Developing a sustainable digital public health strategy to support the population and public health functions and impact of the BC Centre for Disease Control

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. 

Community engagement and HIV research in the age of big data: Building a framework and tools for best practices

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.  

Engagement in opioid agonist therapy and risk for repeat overdose in people living with and without HIV who experienced a nonfatal opioid overdose: Providing insight to improve clinical care

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.

Linking administrative and survey data to examine substance use related diagnoses, hospitalization and mortality among gay, bisexual and other men who have sex with men in Metro Vancouver

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.

Exploring mechanisms, pathways, and mitigation strategies to prevent loneliness, social isolation, and their deleterious health impacts

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.

Eng/aging and HIV: Knowledge exchange between administrative data study and older adults living with HIV in British Columbia

Co-lead:

  • Valerie Nicholson 
    BC Centre for Excellence in HIV/AIDS

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

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.

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.

 

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.

Innovative addiction research program: Addressing polysubstance use

British Columbia (BC) faces a mental health and addiction crisis with an estimated cost of $100 million annually. In April 2016, a public health emergency was declared due to an alarming increase in opioid-related overdose deaths in recent years.

People who use illicit drugs (PWUD) bear a great burden of preventable morbidity and mortality from drug overdoses as well as other comorbidities including mental disorders and infectious diseases. While opioid agonist therapies (OAT) have proven effective in reducing heroin use, concomitant use of opioids and stimulant drugs (e.g., heroin and cocaine) is common among PWUD. Furthermore, recent research has suggested that many PWUD also suffer from untreated chronic pain, which may be driving prescription opioid (PO) misuse among this population. However, little is known about patterns of concomitant use of illicit opioids, POs and stimulants, and how OAT and other health services may serve to mitigate potential harms associated with such polydrug use. Currently, no approved pharmacotherapies exist for stimulant use disorder, necessitating urgent research effort in this area.

Dr. Hayashi's research will inform policies, programs and clinical practice to reduce harms associated with polydrug use. The primary research objectives are:

  • To investigate and address the impact of PO misuse, untreated chronic pain and concomitant opioid and stimulant use on patterns of drug-related harm.
  • Evaluate "naturally occurring" interventions and policy changes (i.e., new opioid addiction-related services and Vancouver Coastal Health's Downtown Eastside Second Generation Strategy) that are relevant to polydrug users.
  • Evaluate the efficacy of a novel pharmacotherapy to treat polydrug users. 

The research will employ vast longitudinal behavioural and biological data collected since 1996 via three ongoing prospective cohort studies of over 3000 PWUD in Vancouver. The findings are expected to inform care development and overdose prevention efforts for a high needs population in BC. One objective will involve implementing a clinical trial to evaluate whether an amphetamine-based medication reduces powder/crack cocaine use among 130 patients on OAT, who have both opioid and cocaine use disorders. If the study medication proves effective, Dr. Hayashi's research will potentially contribute to the identification of the first proven medication for cocaine addiction.

Opioid addiction research program to improve prescribing practices and reduce overdose

Canada is amid an opioid crisis, with six or seven deaths a day due to opioid overdose. Prescription opioid misuse can also transition to illicit opiate and intravenous drug use, substantially increasing the risk for overdose and blood-borne infections. Rates of overdose death due to counterfeit fentanyl have also risen and represent a growing crisis in most regions in Canada, with British Columbia (BC) being particularly hard hit. Half of the 800 anticipated overdose deaths for 2016 in BC are expected to involve fentanyl.

Dr. Fairbairn’s research will:

  • Address the effectiveness of a randomized controlled trial to evaluate a designated opioid prescriber intervention using BC’s centralized prescription network to reduce inappropriate opioid dispensation and overdose risk.
  • Inform overdose prevention strategies by characterizing the inter-relationships between medication prescribing patterns and patterns of illicit drug use.
  • Evaluate the longitudinal impacts of new overdose prevention initiatives and addiction treatment guidelines on overdose outcomes.

This research directly responds to BC’s recent declaration of a public health emergency, Health Canada’s urgent call to develop strategies to tackle the overdose epidemic, and the global challenge of prescription opioid abuse by generating evidence for safer prescribing practices and informing and broadening the evidence base for the treatment of opioid addiction.