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.
 

The role of material security in improving health for people who use illicit drugs

It is well known that an adequate and secure income promotes health. However, material security (e.g., housing, food, and service access) may operate distinctly from income security, particularly for people who use illicit drugs, whose ongoing need to acquire drugs may affect the degree to which income security translates into material security and subsequent health improvements. Nevertheless, material security and its relationship with health are not well understood, an important oversight in research among people who use illicit drugs (PWUD). 

Dr. van Draanen Earwaker will seek to fill this critical gap in the research by examining the role of material security in improving health for PWUD in British Columbia through a longitudinal mixed methods study. The results of her research will generate scientific knowledge about factors that enhance material security, the impact of material security on health, and what material security means to peer workers.

This information is of relevance to the PHS Community Services Society  and other social impact employers in British Colombia, as an increasing number of these social enterprises provide opportunities for reliable income as well as access to community support and resources for PWUD. This research will include an examination of how employment through these social enterprises and harm reduction services affect material security.

Dr. van Draanen Earwaker will work with knowledge users in community-based social enterprises, like PHS, to help spread successful employment models that address material security for highly socio-economically marginalized communities. Knowledge will be shared with the community, including feedback reports for community employers, and knowledge sharing sessions aimed at peer and social impact employers. Ultimately, this work will contribute to an evidence base for designing program and policy solutions to improve health outcomes for PWUD.

 

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.
 

Early-life environmental exposures and development of childhood asthma

In Canada, a striking 13% of children (~500,000) have asthma. It is the leading cause of absenteeism from school, and accounts for more than 30% of Canadian health care billings for children. Asthma is also the leading cause of hospital admissions in both children and the general Canadian population. Given that asthma typically begins in childhood and lasts throughout life, the high prevalence, combined with significant related morbidity, make asthma the most common and burdensome chronic non-communicable disease affecting young Canadians. 

Asthma is a complex disease dependent on the interactions of genetic predisposition with environmental factors including physical, microbial, and social environments. The Canadian Healthy Longitudinal Development (CHlLD), a cohort study funded by CIHR, has recruited over 3,500 pregnant mothers to collect such environmental and biological data from pregnancy up to age five in four Canadian cities: Vancouver, Edmonton, Toronto and Winnipeg. The proposed project will use biological and environmental data from the CHILD cohort and will focus on traffic-related air pollution and natural spaces. These two modifiable environmental exposures have been shown to be associated with asthma exacerbation.

The novelty of this research lies in the study of joint exposures and their interactions over time; their impact likely depends not only on individual genetic profiles, but also on the critical timing of exposure. Early life period, including in utero, is a critical influence on health in later life. Likewise, changes in gene function in relation to environmental influences provide evidence to explain how and why asthma and allergies exist and progress. 

Dr. Sbihi’s research will examine how these changes, called epigenetic modifications, are affected by the early-life environmental exposures, including the body’s microbial milieu. By examining how the environmental exposures (traffic air pollutants, natural spaces, gut microbes) impact DNA methylation and consequently how these epigenetics modifications lead to asthma, we will be able to better understand the mechanisms of asthma development and subsequently provide better targeted prevention measures.

 

Addressing HIV/AIDS, sexual health, and substance use among gay and other men who have sex with men

New HIV diagnoses are 71 times higher among gay, bisexual and other men who have sex with men (GBM) than other men in Canada. Since 2010, BC has adopted Treatment as Prevention (TasP) as a policy to increase HIV testing and engage more HIV-positive individuals in effective treatment to reduce transmission at a population level. However, the number of new diagnoses among GBM in BC has remained largely unchanged. Further, surveillance shows an increase of HIV diagnoses among the youngest birth cohorts of GBM. HIV pre-exposure prophylaxis (PrEP) is a new preventive tool for HIV-negative GBM, but inaccurate information, sub-optimal adherence or risk-compensation could result in a false sense of security, paradoxically leading to increased HIV transmission. In addition to HIV, infectious syphilis is now epidemic among GBM in BC.

This research program will address the HIV and sexually transmitted infection (STI) epidemics among GBM in Metro Vancouver and BC. Dr. Lachowsky will measure HIV risk behaviour over time, determine how PrEP affects bacterial STI incidence, and analyze shifting attitudes about HIV, challenges with HIV prevention and treatment, and changes in sexual negotiation and practices. Results will directly inform population-specific, age-relevant public health policy, programming, and interventions to reduce the burden of HIV for GBM, especially young GBM.

Dr. Lachowsky will employ a bidirectional, integrated knowledge translation approach, with a Community Engagement Committee and key academic, public health, and community partners. An interactive Web 2.0 hub will allow for knowledge dissemination and generation with community and service providers, and will be complemented with more traditional presentations, workshops, and publications.This single research project is part of a larger program of research examining health disparities amongst GBM in BC and Canada using interdisciplinary, community-based approaches.

Improving substance use treatment trajectories for men who have sex with men

British Columbia is currently in the process of developing and implementing new evidence-based policies and clinical reforms to address problematic substance use, including new: (i) pharmacotherapy approaches (e.g., replacement therapies); (ii) clinical practice guidelines; and (iii) integrated service delivery models of care. While men who have sex with men (MSM) represent a key group with historically high levels of substance use disorder and subsequent social and health-related sequelae (e.g., increased rates of HIV and sexually transmitted and blood-borne infections), there remains a gap in our knowledge about how best to design and implement services for today's generations of various sub-groups of MSM who use drugs (e.g., MSM who are: young; Indigenous; economically deprived).

Dr. Knight's five-year population health research program will adapt health policy and service delivery practices to improve substance use treatment trajectories for key groups of MSM who use drugs and are at risk for severe health and/or social consequences (i.e., the criteria for substance use disorder, as defined under DSM-V criteria). The aim will be to identify the most efficacious and scalable combinations of strategies to adapt interventions that respond to MSM's individual needs and broader social and structural conditions. This approach to implementation science offers a way to go beyond describing the problem and to focus on building an evidence base for implementing and adapting context-sensitive and population-specific solutions into routine policy and practice.

With collaborators representing the BC Ministry of Health, Vancouver Coastal Health, BC Centre for Disease Control and YouthCO HIV/Hep C Society and the BC Centre for Excellence in HIV/AIDS, as well as through the engagement of the BC Centre on Substance Use's Community Advisory Board, Dr. Knight's findings will be used to inform the development of policies (including clinical and provincial guidelines) to effectively scale up and integrate services that have the capacity to improve substance use treatment trajectories for MSM. Contributions to new knowledge will include the identification of the individual, social and structural factors shaping MSM's ability to reduce problematic drug use and prevent severe health and social outcomes (e.g., HIV and/or Hep C). Study outputs will also be assessed at an annual Stakeholder Workshop in which recommendations will be developed and refined for clinical and provincial guidelines.

Improving the implementation and impact of evidence-based health promotion interventions in real world settings

Findings from health promotion research that could help Canadians live healthy lifestyles are often not applied in practice. This gap between health promotion research and health promotion practice is particularly concerning for people with spinal cord injury (SCI). Despite people with SCI's urgent need for interventions that respect their unique challenges and barriers to health behaviour change, there are very few health promotion interventions designed for people with SCI. To ensure health promotion research improves the health of all Canadians, there is an urgent need to improve the use of health promotion research in practice.

The aim of this five-year knowledge translation research program is to examine methods for improving the use of health promotion research in real-world practice. Given the lack of health promotion interventions for people with SCI, this research program will examine how we can improve the use of health promotion evidence to enhance the health of people living with SCI. 

Dr. Gainforth will examine how successful and unsuccessful practitioners apply health promotion techniques when promoting healthy behaviours to people with SCI and develop the first evidence-based guidelines, tools and interventions to improve knowledge translation partnerships between researchers and members of the SCI community. Lessons learned from practitioners will be used to develop and test tools and interventions to help other practitioners successfully promote healthy behaviours to people with SCI.

Ultimately, this research will develop best practices for building capacity among researchers and community members to conduct and share research in partnership. In turn, findings and the approach can support other research teams aiming to use partnerships to conduct and share research that enhances the health of marginalized groups.

Development and assessment of strategies to promote social integration into new communities

Social connections and social support networks are essential for physical and mental health. In fact, recent research suggests that how long people live is better predicted by the quality of their social relationships and how well they are integrated in their community, than it is by how much they smoke and drink, or whether they are obese. Loneliness, on the other hand, is linked to negative health outcomes including depression, poor sleep quality, more hospital and doctor visits, and compromised immune system functioning.

This research will focus on the processes involved in successful social interactions with strangers, friendship formation, and social integration. It will focus on questions including: Why do some people have a harder time making friends than others? How do people develop a sense of belonging when they move to a new community? How do the size of someone's social networks, and the availability of social support, influence specific health outcomes like immune function and cardiovascular disease risk? Given that Canadian culture is characterized by high rates of immigration and residential mobility, developing effective evidence-based strategies for combating loneliness and social isolation can have direct benefits for individuals and communities alike.

Knowledge translation activities for this research will include active engagement with broad audiences of university administrators and advisors, student mental health groups, and community members. Dr. Chen will produce reports for groups directly involved in promoting community social integration efforts, whilst serving as a scientific/faculty advisor for initiatives to disseminate research findings directly to the public. She will use research findings to develop specific interventions to facilitate friendship formation and social integration, targeted to individuals who are experiencing social disruptions or difficulty transitioning into new environments. Enhanced knowledge about these topics is expected to contribute to the public good and welfare of British Columbians.

Towards a provincial policy framework for substance use services in BC

Opioid use disorder is one of the most challenging forms of addiction facing the health care system in BC and is a major driver of the recent surge in illicit drug overdose deaths in the province. In the context of the current public health emergency, Provincial Health Services Authority agencies the BC Centre for Disease Control (BCCDC) and BC Mental Health & Substance Use Services (BCMHSUS) have identified an urgent need for a policy framework articulating the full range of therapeutic options for the optimal treatment and harm reduction measures those with opioid use disorder.

Drawing on his expertise on substance use, first responder support and policy development, Adam Vaughan will work with experts and researchers at BCCDC and BCMHSUS, senior decision makers in the BC Ministry of Health and regional health authorities, and various addiction-related departments at UBC and SFU to develop a provincial policy framework that outlines a proposed continuum of care for those who require harm reduction, overdose prevention and opioid treatment services.

Vaughan's work on an opioid use disorder continuum of care will also contribute to the current development of an overarching provincial substance use policy framework and ultimately help advance BC drug policy. 

Integrating equity and cultural safety lenses to promote Indigenous health in BC’s southern interior

Interior Health (IH) serves more than 215,000 km² of BC’s southern interior. This part of BC falls within the traditional, unceded territories of the Secwepemc, Ktunaxa, Syilx, Nlaka’pamux, Ulkatcho, Tsilhqot’in and St’at’imc peoples. Within these territories are people, both on and off reserve, who live in small urban, rural or remote communities. The First Nations, Metis, and Inuit populations served by IH are disproportionately affected by health inequities. 

IH’s Aboriginal Health team is currently exploring ways in which health equity and cultural safety can be more systematically integrated into IH’s operational processes, program planning, and policy arenas. Dr. Shahram will focus on creating a policy proposal for broad integration of health equity impact assessments into the cultural fabric of IH — making culturally safe, equity-centred thinking the norm for leadership and practice. 

Dr. Shahram will bring her health research expertise and engaged scholarship methodologies (e.g. action research, integrated knowledge translation), and work with IH leadership to create a strategic plan for capacity building and policy change that will enable the advancement of a system-wide policy agenda aimed at integrating cultural safety and health equity assessment into IH policy and operations.

Dr. Shahram received a 2016 Research Trainee Award to examine how health equity strategies in the BC public health system could benefit from Indigenous knowledge and worldviews. This award will placed on hold during her health policy fellowship assignment.