Time frame: 2020-2022

Overview:
Not long after the World Health Organization declared COVID-19 a pandemic, Dr Natalie Prystajecky and Dr Melissa Glier, who had already been studying viruses in wastewater since 2018, were able to quickly leverage an existing collaboration, methods, and equipment for testing enteric viruses in wastewater to be able to test for SARS-CoV-2, the virus that causes COVID-19. Recently adopting an alternative sampling method that allows to test wastewater from an entire community, their team is also working on a method to test wastewater as it exits a building, thus providing key information on how COVID-19 is being spread throughout and among BC communities.

Results:
Funding for their work allowed Drs Prystajecky and Glier’s team to optimize their methods and test for SARS-CoV-2 in five wastewater treatment plants in Metro Vancouver, covering nearly 50% of BC’s population, along two regional health authorities. Weekly reports are shared with medical health officers and epidemiologists within regional health authorities, BC Centre for Disease Control staff, and Metro Vancouver.

Their collaborations have extended to the development of a three-day rapid sequencing method to effectively track COVID-19 variants of concern within a region, and key findings from their studies have been published in the Journal of Environmental Sciences and the American Society for Microbiology, with more to come. With the Omicron variant, wastewater testing has become a critical and necessary component of SARS-CoV-2 monitoring and surveillance.

Rapid SARS-CoV-2 Vaccine Research Initiative in BC

Time frame: 2021-2022

Overview:
In a new and unique partnership with Genome BC and Michael Smith Health Research BC (formerly the Michael Smith Foundation for Health Research), we funded nine new rapid-response vaccine research projects addressing COVID-19 vaccine research priorities and knowledge gaps. This funding program was developed and implemented in real-time, enabling us to get funding to critical research projects rapidly in order to have high-impact on vaccination roll-out for BC. Collective funding of around $1.3M is allowing for vaccine research that ultimately focuses on public health response and ensuring access to, and confidence in, vaccination programs for everyone in BC.

More specifically, the projects funded address areas such as:

• vaccine breakthrough infections;
• vaccine effectiveness in the context of Variants of Concern and in immune response;
• viral transmission;
• equitable distribution;
• vaccine acceptance and attitudes towards vaccines; and
• vaccine literacy and hesitancy among people who are pregnant or breastfeeding, people who are incarcerated, people who work in long-term care homes and a variety of multicultural communities in the Lower Mainland.

For a summary of the projects, go here.

Results:
We’ll continue to share outcomes of this research as these projects progress. You can stay connected on project updates by visiting this page and subscribing to our newsletter.

The post COVID-19 Response: From Monitoring to Vaccination appeared first on Pacific Public Health Foundation.

Buprenorphine/naloxone Standard Dosing and Microdosing in the Emergency Department: A feasibility study (2019)

Research Lead: Dr Jessica Moe

Many vulnerable populations, such as First Nations, construction workers, and people who use drugs alone, are at high risk for overdose, and may only seek out healthcare services in Emergency Departments (EDs). Yet, EDs don’t have a good way of identifying those at risk and offering treatments that could prevent future overdoses. By preventing cravings and withdrawal symptoms, Buprenorphine/naloxone (Suboxone) is the recommended treatment for patients with opioid addiction who wish to decrease their harmful opioid use, and studies show that starting people on buprenorphine/naloxone during ED visits helps to connect them with addictions services.

At the same time, many barriers exist that prevent people from accepting this treatment, like experiencing uncomfortable opioid withdrawal symptoms like agitation, nausea, vomiting, and sweats, before starting buprenorphine/naloxone at standard doses, plus, the medication can make patients’ withdrawal symptoms worse if started too early. As a result, microdosing is a new way of starting buprenorphine/naloxone where people take small doses that gradually increase over 6-7 days. People also do not need to be in withdrawal before a microdosing method is started, and the risk of causing worsening withdrawal symptoms during initiation is low. Still, the longer time to reach a target dose is a downside. This innovative study examined the feasibility of starting people on buprenorphine/naloxone from the ED using both standard dosing and microdosing methods, and was the first to address knowledge gaps on the acceptability of these methods, further contributing to the understanding of barriers to induction methods and of how to optimize buprenorphine/naloxone provision for vulnerable ED patients.

Opioid prescribing evaluation and research activities (2016-2018)

Research Lead: Dr Roy Purcell

Deaths due to illicit drug overdoses in BC is on the rise. This dramatic increase in deaths due to illicit drugs is partially due to patients transitioning from prescription opioid use to illicit drug use, which is very common. Many drugs sold illicitly contain fentanyl, an extremely dangerous opioid that is many times more potent than heroin. Patients who transition from taking prescription pain relievers containing opioids to injecting illicit drugs will be a much higher risk of overdose death.

Funding from the BCCDC Foundation allowed researchers to use data from the BC Hepatitis Testers Cohort (BC-HTC), a comprehensive population-based longitudinal cohort consisting of all BC residents who have been tested for HCV or HIV at the BCCDC Public Health Laboratory, to investigate the association between prescribed opioid therapy and objective measures of intravenous drug use (IDU) in a population-based cohort of almost 1.4 million people in Canada. Importantly, this grant was a key component of further funding to complete this research.

CDPC National Knowledge Exchange and Consultation on Supervised Consumption Services (2016)

Research Lead: Dr Naveed Janjua

People who inject drugs face serious potential health risks, including vulnerability to HIV and HCV. As Canada is in the grips of an overdose crisis, many groups are working to establish Supervised Consumption Services (SCSs) as part of a comprehensive response to the overdose situation. Funding from the BCCDC Foundation brought the Canadian Drug Policy Coalition (CDPC) and the Canadian HIV/AIDS Legal Network (Legal Network) together for a two-day facilitated “National Knowledge Exchange and Consultation on Supervised Consumption Services (SCS)” in Vancouver, BC, hosting 100 guests from 20+ localities in Canada considering and/or implementing SCSs.

The event successfully enabled the development of a comprehensive analysis of barriers created by the Respect for Communities Act, and a greater understanding of challenges encountered when operating a supervised consumption site. Additionally, an important network of stakeholders such as community groups, health authorities, harm reduction workers, and people who use drugs, was established to further future knowledge exchange efforts and coordination. The CDPC continues to work at a national level and focuses on including a broader range of participants in its network and activities related to SCSs. With the newly refreshed network of SCS advocates, the CDPC will look at implementing new digital engagement strategies, and may create some task sub-groups to focus on issues of SCS applications, operations, and community advisory processes.

Peer engagement and evaluation project (2015-2016)

Research Lead: Dr Jane Buxton

Harm reduction programs are internationally accepted as effective for reducing health disparities associated with drug use. However, there are large variations in the availability, accessibility, and utilization of these programs across BC. Partnering with people who use drugs, or ‘peers,’ reduces inequities by making services relevant and responsive. The Peer Engagement and Evaluation Project (PEEP) aimed to develop, implement, and evaluate best practice guidelines for peer engagement for harm reduction initiatives using an approach that includes capacity building, empowerment, and engagement of peers, providers, and decision makers.

BCCDC Foundation funding was granted for the purpose of a team meeting, for which one of the main findings was understanding the amount of stigma and discrimination among health providers across the province. As a result, the development of knowledge translation tools, including anti-stigma training with a photo series, were used at presentations across the province, as well as the development of best practice guidelines, which have been directly informed by the validation of their focus group findings at the team meeting.

You can stay connected on all project updates by visiting this page and subscribing to our newsletter.

The post Reducing Harms: Seed and Pilot Funding for BCCDC Researchers appeared first on Pacific Public Health Foundation.

The post Newsletter #35: April 2022 appeared first on Pacific Public Health Foundation.

The introduction of vaccination for COVID-19 was a game-changing moment in our pandemic, and equally important was the immediate launch of research to study the new vaccine technologies, and to monitor the effectiveness of SARS-CoV-2 vaccines in the real world and in real time.

Through one of the most critical COVID-19 projects we are funding, Dr Danuta Skowronski, Epidemiology Lead, Influenza & Emerging Respiratory Pathogens at the BC Centre for Disease Control (BCCDC), is leading this novel and real-time vaccine effectiveness research. Vaccine effectiveness (VE) looks at strength, durability, and interchangeability (protection offered when mixing vaccines), among other factors, and allows researchers and public health experts to learn about vaccines in real-world populations (this is different from efficacy, which is based on clinical trial data).

VE monitoring is critical in guiding vaccine policies and programs (e.g., target populations, intervals between doses, number of booster doses), and it is this monitoring that informs changes to vaccine programming and evidence-based decision-making, especially in relation to variations in pandemic waves and variants of concern (VOC).

Early work included reporting of the strength and duration of SARS-CoV-2 vaccine protection against infection, including emerging VOC and serious outcomes. This included:

• Single-dose effectiveness in healthcare workers and long-term care facility residents;
• Comparing mRNA vaccines versus AstraZeneca effectiveness in younger adults;
• The strength, durability, and interchangeability of two-dose VE including mixing different types of vaccines and extended intervals between doses.

Early findings demonstrated:

• The mRNA formulations gave higher protection against infection compared to AstraZeneca, but both provided excellent protection against severe outcomes.
• An AstraZeneca dose, plus a single dose of an mRNA vaccine in a mixed two-dose schedule, is as effective as two mRNA doses.
• Protection was better with a longer interval between first and second doses, and that the decision to extend the interval between first and second doses in BC not only brought first dose protection to more people more rapidly, but it also may have resulted in better responses to one’s second dose.

Recent findings are demonstrating that:

• Two-doses of vaccine provided protection against the Delta variant in both teens and adults.
• As we transitioned from Delta to Omicron, VE against infection decreased, but against hospitalization it remained comparable.
• With the rise of Omicron in December 2021, two-dose protection against severe outcomes was also well-maintained in adults.
• A third vaccine dose boosted protection from Omicron for adults, but less so than for Delta, and offered comparative protection against hospitalization.
• The incremental value of booster doses during times of low incidence (not in a ‘wave’) needs further study.

Perhaps you’ve learned about some of these findings in Dr Henry’s modelling updates, demonstrating why research like this is vital to the progression of the COVID-19 pandemic, to our understanding of vaccination, for decision-making around vaccine programming, and to care for our population as we experience differing waves or periods of high incidence versus low incidence.

Both early and recent findings, as well as continued findings as this work progresses, have been, and will continue to be, used to guide decisions for vaccination in BC. With the loosening of public health restrictions, and the transition to weighing one’s own personal risk and self-management (going at your own pace), vaccination will continue to be critical in our ability to protect ourselves and others from COVID-19.

For vaccination to continue to offer this protection, we have to understand how the evolution of SARS-CoV-2 impacts vaccines and how well they work—across all age groups, in all settings, and against new VOC. Ongoing monitoring of VE is critical to assess: potential waning of vaccine protection; impact of booster doses; protection in children; and with continued evolution of VOC, evaluating the strength, durability, and interchangeability of vaccines is an ongoing need for all target groups.

For this reason, we are partnering with the BC Ministry of Health, the BCCDC, and private donors to ensure this research can continue to provide critical evidence, for as long as our pandemic continues to impact BC, and the world. It is research like this that has been shaping our pandemic response in BC, and saving lives; and it is research like this that will ensure we keep everyone protected as we look ahead and learn to live with COVID-19 as safely as we can.

Vaccination remains our strongest tool in our toolkit, and we need to understand vaccine effectiveness in real-time and continue monitoring and providing evidence for decision-making. Findings from this research have already had substantial impacts on public policy provincially, nationally, and internationally. If you’d like to support this work, you can donate via our Emergency Response Fund.

The post Monitoring the Effectiveness of SARS-CoV-2 Vaccines in British Columbia appeared first on Pacific Public Health Foundation.

Researchers: Drs James Johnston, Jennifer Gardy, and Patrick Tang

Tuberculosis (TB) is an infection caused by a slow-growing germ most often in the lungs spread through the air from one infected person to another through coughing, sneezing, laughing, or singing. TB isn’t a disease of the past–decades after the first antibiotics to treat TB were developed, Canada still sees five people diagnosed with TB every day. Federally and provincially, Canada is committed to eliminating TB, and in British Columbia (BC), innovative genomics techniques are being used to accelerate our progress towards elimination.

The BCCDC Foundation is proud to have funded a five-year project—one of the largest TB genomics projects at the time (nearly 1500 TB genomes)—that used DNA sequencing of the TB bacterium to understand how it is entering BC, how it is moving from person to person across the province, and, most importantly, how this transmission can be stopped, resulting in fewer cases of this serious illness.

Drs Gardy and Johnston felt that the impact of this project was profound, a world first, and it generated actionable insights into TB transmission, changing how BC approaches TB prevention.

This project has been the best experience of our scientific lives so far!

Dr Jennifer Gardy, researcher, in 2018

As of 2018, this work had generated 16 publications and been presented internationally, with over 50 invited talks and poster presentations. Begun with funds through the BCCDC Foundation in 2014, additional funds were secured through Genome BC, allowing the Foundation to successfully leverage our initial investment and extend the project and expand the outcomes well beyond the initially-proposed aims. Though this project wrapped up in 2019, we’re very proud to have made such an impact to TB research for BC and know that we helped set this research team on a path to further success.  

You can stay connected on all project updates by visiting this page and subscribing to our newsletter.

The post Molecular Epidemiology of Tuberculosis in British Columbia appeared first on Pacific Public Health Foundation.

The post Newsletter #34: March 2022 appeared first on Pacific Public Health Foundation.

Q Sofia: Can you tell me how you describe your job with UTG, and how does UTG work?

Cheri: I’m a Peer Health Mentor with Unlocking the Gates; we walk alongside people when they are leaving corrections, help guide them on accessing services, and whatever other things they need assistance with. Having people with lived experience of incarceration involved in this period of transition when someone is leaving corrections makes a huge difference to how clients react to services that are offered!

Q Sofia: What is the Test Link Call (TLC) Project and how are you involved in it?

Tammy: We identify clients coming out of corrections who have hep C and who haven’t been linked to care or treatment yet—so we talk about hep C, hep B, HIV, we check with all our clients about that. If they have hep C infection, we find out if they did treatment yet, we tell them about the new treatments and how easy they are, I tell them about my previous clients who have done hep C treatment successfully, and we tell them about TestLinkCall Project. What that involves is we will link them to care with a treatment provider, give them a cell phone, and walk with them through treatment.

Pam: I hear things about the old hep C treatment still all the time from clients, the old interferon treatment hasn’t gone from peoples’ minds. The old treatment overwhelmed people for a long time. I’ve had clients do the new treatment and all they had was a headache. When I hear people talk about the old treatment, I address all their fears and misconceptions, so a lot of the time what we’re doing is education.

Q Sofia: How do you think TLC Project has helped UTG clients so far?

Pam: Our clients can do video calls with their hep C care providers now; that’s been a huge help for them. It’s so convenient to do their hep C treatment all by phone because a lot of them can’t get to appointments! But without a phone, telehealth, or video calls are impossible.

Cheri: The TestLinkCall program has been great because the Peer Health Mentors can check in with clients every few weeks by calling their cell phone, we just say “How you doing? How’s the treatment going? Hope you’re doing great!” It means a lot to them.

Tammy: Quite often, we are the only ones in our clients’ corner. We are often their only social connection—and giving them a phone actually helps a lot for them to feel like we are there for them.

Pam: I think it’s also been great that our clients can use social media and use video chat now to connect with family. There’s also these apps on the phones, before we give them to the clients, like the LifeGuard app, which is for safer substance use and can help alert first responders in the event of accidental overdose. I don’t know for sure that my clients who have received a phone are using the LifeGuard app, but at least we tell them about it and how to use it, and it’s on the phones.

Cheri: I know for sure one of my clients used the LifeGuard app on their phone that we gave them!

Tammy: Also, the phones are so good for the clients to be able to connect to other services, like trying to get into a drug detox facility.

Q Sofia: How do you think TLC Project can contribute to overall public health and hep C elimination in the overall population?

Cheri: Honestly I never heard of the overall goal for hep C elimination until today! But I’ll tell you, I don’t see hep C elimination being possible without things like TestLinkCall Project, or having other ways to connect people to care. We really need things like TestLinkCall Project where Peers who are connected with people at risk of hep C, like people in the prison system, have got support and resources to help link these clients to care. Or else hep C elimination is not going to work!

Pam: The prison population has such a high number of people living with hep C infection, it’s such a good place to start to get people connected to care, as part of these overall hep C elimination goals. But you know there’s so many other places we could also go to! Like recovery houses or homeless shelters, so I think this project could be scaled up or expanded even more!

Cheri: And I think if Peers could collect samples for hep C testing or do point of care tests, this would reach a lot of people and would be very acceptable for our clients. And this would work really well with TestLinkCall Project and the process we already established for linkage to care!

Tammy: Yes, if Peers could do testing or collect samples, clients would feel so much safer, and everything will move by so much quicker because we would be able to do everything on the spot at the shelter or wherever else we find them.

To learn more about Test, Link, Call (TLC) Project, read Dr Bartlett’s guest blog post Test, Link, Call (TLC) Project: Improving Connection to Hepatitis C Virus Treatment After Release from Provincial Prisons in BC.

The post Interview: Peer Health Mentors Work to Improve Connection to Hepatitis C Virus Treatment After Release from Provincial Prisons in BC appeared first on Pacific Public Health Foundation.

The post Newsletter #33: February 2022 appeared first on Pacific Public Health Foundation.

Sexually transmitted and blood-borne infections (STBBIs) like hepatitis C virus (HCV) are much more prevalent among people who are in prison, compared to the overall population in Canada. Accordingly, the Blueprint to inform hepatitis C elimination efforts in Canada produced by the Canadian Network for Hepatitis C (CanHepC), identifies people who have experienced incarceration as a priority population to link to HCV testing and treatment. And as BC Mental Health and Substance Use Services (BCMHSUS) now provide healthcare in all 10 BC Provincial Correctional Centres, and HCV testing and diagnosis in these centres has improved considerably in the last four years, there was a greater need to find ways to make the connection to HCV care after release from prison more efficient and effective.

So, with funding and support from the BCCDC Foundation for Public Health, a team from BCCDC, BCMHSUS, BC Hepatitis Network and UTG came together to create and launch the Test, Link, Call Project (TLC). This Quality Improvement project aims to increase the proportion of people affected by HCV infection who connect to a community HCV treatment provider after release from BC Provincial Correctional Centres.

This is achieved by creating a Transitional Care Plan (TCP) for each participant before release, then providing them with a cell phone that has an unlimited calling and text plan for six months on it, on the day they are released from custody.

Experienced Peer Support Workers from BC Hepatitis Network provide HCV patient navigation training to UTG Peer Mentors who have lived experience of incarceration. This allows the UTG Peer Mentors to meet participants on the day they are released from custody, give them their new phone and help them set it up, then provide on-going support with HCV medication and appointment reminders, as well as assistance with transportation and other needs.

By providing TCPs, cell phones, and peer support and mentoring to people as they are released from corrections, we aim to increase linkage to care and HCV treatment uptake among this priority population, as well as aid in successful re-integration back to the community.

Read an interview with Peer Mentors here.

The post Test, Link, Call (TLC) Project: Improving Connection to Hepatitis C Virus Treatment After Release from Provincial Prisons in BC appeared first on Pacific Public Health Foundation.

Last summer, Dr Natalie Prystajecky (Principal Investigator) and Dr Melissa Glier (lead researcher) provided an introduction to wastewater testing for SARS-CoV-2. Here, Drs Glier and Prystajecky provide an update on research progress and how wastewater data continues to be used in the pandemic response.         

Soon after the World Health Organization declared the global outbreak of COVID-19 a pandemic, the BC Centre for Disease Control (BCCDC) Public Health Laboratory (PHL) and Metro Vancouver began working together to test wastewater for SARS-CoV-2.

We quickly leveraged an existing collaboration, methods, and equipment for testing enteric viruses in wastewater to be able to test for SARS-CoV-2, the virus that causes COVID-19. But we weren’t the only lab in Canada doing this work–across the nation, researchers like us were developing and optimizing methods. To ensure that the methods used across Canada were robust and that the data were comparable, the Canadian Water Network’s COVID-19 Wastewater Coalition conducted an Inter-Laboratory Study, hosted by Canada’s National Microbiology Laboratory.

The goal of this study was to better understand the variability associated with methods that are being used in Canada, with a focus on method optimization. This study set the stage for sharing methods and data amongst Canadian experts to achieve the collective goal of rapid development of methods that can support public health. The study’s key finding and recommendations have been captured in an outcomes report and a publication where Dr Glier is the second author.

By participating in the inter-laboratory study, our team was able to optimize our methods and apply them to testing for SARS-CoV-2 in five wastewater treatment plants in Metro Vancouver, which cover nearly 50% of BC’s population and located within two regional health authorities.

The SARS-CoV-2 wastewater data is compared to trends in the incidence of community cases by BCCDC’s public health physician Dr David McVae, medical geographer Sunny Mak, and data analyst Michael Kuo. Weekly reports are shared with medical health officers and epidemiologists at the regional health authorities, staff at the BCCDC and Metro Vancouver. In addition, Metro Vancouver launched an online tool which allows residents to track the SARS-CoV-2 viral load in wastewater at each of the region’s five treatment plants. The results (wastewater data graphed with the case data over time) are also available online within the bi-weekly BC COVID-19 Data Summaries.

Furthermore, last year we collaborated with UBC’s assistant professor Dr Ryan Ziels and PhD student Xuan Lin to develop methods to detect SARS-CoV-2 variants of concern in positive wastewater samples. This project led to the development of a rapid sequencing method (3-day) to effectively track COVID-19 variants of concern within a region. More details pertaining to this study can be found on the UBC News website and in this publication.

Our team continues to work on method development and recently adopted an alternative sampling method. For the work to date, we have focused on sampling from wastewater influent (as the wastewater enters the wastewater treatment plant). This allows us to test wastewater from an entire community.

We are now evaluating a method to test wastewater as it exits a building; this allows us to test the wastewater for a specific community. Wastewater samples are collected by placing a testing device called the COVID-19 sewer cage (COSCa) into a manhole as wastewater exits a building.

The COSCa device, which is 3D printed, was created by PhD student Emalie Hayes at Dalhousie University and emphasizes the role of innovation in responding to the pandemic. We are using the COSCa sampling method, in collaboration with the Ziels laboratory, to investigate SARS-CoV-2 and the variants of concern in wastewater discharged from UBC residences. By the end of the project, we will have developed a robust wastewater testing program to support public health decision makers respond to the COVID-19 pandemic in BC.

We are already starting to plan for wastewater testing beyond COVID-19, with an aim to build a comprehensive enhanced wastewater surveillance system for BC. This includes adding additional testing targets of public health concern, such as for surveillance of flu, foodborne pathogens or organisms carrying antimicrobial resistance. We anticipate the wastewater-based testing will have an important role in surveillance systems of the future.

We’d like to recognize our funders: the BCCDC Foundation for Public Health, NSERC, Metro Vancouver, and Health Canada.

We also recognize the enormous contribution of our team and collaborators, including the team that processes and tests the samples: Liam Byrne and Tina Lee (current coops), Tenysha RossVanMierlo, Matthias Krushel, Ziwen Ran (previous co-ops), and Jennifer Kopetzky (technician). We recognize the contributions of the following as well; Christine Tchao, Daisy Yu, Tracy Chan, Dr John Tyson (BCCDC PHL); Dr Ryan Ziels, Xuan Lin, Kevin Kuchinski, (UBC); Dr David McVea, Sunny Mak, Michael Kuo (BCCDC) Farida Bishay, Alvin Louie, Daisy Espinosa, Dr Andjela Knezevic-Stevanovic (Metro Vancouver), Dr. Chand Mangat, Dr. Michael Mulvey, Dr. Anil Nichani (NML/PHAC); Dr. Alex Chik, Bernadette Conant, and Dr. Steve Hrudey (CWN).

The post Project Update: BCCDC’s COVID-19 Wastewater Surveillance in Metro Vancouver Communities appeared first on Pacific Public Health Foundation.