As people living with HIV (PLWH) live longer due to effective antiretroviral therapy (ART), new health issues, such as chronic pain, have emerged. Research shows that PLWH with chronic pain may struggle with ART adherence and are at increased risk for substance use disorders and overdoses. However, there is limited knowledge on how chronic pain and overdose are connected in PLWH, especially if substance use disorders mediate this link. This project aims to close this gap. I hypothesize that PLWH who experience chronic pain are more likely to use illicit substances, which in turn increases their risk of substance use disorder and subsequent overdose.
Using data from the Comparative Outcomes and Service Utilization Trends (COAST) study, which includes comprehensive health data on all PLWH in British Columbia, this project will:
Analyze if PLWH with chronic pain are more likely to develop substance use disorders, potentially increasing overdose risk.
Assess whether racialized PLWH face greater overdose risk due to compounded challenges with chronic pain and substance use than White PLWH.
Develop knowledge translation guidelines to improve health outcomes for PLWH experiencing chronic pain and overdose.
Anti-HIV medications stop the virus from replicating in the body, prolonging life and preserving health. But, these medications are not a cure. This is because HIV, like all retroviruses, can persist within cells called “HIV reservoirs”, which can reactivate at any time to produce virus. This is why anti-HIV medications must be taken for life.
While taking anti-HIV medications, some people experience something called “persistent low-level viremia” where HIV levels in blood suddenly become detectable for no obvious reason. Historically, this was attributed to difficulties in taking medication daily, or the development of HIV drug resistance, so doctors would try to resolve it by changing the medications. But, this would often fail to resolve the issue, causing great stress. Recently, a major discovery was made: that persistent-low-level viremia can originate from HIV reservoirs. Namely, these cells can make clonal copies of themselves, which reactivate to produce HIV. But, many questions remain, and these new discoveries also need to be translated into practice. I will study a unique cohort of people living with HIV using cutting-edge techniques to advance our understanding of the HIV reservoir and improve HIV clinical care.
The Hepatitis C virus (HCV) care cascade in British Columbia (BC) revealed gaps in testing, treatment initiation, and key disparities among priority populations. The introduction of Direct Acting Antivirals and policy changes, such as removing liver fibrosis stage as a treatment criterion, improved all stages of the care cascade by 2018 compared to 2012. However, limited data exist on high-priority populations, particularly those with high HCV prevalence and follow-up challenges, such as Vancouver Downtown East-Side (DTES) residents.
This study will assess the updated HCV care cascade in BC among individuals living and accessing services in the DTES, including priority subgroups. It will evaluate cascade steps over time and progress to date. We will engage stakeholders, including provincial/national initiatives and a DTES-focused social service agency, throughout the research process.
We anticipate lower HCV testing and care linkage rates among DTES residents and persistent gaps in high-risk groups.
Findings will inform health services and policies to advance Canada’s goal of eliminating HCV as a public health threat by 2030, reducing mortality, and improving outcomes for vulnerable populations.
GetCheckedOnline is a digital service in British Columbia that allows people to get tested for sexually transmitted infections (STIs) without visiting a clinic. It has been successful in reaching people who face challenges accessing traditional healthcare. As the program continues to grow, it is important to find ways to keep its benefits accessible to everyone while managing resources effectively. This project will examine evidence from similar programs elsewhere, analyze GetCheckedOnline’s existing data, and conduct interviews with those involved in running the program. Our goal is to develop a plan to ensure GetCheckedOnline remains sustainable and well-integrated within the broader health system, continuing to serve all residents of British Columbia effectively.
Big data science is becoming more prominent in many fields, including HIV. Data science utilizes electronic data already collected from multiple health sources, including administrative health data, i.e. data produced at each encounter with the healthcare system for administrative or billing purposes. Historically, active participation by People Living with HIV (PLHIV) has been pivotal to HIV research. However, data science has largely excluded PLHIV participation. It is established that community engagement is a matter of ethics and improved science, and it is problematic that this practice is underdeveloped in data science. Knowledge creation through data science brings two important shifts from traditional community-engaged research: data are typically not collected for research purposes, and opportunity for research collaboration comes after data collection. There is a need to develop new ways to engage people with lived/living experience in this form of research. This project brings together a team of older adults living with HIV, data scientists, clinicians and social scientists. We will examine how to authentically engage community members in data science while piloting community-led administrative data research. Our research investigates rates of survival from, and recurrence of, cardiovascular events among PLHIV compared to people without HIV in BC. Research about recurrence of cardiovascular events for PLHIV, particularly in Canada, is lacking.
The goal is to build a framework for researchers to engage community in data science for improved health outcomes among PLHIV in BC and British Columbians generally. We also hope to help reframe big data science research from an extractive to a collaborative process for more impactful research elsewhere.
The ongoing drug toxicity and overdose (OD) crisis has ruined the lives of many people in British Columbia (BC). Opioid agonist therapy (OAT) reduces the risk for an OD, but not everyone who needs OAT has access to and is taking OAT. People living with HIV (PLWH) are disproportionately affected by the OD crisis and may be less likely to have access to OAT. This project aims to contribute to a strategy to connect people who visit an emergency department (ED) or a hospital due to a nonfatal opioid OD (NFOOD) with primary care and OAT. I will use routinely collected health data on all PLWH and a 10 percent random sample of the general population in BC, between 1992 and 2020. I will investigate — of everyone who visited an ED or a hospital after a NFOOD — who is most at risk of 1) not being connected to primary care and OAT, and 2) a repeated OD. I will compare people living with and without HIV. I also will have conversations with professionals from various backgrounds and individuals with lived and living experience. Through these, I hope to learn more about barriers to care. Based on what I learned, I will formulate recommendations on how to help people that experienced a NFOOD connect with care that best suits their needs, including OAT.
Every day, over 400 Canadians are hospitalized because of drug and alcohol-related causes. These admissions are widespread, costly and deadly. This issue is especially problematic in British Columbia (BC) where hospitalizations related to alcohol abuse are highest in the country. Population data consistently highlight that licit and illicit substance use is more common among gay, bisexual and other men who have sex with men (GBM) compared with heterosexual individuals. However, research assessing substance use related mental and behavioral disorders, hospitalizations and mortality is lacking for GBM due to the lack of identifiers for sexual orientation in administrative research. This study links administrative and survey data to examine substance use related outcomes from 2012 to 2020 and compare these rates between GBM and heterosexual males in BC. Further, we will use cohort survey data to examine behavioural and structural factors associated with substance use related disorders, hospitalizations and mortality among GBM in BC. Our results will inform recommendations to improve substance use healthcare for GBM and support reductions in hospitalization costs related to substance.
We experience hunger so we eat, thirst so we drink, tiredness so we sleep, and loneliness so we find social connection. Social needs are fundamental to humans and when we are lonely the body’s central stress response system is dysregulated. As a result, our capacity to manage stress, inflammation, and energy reserves is reduced. The end result: lonely people live shorter and sicker lives.
In the wake of COVID-19, which itself manifested in an era of already increasing social isolation, it has never been more important to study loneliness. Yet, while a robust literature base has examined loneliness in older adults, we still know very little about what we can do to respond to experiences of loneliness across the life-course. This is particularly true in marginalized populations, such as gay, bisexual, and other men who have sex with men (gbMSM), who are especially vulnerable to social exclusion and related stressors, but they also exhibit unique coping strategies that may buffer these effects.
My research will help us better understand the epidemiology of loneliness among gbMSM in order to prevent its deleterious effects on these individuals, their communities, and the broader population in the wake of COVID-19.
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Co-lead:
- Valerie Nicholson
BC Centre for Excellence in HIV/AIDS
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Team members:
- Kathleen Inglis
SFU
- Wayne Campbell
AIDS Vancouver
- Antonio Marante
BC Centre for Excellence in HIV/AIDS
- Patience Magagula
Afro-Canadian Positive Network of BC
- Silvia Guillemi
BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Dr. Peter Centre
- Andreea Bratu
BC Centre for Excellence in HIV/AIDS
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Since the 1980s, HIV/AIDS community groups have engaged with science to ensure that research is done with them instead of simply about them yet it is rare for communities to engage with studies using administrative health data — that is, data electronically generated at every encounter with the health care system for administrative or billing purposes. This is a collaborative project amongst researchers and people living with HIV that explores how to embody the “nothing about us without us” principle in administrative data studies to ensure ongoing authentic engagement across all HIV research. Engaging with an administrative data study called COAST at the B.C. Centre for Excellence in HIV/AIDS, we will co-develop, pilot, and evaluate a process to research the experience of aging with HIV. In B.C., over half of people living with HIV who are on treatment are over 50 years of age. People with HIV are living longer lives. Through a regular series of meetings with our research council, we aim to develop a way to leverage administrative data (COAST) to better understand the complex reality of aging with HIV that is relevant to people living with HIV, which may help improve health services and health outcomes for people living with HIV.
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.
