Tobacco, alcohol and other substance use disorders (SUD) are among the most important risk factors for the global burden of disease, with a 38 percent increase in global burden of the disease from substance use in the 20 years between 1990 and 2010, mainly driven by increased drug use (57 percent) and alcohol use (32 percent). The tobacco consumption is also worrisome considering the highest incidence of smoking is among men in low and middle income countries (LMIC), and that in the poorest LMIC households, 10 percent of the total income is spent on tobacco, to the detriment of consumption of healthy food and other essential elements for the health of the whole family.
Clinical prevention and care for these disorders are lacking in LMIC. A project funded by Grand Challenges Canada and run by NextGenU.org and the Africa Mental Health Foundation seeks to address that gap through:
- Piloting online training in SUD intervention for health care workers in rural and urban areas of Kenya
- Conducting randomized control trials (RCT) of the impact of alcohol brief intervention
- Determining the feasibility of sustaining the delivery of the interventions post-randomized control trials
The studies are ongoing, with screening data collected on more than 22,000 adults, enabling recruitment of 1,200 patients from October 2014 to February 2015 in 10 facilities from three counties. The clinical courses to address substance use disorders, and other NextGenU courses, are being used in 134 countries.
The screening included SUD, BMI and physical activity level (to mask the purpose of the trials and to decrease barriers from stigma).
Preliminary analysis shows that the outcomes include alcohol use reduction for the patients, and decrease in stigma from healthcare worker, as well as feasibility of sustaining the intervention post RCT.
This project will analyze the data, including the impact on quality of life, self-stigma, depression, risky sexual practices, general health and mental health status, and other substance use consumption. It will also perform knowledge translation of the clinical impact, and continue to carry out the feasibility assessment of sustaining the interventions.
Access to health care services is critical to improving the health and well-being of people living with or vulnerable to HIV. Factors such as density of services or neighbourhood violence play a substantial role as barriers or facilitators to health care access in broader populations, but limited research is available to show that this is also true for people living with or vulnerable to HIV. This study will investigate, within BC:
- The distribution of access and use of health services, especially health services in HIV testing and treatment.
- The barriers and facilitators related to access.
- How to develop a rigorous methodology to capture, quantify and analyze data on access and use of health services.
The proposal will draw data from several large, multi-year studies conducted by the BC Centre for Excellence in HIV/AIDS and will link to external datasets for the development of key measures. This project will focus on analyzing data regarding health care services utilization across different regions in BC over time. The proposal aims to improve access to services for earlier diagnosis and improved treatment for people living with HIV.
Over 40,000 babies are born each year in BC; approximately 15,000 to mothers who live outside the core urban areas of the province. A wave of obstetric service closures over the past ten years has resulted in increasing numbers of pregnant women having to travel long distances to access maternity services or having to relocate to a referral centre in their third trimester. Recent research from BC shows that women who live in communities without local maternity services experience more stress and anxiety during pregnancy due to the financial and emotional hardship incurred by leaving their communities to access services. Babies of women from BC who live further away from services are also more likely to experience negative outcomes, such as stillbirth or neonatal death.
The goal of of this study is to determine how the composition of rural maternity services relates to maternal and newborn outcomes, taking into consideration the characteristics and risk profile of childbearing women.
Using data from British Columbia Perinatal Services, and detailed information about the number and mix of maternity care providers (family physicians, obstetricians, midwives etc.) in each rural hospital catchment, Dr. Stoll will study the outcomes of mothers and babies over a ten-year period (2000 – 2010). In addition, she will examine whether the proportion of women who give birth in their home community as opposed to a referral hospital, changes with different maternity care provider compositions. She will describe how the number and mix of maternity care providers in rural communities relate to population outcomes using quantitative analysis.
Findings from this study will contribute to formulating optimal models of maternity care delivery for rural communities in BC and across Canada.
Serious mental illness (SMIs), like schizophrenia, schizoaffective, and bipolar disorder, impact almost one million Canadians. The cause of SMIs are extremely complex. While research clearly demonstrates a genetic component, multiple genes are thought to interact with environmental factors to cause the illnesses. Until recently, knowledge on the genetic and environmental causes of SMIs have not been addressed in standard medical care. However, emerging evidence suggests that genetic counselling (GC) can provide important and far-reaching benefits for patients, including decreased internalized stigma and increased perceived control. Anecdotal evidence also suggests that GC may improve treatment adherence, which represents a serious and significant challenge in illness management for persons with SMIs.
This study will explore and identify the aspects of the GC process that most effectively and positively influence outcomes, specifically medication adherence, for persons with SMIs.
Males and females with schizophrenia, schizoaffective, or bipolar disorder will be invited to participate in two interviews — one conducted prior to receiving GC, and the other within two weeks of receiving GC. Interviews will explore patients’ perceptions of SMIs and psychotropic medication; psychosocial and informational needs; and expectations about GC. The nature of the patient-counsellor interaction; the depth/type of information provided; and the effectiveness of different counselling approaches in relation to patients’ needs and expectations will also be examined. All interviews will be audiotaped, transcribed verbatim, and analyzed using the constant comparative method and coding procedures of Grounded Theory.
The ultimate goal of Semaka’s study is to develop a theoretical model that explains how GC influences patient outcomes, specifically treatment adherence, which will inform the development of evidence-based clinical practice guidelines for the routine delivery of GC for SMIs.
As a member of the CIHR New Emerging Team for Rare Diseases, Nick is exploring citizens’ attitudes and behaviour as they relate to the challenge of providing accessible treatments for patients suffering from rare diseases. The development of accessible orphan drugs poses a dual problem. On the one hand, the small potential market for orphan drugs for rare diseases makes it difficult for many innovators to access sufficient private capital to develop new orphan drugs, resulting in a lack of treatment options for many rare disease patients. Nick is exploring how patient groups and the general public may be able to address this funding gap. Specifically, he is investigating the extent to which crowdfunding – an emerging approach to online fundraising – might be used to help “de-risk” early-stage orphan drug research by allowing investigators to fund exploratory studies that make it possible for them to attract subsequent grant funding or private investment.
On the other hand, provincial health insurance plans are faced with a decision-making challenge due to the fact that orphan drugs for rare diseases are often very expensive. This poses a moral dilemma, since the same funds used to treat one individual with a rare disease could provide less costly medications for many more Canadians. Because taxpayers must ultimately bear the cost of funding these treatments through the public insurance system, empirically estimating society’s willingness to pay for expensive treatments for rare diseases, despite the significant opportunity costs, is a key element of democratic decision-making. Using data from an online survey of adult Canadians, Nick is exploring societal preferences for orphan drug funding by analyzing respondents’ choices in different scenarios in which provincial health authorities must decide whether or not to fund a specific treatment through the provincial insurance system.
The recruitment and retention of health care professionals is one of the most pressing challenges currently facing the Canadian health care system. In rural communities, the number of obstetricians and general surgeons is diminishing for a number of reasons, including difficulties in recruitment, an aging workforce, resistance to a demanding call schedule, and an increase in sub-specialization resulting in fewer ‘general’ surgeons. In some rural communities, maternity care is provided by general surgeons with enhanced obstetrical skills.
There are approximately 4,000 pregnant women in BC living in rural communities whose maternity care comes from these general practice (GP) surgeons. Despite the important role these practitioners play in sustaining rural maternity care in BC, to date, there has been no systematic research into their current experiences, and no official policy regarding guidelines for the practice, training, and maintenance of skills. Dr. Jude Kornelsen is investigating the role of these practitioners in rural health care in BC and their contribution to sustainable maternity care in these communities from a multi-disciplinary perspective.
Primarily through in-depth interviews, she will detail the experiences of GP surgeons in providing obstetrical care to rural communities including understanding their motivation, the nature of support received, and identifying any barriers to practice. She will describe the relationship between GP surgeons and specialists in their local community and in referral facilities, and determine how they receive ongoing training, mentoring and education. Ultimately, this research will provide a greater understanding of the culture of GP surgeons’ role in rural maternity service delivery in rural BC, and will help to inform policy guidelines regarding the practice, training, and maintenance of skills.
Canadians take part in medical tourism when they travel to other countries with the intent of accessing private medical care. It has been speculated that medical tourism by patients from countries such as Canada is exacerbating health inequities in destination countries, and particularly in developing countries. However, there is a lack of evidence demonstrating that this is the case. There is also a lack of evidence to support claims that medical tourism is having a positive impact on destination countries by enhancing health-care infrastructure and bringing revenues into the public sector, among other potential benefits.
Dr. Valorie Crooks and her team are addressing this pressing knowledge gap by qualitatively examining the health equity impacts of medical tourism in six purposefully selected sites: Bridgetown, Barbados; Guatemala City, Guatemala; Monterrey, Mexico; Mexico City, Mexico; Chennai, India; and Bangalore, India. The results will be useful to Canadian health service providers and administrators, as medical tourism poses particular challenges to Canada. While the ethos of our health-care system rejects two-tiered care for essential services, the number of Canadian medical tourists paying out-of-pocket to go abroad is already considerable and steadily increasing. This research will allow for valuable insights to be gleaned early on in the “global conversation” about medical tourism, ultimately allowing Canadian patients to make informed choices and Canadian health-care providers and administrators to provide needed guidance to patients. The findings will also help Canadian health policy makers ensure that Canada’s normative and legal obligations to improve global health equity are being met, and that efforts to expand universal health-care and sustainable health system financing efforts in destination countries are not being undermined through the medical tourism industry and Canadians’ participation in it.
Access to antiretroviral therapy (ART) for HIV infection has dramatically increased in recent years. More than eight million people worldwide are now being treated, the majority of whom reside in sub-Saharan Africa. The success of ART roll-out has been possible through large increases in funding, but has been facilitated by the promotion of the “public health approach” to implementing ART in resource-limited settings. The public health approach is characterized by simplified drug formularies and standardized treatment monitoring, which does not insist on laboratory tests that are commonly used for ART management in industrialized countries.
In regions of the world where ART became widely available in the mid 1990s, such as British Columbia, ART expansion was associated with dramatic declines in HIV-related mortality and HIV transmission. However, the population-level impact of ART programs in Sub-Saharan Africa remains to be seen. Dr. David Moore’s program of research will examine how health policies regarding the design and implementation ART treatment programs in Uganda, a low-income country with a generalized HIV epidemic can potentially affect the future shape of the epidemic there.
