Grant: Partnerships for Health System Improvement (PHSI)

Blood Borne Infections; Core Groups; Data Linkage; Disease Transmission; Neighbourhood Environment; Sexually Transmitted Infections; Spatial Analysis; Surveillance; Syndemics

<html> <body> <strong><u>Background &amp; Rationale:</u></strong> HIV epidemics co-occur with epidemics of sexually transmitted infections (STI), and blood borne infections (BBI) such as hepatitis B &amp; C and tuberculosis. Management of these synergistic co-epidemics (syndemics), mandates a shift from disease-specific to integrated public health services across these epidemics. Targeting services to individuals within and across these overlapping epidemics at greatest risk of acquisition or transmission of STIBBIs (<strong>core groups</strong>) would be more efficient. However, evidence in support of integrated approaches is limited and requires complex, real-time linkage of multiple datasets, logistically challenging for most jurisdictions. <br> <br> <strong><u>Study Objective</u></strong><strong>:</strong> We aim to further STIBBI prevention by applying concepts of core groups and syndemic theory to unparalleled provincial surveillance, laboratory, and healthcare utilization data linkages and examine whether real-time data linkage to understand core groups could improve integration and delivery of health services across these epidemics. <br> <br> <strong><u>Research Approach</u></strong><strong>:</strong> We will use two novel and unique provincial data linkages, developed in partnership between the BC Centre for Disease Control, the BC Public Health Microbiology Reference Laboratory, and the Ministry of Health. Together, these linkages will support analysis at individual and neighbourhood levels for at least the last 20 years. We will use this information to:<br> <strong><em>1.</em></strong> <strong><em>describe the STIBBI syndemic overlap and identify core groups in BC.</em></strong>We will use descriptive and spatial analyses to describe syndemic overlap and identify geographic clusters in time and space to define core groups and core areas. <br> <strong><em>2. use defined syndemics and core groups to improve</em></strong> <strong><em>STIBBI</em></strong> <strong><em>health services and interventions</em></strong><strong><em>.</em></strong> We will compare health service delivery levels across core and non-core areas, and develop decision algorithms to prioritize interventions for people diagnosed with STI. <br> <strong><em>3. examine the ethical and implementation impact of re-orienting health services to syndemics and core groups.</em></strong> We will apply our results in a case study design to evaluate integrated testing, care and prevention strategies in the Fraser Health Authority in BC. We will assess the impact of our approach qualitatively, by holding stakeholder interviews and a series of regional dialogues, with particular attention to ethical implications of using linked data for STI interventions. <br> <br> <strong><u>Potential Impact</u></strong><strong>:</strong> Our project will lead to improvements in STIBBI prevention by providing population level evidence on the applicability of integrated health services and interventions for STIBBI prevention; and by examining the impact of real-time integrated data on optimal deployment of services while considering program and ethical implications. <br> Our project will also further scientific methods by advancing understanding of STIBBI syndemics and extending the concept of core groups from incident bacterial STIs to chronic viral BBIs. This will inform the development and refinement in intervention strategies, and so our findings will be relevant to initiatives in other jurisdictions as well.<br>&nbsp;<br> <strong><u>Study Team</u></strong><strong>:</strong> Our team comprises researchers with relevant expertise (including linkage of administrative datasets for HIV and co-infections, spatial and qualitative analytic methods) working with public health and community leaders who are well situated within provincial and national networks to facilitate rapid knowledge translation and application of study findings across Canada.</body> </html>