Population-level impact of hepatitis C virus (HCV) direct-acting antiviral therapies on extrahepatic manifestations

Hepatitis C virus is an important public health concern in Canada; however, there is limited information concerning the impact of new direct-acting antiviral therapies on manifestations outside the liver (extrahepatic manifestations, or EHMs), including chronic diseases, cancers, and health-care resource utilization in Canada.

This knowledge is important, as new HCV treatments are generally restricted to those with advanced liver disease and there are no estimates of the reductions in EHMs that can be achieved with expansion of therapy.

Using data from an administrative-linked population-based cohort in BC, Dr. Rossi will assess the impact that HCV treatments have on EHMs and associated health-care utilization.

Results from this study could lead to improved clinical and population health practices in BC by:

  1. Helping to inform targeted treatment strategies by identifying patients at the greatest risk of developing EHMs associated with HCV.
  2. Identifying areas where additional allocation of resources will be necessary to manage chronic comorbidities associated with aging.

This study will also provide a better understanding of the challenges and limitations associated with using administrative data for population health research.

The real-world effectiveness of hepatitis C virus (HCV) treatment on decompensated cirrhosis and hospitalizations

Between 230,000 to 450,000 Canadians are infected with hepatitis C virus (HCV). Most of these people were infected decades ago and remained untreated due to the severe side effects and low effectiveness of interferon-based treatment regimens. Therefore, HCV associated liver related morbidity and mortality are now on the rise, with substantial impact on health care utilization. 

Recently, highly effective interferon-free direct acting antiviral (DAA) treatments have started to become available. However, data on real-world effectiveness of DAAs in terms of hospitalization, cirrhosis, decompensation, hepatocellular carcinoma  and mortality is not yet available. 

Dr. Darvishian will address crucial knowledge gaps in the HCV response to DAAs. Specifically, her research will:

  1. Assess the real-world effectiveness of DAA treatments on overall and liver disease-related hospitalizations and the number of hospital admissions.
  2. Assess the real-world effectiveness of DAA treatments in preventing decompensated cirrhosis.
  3. Assess the potential modifying effect of metformin and/or statin on effect of DAAs and their synergestic effects on hospitalizations and decompensated cirrhosis.

The results of this study will be critical for designing an optimal strategy for HCV care and DAA treatment and refining HCV treatment guidelines and strategies.
 

Can specialized sexual health clinics address unmet mental health needs of sexual minorities?

Gay, lesbian and bisexual (GLB) Canadians are at higher risk of depression, anxiety, drug and alcohol use problems and suicide attempts, but there are few places where these mental health needs can be met in a way that is mindful of the judgment GLB people may fear on the basis of their sexuality. Many sexual health clinics already serve as GLB-sensitive points of care for diagnosing and treating sexually transmitted infections, including HIV. These clinics and their nursing staff could be supported in routinely offering assessment, referral, and counseling for mental health concerns; however, the extent to which this is needed and desired has not yet been explored. Dr. Salway will use a combination of data sources and methods to characterize the potential for such interventions.

This study will answer three questions:

  1. What are the unmet mental health service needs of GLB clients of sexual health clinics?
  2. How can these needs potentially be met through the sexual health clinics?
  3. What is the appeal of new approaches to meeting mental health needs through sexual health clinics?

Dr. Salway will use a large, linked data set to estimate how many sexual health clinic clients currently access mental health-related services from other hospitals or clinics. Interviews will be conducted with nurses and clients, and a survey will be administered at three sexual health clinics in Vancouver that predominantly serve GLB populations. 

Dr. Salway’s research will be conducted in collaboration with nurses, clinic managers, and policy-makers to ensure that results are applied to existing services. Through these collaborations, findings will be translated into clinical guidelines, training programs for clinicians, and policy recommendations. Ultimately, this study will provide evidence for promising strategies that will not only improve health care for sexual health clinic clients, but also contribute to reductions in mental health disparities that continue to affect GLB Canadians today.
 

Wealthy and healthy: Socioeconomic status (SES) and syndemics

Co-infections with sexually transmitted infections and blood borne infections (STIBBI) are common among people living with HIV. They occur because of shared risk behaviours and common social conditions. It is a significant public health issue because groups of people at high risk of acquiring and transmitting infections can spread them more readily to the broader population.

This study proposes to examine neighbourhood-level characteristics (e.g. socio-behavioural groupings, geographic areas) to describe how contextual variables and socioeconomic status contribute to STIBBI co-infection trends. We will use provincial surveillance, laboratory, and healthcare utilization data linkages.

Our goal is to shed light on whether real-time data linkage could improve delivery of health services to core groups of people living with HIV. Ultimately, this work could inform health service policies and procedures that improve quality of life and reduce the spread of STIBBI among the general population.

Risk Assessment and Prediction of Infectious Disease Outbreaks (RAPID): An integrated framework of quantitative public health policy design

Traditionally, British Columbia has played an important role in public health policy design in Canada. BC has a reputation for providing leadership in population health research aimed at improving the health of its residents. To continue providing leadership in this realm, BC needs to create a timely, quantitative framework to stifle the increasing threat of emerging and re-emerging infectious diseases. Despite medical advances, communicable diseases remain a major cause of death, disability and social and economic upheaval for millions around the world. Consequently, combating infectious diseases requires planning beyond individual-based interventions. Dr. Babak Pourbohloul is working to develop an integrated research, mentoring, education, and knowledge translation platform. He will create a quantitative risk assessment and predictive framework to understand the pattern of infectious disease spread, and will develop mathematical models to identify optimal, cost-effective control strategies against a wide variety of infections. This research will enable public health leaders to address six key areas: the most effective control strategies for emerging respiratory infectious diseases and influenza pandemic preparedness; vaccination program evaluation; public safety and bioterrorism; public health issues associated with infection control in marginalized populations; hospital infection prevention; and outbreak containment. Through Dr. Pourbohloul’s research, both the province and the BC Centre for Disease Control can maintain their vision and leadership in managing the complexity of infectious disease transmission with innovative and sophisticated quantitative tools – improving the health of all Canadians.

Molecular epidemiology of Giardia lamblia in British Columbia’s drinking water supplies

Giardia lamblia is a waterborne parasite that causes giardiasis, a diarrheal disease commonly called ""beaver fever”. Despite the comprehensive water quality management measures in B.C., this parasite is often detected in surface water supplies and is the second leading cause of gastrointestinal illness in the province. While current surveillance methods for G.lamblia in water supplies allows for enumeration of the parasite in water, the test cannot differentiate between infectious and non-infectious strains. Natalie Prystajecky is examining a library of archived water samples collected across B.C. over 13 years to determine if the strains in B.C. surface water are infectious to humans and how frequently, what the sources are, and where these strains are found. She is also assessing the effectiveness of control measures such as watershed protection and agricultural waste management best practices in protecting water quality. This information could lead to more effective environmental and health policies and public health interventions.