices in pandemic response?

The lessons learned from the projects will inform strategies for pandemic response, which will be shared with other long term care homes across Fraser Health. The findings of this study will add to the efforts of 14 research teams across Canada as part of a larger initiative aiming to improve pandemic response in long-term care.

Funding Competition: CFHI-led Implementation Science Teams (IST) – Strengthening Pandemic Preparedness in Long-Term Care (LTC) Funding Opportunity

Funders: MSFHR; BC Ministry of Health

Implementation of the “one high risk site only” policy – its impact on staff, family and LTC residents

Dr. Joanie Sims-Gould’s team is one of two BC research teams being co-funded by MSFHR and the BC Ministry of Health, and supported by the BC Patient Safety & Quality Council, as part of the Implementation Science Teams – Strengthening Pandemic Preparedness in Long-Term Care Initiative led by the Canadian Foundation for Healthcare Improvement (CFHI) and the Canadian Patient Safety Institute.

It is essential that we stop the spread of the COVID-19 virus in long-term care. The Public Health Agency of Canada instituted evidence-based, rapid redesign and resource redeployment practices to protect the health and ensure the safety of staff, residents and their families. Measures included strict visitation and “one high risk site” staffing policies, prohibiting LTC staff from employment in more than one facility. Our mixed methods, exploratory study will focus on implementation and impact of the “one high risk site” staffing policy on staff, family and residents in 4 LTC facilities in 2 British Columbia health authorities. We are guided by the Consolidated Framework for Implementation Research (CFIR). 

We have the necessary expertise to conduct this study that spans implementation science, LTC, quantitative and qualitative methods and knowledge translation (KT). Our team includes early (Havaei – co-PI, Hung), mid-career (Sims-Gould – PI) and established (Macphee, Phinney, Robinovitch, McKay) researchers, and trainees (Franke, Staempfli) together with committed and passionate LTC administrators (Keselman, Lee, Kirk, Strath), senior health authority executives (Mak, Sorensen) and Min of Health (Neilson) partners and KU. Two collaborators offer expertise in implementation measures (Lewis) and national LTC policy (Tamblyn-Watts).

Short-term outcomes: Knowledge users are positioned to immediately translate evidence into practice to inform LTC improvements at the facility level. We will share results through the LTC+ Acting on Pandemic Learning Together Initiative. Facilities that signed up to participate in this initiative have immediate access to results of our study across jurisdictions.

Long-term outcomes: Lessons learned about positive and negative consequences of the “one high risk site” policy can be applied in other jurisdictions. We will provide a roadmap to effectively implement future policies in response to COVID-19 in LTC settings. Partnerships we develop foster future collaborations and capacity building among academics and the LTC sector.

Funding competition: CFHI-led Implementation Science Teams (IST) – Strengthening Pandemic Preparedness in Long-Term Care (LTC) Funding Opportunity

Funders: MSFHR; BC Ministry of Health

Evaluation of innovative risk mitigation services in the context of dual crises of COVID-19 and overdose among people who use opioids in Vancouver, BC

Through funding from the Canadian Institute of Health Research (CIHR) and MSFHR, Principal Investigators Dr. Kanna Hayashi, Research Scientist at the BC Centre on Substance Use (BCCSU) and St. Paul’s Hospital Chair in Substance Use Research and Assistant professor in the Faculty of Health Science at Simon Fraser University (SFU) along with Dr. Kora DeBeck, Research Scientist at the BCCSU and Associate Professor in the SFU School of Public Policy aim to conduct preliminary evaluation of two novel measures introduced by the BC government in March 2020 to address the dual crisis of overdose and COVID-19.

Specifically, these measures include expanding the opioid agonist treatment (OAT) prescription guidelines and pandemic prescribing of pharmaceuticals (e.g. opioids) to people who use illicit drugs. By providing pharmaceutical alternatives to the toxic illicit drug supply, the interventions are intended to reduce physical encounters involved in obtaining illicit drugs and the use of toxic street drugs, thereby supporting both overdose and COVID-19 prevention efforts. To date, however, the impacts of these interventions have not been evaluated.

The proposed BC-based research aims to fill critical knowledge gaps by examining the reach and preliminary impacts of pandemic prescribing and expanded OAT prescription services among people who use opioids in urban Vancouver. Through this work, the research team, which consists of highly productive investigators and knowledge users with direct clinical and policy expertise, seeks to inform efforts to improve the delivery and effectiveness of the interventions.

Funding Competition: CIHR Operating Grant: COVID-19 Mental Health & Substance Use Service Needs and Delivery Funding Opportunity

Funders: CIHR; MSFHR

Tracking the Prevalence and Incidence of Modifiable Suicide Risk Factors During the COVID-19 Pandemic to Inform Targeted Suicide Prevention in British Columbia

Problem: Half of Canadians report worsened mental health since the COVID-19 pandemic began disrupting our lives this Spring. These impacts, combined with rising prevalence of known suicide risk factors such as unemployment and financial hardship, social isolation, alcohol and substance use, relationship strain and domestic violence, have raised concerns that of rising suicide risk in the Canadian population. Canada loses 3,800 to 4,500 lives to suicide each year. Suicide death and bereavement confer long-term psychological and social risk to families and communities. A small increase in suicide rate can thus result not only in excess loss of life, above and beyond the direct impacts of the pandemic, but also confer long-term vulnerability in our communities.

Research: In collaboration with an international team of researchers led by investigators Shanaya Rathod and Peter Phiri in the UK, our Canadian team aims to characterize the specific mental health and related cognitive impacts of the COVID-19 pandemic to inform evidence-based policy that can mitigate secondary mental health and suicide risk. We will conduct three pan-Canadian general population surveys, in September 2020, December 2020, and March 2021. For each survey, we will recruit at least 5,000 community adults, balanced by sex, age, and geographic region. Surveys will focus on Canadians' emotional, physical, and cognitive wellbeing across distinct phases of the pandemic. In addition, we will work with mental health service leaders, providers and users to co-create supplemental surveys to assess the mental health experiences and needs of three potentially vulnerable groups: frontline health workers, Indigenous peoples, and people living in rural or remote areas. Our results can inform mental health strategies by identifying where, with whom, and what kind of intervention is needed to effectively reduce suicide risk in the population. Support from MSFHR and the BC Ministry of Health will enable us to over-sample British Columbians so that we can understand mental health needs within this province and identify sectors or populations with mental health needs.

Research Team: Our interdisciplinary research team, led by Co-PIs Brianna Turner, Theone Paterson, and Chris Lalonde, includes psychology, social work, and sociology researchers, as well as community knowledge users representing the United Way of the Lower Mainland, the Ontario Association of Social Workers, and the Canadian Mental Health Association.

Website: https://onlineacademiccommunity.uvic.ca/covidmentalhealth

Funding Competition: CIHR Operating Grant: COVID-19 Mental Health & Substance Use Service Needs and Delivery Funding Opportunity

Funders: CIHR; MSFHR

Keywords: Suicide Prevention, Mental Health, Sleep, Depression, Substance Use, Social Connectedness, Public Health, Survey

Addressing the dual public health crises of COVID-19 and overdose

A team led by Dr. Amanda Slaunwhite, Senior Scientist with the BC Centre for Disease Control and an adjunct professor in the School of Population and Public Health, were awarded $75,000 from the Michael Smith Foundation for Health Research and $777,439 from CIHR as part of the Novel Coronavirus (COVID-19) Rapid Research Funding Opportunity. The researchers will assess the impact of the new risk-mitigation guidance that permits prescribing of pharmaceutical alternatives to the toxic drug supply. Researchers will determine the effects of the pandemic and risk mitigation measures on COVID-19 infection, continuity of care for treatment of substance use disorders and non-fatal and fatal overdose in BC. The researchers will also identify barriers and facilitators to implementation from the perspectives of people who use substances, prescribers, harm reduction workers, and other providers and community members.

The team is led by principal investigators at UBC, the Canadian Institute for Substance Use Research (CISUR) at the University of Victoria (Dr. Bernie Pauly and Dr. Karen Urbanoski) and Simon Fraser University (Dr. Bohdan Nosyk and Dr. Natt Hongdilokkul). The team includes co-investigators and collaborators from the First Nations Health Authority, Ministry of Mental Health and Addictions, BC Centre on Substance Use, the BCCDC-based Compassion Inclusion and Engagement (CIE) (PEEP) peer network, Provincial Health Services Authority, BC-Yukon Association of Drug War Survivors and Public Health Agency of Canada.

Funding Competition: CIHR Operating Grant: COVID-19 Rapid Research Funding Opportunity – Social Policy and Public Health Responses

Funders: CIHR; MSFHR

Extracellular Vesicle Associated Glycans as a Novel Platform for Breast Cancer Detection

Breast cancer is the most common cancer amongst women in Canada. Breast cancer cells shed tiny pieces of themselves into the blood stream called extracellular vesicles. These tiny pieces, or cell fragments, are different from those of a healthy breast cell and we think they could be used to detect a breast cancer at its earliest stage. Importantly, we can isolate and study these fragments from the blood of healthy females and breast cancer patients. We think that by looking at the sugars and proteins they contain we will find markers that could help in the detection of breast cancer. We are also going to look at tumor cell fragments from patients whose cancer came back years after treatment, a process known as metastasis, and find unique markers that could predict this outcome. By identifying breast cancer early and figuring out whose at risk for a having their cancer come back we can improve how women are treated and reduce the chances of the cancer coming back.

MSFHR is providing match funding to the glycomics-based early cancer detection project which is funded by the Canadian Glycomics Network through a GlycoNet Collaborative Team Grant. This Pan-Canadian project involves research teams in British Columbia and Alberta. Dr. Williams, lead PI, is an assistant professor at UBC’s Faculty of Pharmaceutical Sciences and her team includes clinical pathologist Dr. Peter Watson (BC Cancer) and Professor of Chemistry Dr. Lara Mahal (University of Alberta).

Please visit Canadian Glycomics to learn more about this project.

The EARLY study: Economic evAluation of a novel pRostate cancer gLYcan-based diagnostic tool

Early detection of prostate cancer uses methods that are controversial and lead to uncertainty in care; this leads to a lot of overdiagnosis and overtreatment in men who are healthy or have inactive disease. We recently developed a test using a sugar found on aggressive cancer cells that acts as a biomarker to detect high-risk cancer in patients and support biopsy decision-making. But, for this test to be taken up in Canada to improve patient care, it needs to be evaluated for its potential value for money for the healthcare payer. This pan-Canadian project is the first analysis of the cost-effectiveness of a new sugar-based prostate cancer diagnostic tool. It will tell us whether the maximum possible gains from the new test versus status quo (or other new technologies) are worth their costs, and in which subgroups of patients we see the most positive net benefit.

The leading PI is Dr. Conklin, assistant professor at UBC’s Faculty of Pharmaceutical Sciences and scientist at UBC’s Centre for Health Evaluation and Outcome Sciences (CHEOS). Dr. Conklin’s BC-based team include Drs. Wei Zhang and Larry Lynd (also Scientists at CHEOS) and Dr. Williams (inventor of the new sugar-based test); the team also includes Dr. Liu, a clinician collaborator from Sunnybrook Hospital in Toronto.

MSFHR is providing match funding to the economic evaluation project which is funded by the Canadian Glycomics Network through the GlycoNet Collaborative Team Cycle II renewal application grant. It will address a critical gap in test development early on to avoid the pitfall of creating an economically non-feasible test. The output of this project could contribute to improved patient care and to better decision-making of patients, guideline developers and health ministers.

Please visit Canadian Glycomics to learn more about this project.

Towards clinical implementation of pharmacogenomics to improve the treatment of people with depression in BC

In Canada, more than 1 in 10 people will suffer a major form of depression at some point in their lives. There are many effective treatments for depression, including drug therapy. Finding a medication that both works and does not cause severe side effects is often a matter of trial-and-error. This may contribute to the high non-adherence rates and, subsequently, to poorer health outcomes and increased costs. An individual’s genetic makeup is thought to be partly related to whether particular drugs work and whether there are side effects with the drug. “Pharmacogenomic” testing, that is, using the patient’s genetic information to determine which particular drug might work best, at the right dose, with the fewest side effects, is a new and promising approach.

In this study, we want to know if pharmacogenomic testing for depression treatment should be routinely used in British Columbia. Through a series of research activities, we will evaluate how much improved health patients might see, as well as whether the testing is good value for money for the health system. As a whole, the project will provide tools for evaluating and addressing societal and economic considerations for the implementation of pharmacogenomics tools into clinical practice.

Dr. Stirling Bryan (Principal Investigator) is a health economist, Professor in UBC’s School of Population and Public Health, a Senior Scientist at the Centre for Clinical Epidemiology and Evaluation (Vancouver Coastal Health Research Institute), and President of the BC Academic Health Science Network. Dr. Jehannine Austin (co-Principal Investigator) is a genetic counsellor, Professor in Psychiatry & Medical Genetics at UBC and executive director of the BC Mental Health and Substance Use Services Research Institute. The remaining multi-disciplinary Canadian team has expertise in health policy research, simulation modeling, systematic reviewing, knowledge translation, and includes patient partners.

This 2-year study is funded by Genome BC, Genome Canada, and the Michael Smith Foundation for Health Research.

A scoping review of literature on different models of allocating funds to facilitate integrated care

Jason Sutherland is Professor in UBC’s Centre for Health Services and Policy Research in the School of Population and Public Health. He is also a Scholar of the Michael Smith Foundation for Health Research.

This is a two-province research team, though the scope of the project is examining integrated funding models across the globe. Little is known regarding how other countries have developed and implemented policies for supporting integrated healthcare. This study will conduct an extensive review of the literature and synthesize the evidence regarding the scope and breadth of policies and their effectiveness to improve integration of healthcare across sectors of the delivery system.

Knowledge translation activities:

  • Policy roundtable to disseminate findings to knowledge users in Calgary, Alberta
  • Policy roundtable to disseminate findings to knowledge users in Vancouver, British Columbia
  • Patient Groups Compensation (honorarium, travel cost, parking) in Calgary, Alberta
  • Patient Groups Compensation (honorarium, travel cost, parking) in Vancouver, British Columbia
  • Open Access Publication jointly by University of Calgary and University of British Columbia
  • Webinar and YouTube video preparation by the University of British Columbia

The team expects to share findings of the project with key public stakeholders regarding attributes of policy and delivery systems that integrate sectors of the healthcare delivery system to improve care and outcomes.