Mifepristone outcomes study: Examining abortion access, outcomes, and costs following the introduction of mifepristone

Abortion is a common reproductive health procedure, with nearly one-third of women in Canada having had at least one abortion. However, abortion access is not equitable. Most abortions are surgical, and are provided in a small number of facilities located in BC’s largest cities. Some women, particularly those in rural or remote regions, experience significant wait times and must travel long distances to reach abortion services.

The medical abortion drug mifepristone became available in BC in 2017. Mifepristone can be provided in primary care and is a safe and effective alternative to travelling to large centres for surgical abortion, enabling abortion to occur at earlier (and therefore safer) gestations. Mifepristone medical abortion delivered in primary care has the potential to improve equity for abortion access and outcomes in BC, while reducing pressure on surgical services.

Dr. Schummers’ research will centre on a population-based cohort study using BC linked health administrative data to understand abortion access, outcomes, and costs before and after mifepristone became available.

The results of this study will inform knowledge users and health policy-makers about the effect of mifepristone medical abortion delivered in primary care on abortion service access, outcomes, distribution, and costs.

Sexual pain in endometriosis: Role of somatic mutations

Endometriosis is a common condition, affecting 1 in 10 women of reproductive age, or approximately one million women in Canada. Endometriosis occurs when tissue from inside the womb grows outside of the womb, such as in different areas of the pelvis. Half of women with endometriosis experience sexual pain, which is felt as pelvic pain with deep penetration during sexual activity. 

Sexual pain in endometriosis can occur when the endometriosis cells show invasive qualities. We recently identified non-inherited gene mutations in this type of invasive endometriosis. 

Our team has established a registry of endometriosis patients along with surgical samples from these patients. I will validate the role of gene mutations in endometriosis sexual pain, in particular whether these mutations are associated with invasion of endometriosis, and also with increased nerve growth around endometriosis. 

In the future, gene mutation testing could be incorporated into clinical care for endometriosis to identify subgroups and promote more individualized care. These mutations could also be potential novel treatment targets for this common condition in women.

Individual disposition and mHealth: Personalized care to improve outcomes

Today the greatest barrier to optimal health among persons living with HIV (PLWH) is antiretroviral (ART) adherence. The WelTel program uses weekly text-messages to improve ART adherence and HIV viral suppression among PLWH, but does not work for everyone. The literature states that personality traits and sense of purpose (dispositional traits) play a role in HIV-related outcomes. Measuring disposition is simple and rapid, and could be used to personalize adherence supports for clients with relative ease. 

We will enrol 300 PLWH from three Vancouver HIV clinics into the WelTel program. Participants will receive a basic cell phone and phone plan if they do not have one, and receive a weekly (two-way) text message for 12 months asking 'How are you?'. Problem responses will be triaged by a nurse. 

We will use existing validated tools to measure disposition at baseline/over time to determine whether we can predict who is most likely to benefit from the WelTel program, and how WelTel works to enact behaviour change. In this way we hope to provide a means by which limited resources could be triaged in vulnerable populations struggling with adherence to provide well-suited programs to the greatest number of individuals possible.