Additional Harm Reduction Services in Two Sites in Nova Scotia
Principal Investigators: Dr. Lois Jackson (Dalhousie University), Diane Bailey (Mainline Needle Exchange), Margaret Dechman (University of Cape Breton), and Christine Porter (Ally Centre of Cape Breton)
Status: Completed The purpose of this one-year study was to explore what people who use substances (PWUS) and key local stakeholders think about additional harm reduction services in their communities of Halifax and Sydney. For the purpose of this study, additional harm reduction services include: no cost naloxone programs; peer-staffed community detox/withdrawal management programs; supervised consumption rooms; peer-run navigation services; and no cost needle syringe distribution and disposal programs within existing local services. For the Sydney site, it also includes a community-based, low-threshold opioid substitution program.The project is being conducted in two main phases, the first involving the administration of questionnaires for PWUS through Mainline Needle Exchange in Halifax (100 participants) and Sharp Advice Needle Exchange in Sydney (50 participants) sites. The second phase was launched in early 2018, and involved a small number of interviews with various local key stakeholders. A community report, “Increasing services, reducing harms: Results from a community-based study in Nova Scotia “was released in August 2019.
A New APPROACH to HIV Testing: Adaptation of POCT for Pharmacies to Reduce risk and Optimize Access to Care in HIV
Principal Investigator: Dr. Deborah Kelley (Memorial University of Newfoundland)
Completed: 2018
An estimated 21% of Canadians with HIV are unaware of their infection. There is a need to improve access to HIV testing to detect infections earlier so individuals can access care early and take steps to prevent transmission to others. Barriers to HIV testing include limited access or reluctance to go to traditional testing sites (doctor’s offices and sexually transmitted infection clinics), and the lengthy wait time to receive test results from standard laboratory-based HIV testing (usually 1-2 weeks). These deterrents are particularly significant for those at highest risk of infection, who may be socially marginalized or stigmatized. In rural areas, HIV testing may only be available through doctor’s offices and hospitals, yet many Canadians do not have access to a family physician. Pharmacists are among the most trusted and accessible healthcare providers, and are well positioned to improve access to HIV testing. Point of care tests for HIV are easy to administer and results are available within minutes, making them ideal for use in the community pharmacy setting. Point of care testing (POCT) by pharmacists can ensure individuals receive their test results, and facilitate timely linkages to care and treatment. This adaptation grant will look at factors influencing the acceptability and feasibility of pharmacist-provided rapid POCT for HIV in two Canadian provinces, including pharmacies in both urban and rural areas. The effectiveness of pharmacist-delivered POCT will be considered from a variety of perspectives including people living with or at risk of HIV, as well as pharmacists as the service providers.
Grinding Against HIV Prevention Discourse: A critical exploration of risk among user of mobile gay cruising apps
Principal Investigator: Dr. Matthew Numer (Dalhousie University)
Completed: 2017 This project seeks to understand how men who have sex with men (MSM) use social networking applications (apps) to engage in sexual encounters and how these encounters may involve risk taking behaviours. In 2009, Grindr was introduced as a mobile app for smartphones to allow MSM to see the profiles of other men in their vicinity (using GPS technology) and to use the “chat” function to talk to them. This app is commonly known as a “hook-up” app for people to contact other men for the purposes of sexual encounters. This app quickly became the most popular of its kind and as of 2014 there have been 10 million user downloads since its inception and 5 million accessing monthly. The challenge for those working in HIV and STI prevention is that despite the education campaign to reduce HIV and other STIs among MSMs, infections continue to occur at a higher rate among this subgroup of the population. They believe that the increased availability of sexual encounters through mobile devices may contribute to the continued spread of HIV and for the recent outbreak of other STIs among MSM. This research seeks to provide new insight into how mobile apps can be (re)considered in HIV and STIs prevention.
“Overdose Prevention Training and Take Home Naloxone” Pilot Project
Team Lead: Cindy MacIsaac (Direction 180) and Diane Bailey (Mainline Needle Exchange)
Completed: 2016 Since the fall of 2015, the Atlantic Interdisciplinary Research Network for Social and Behavioural Issues in Hepatitis C and HIV/AIDS (AIRN) has been working with a steering group of stakeholders to conduct an evaluation of Mainline Needle Exchange. Mainline commissioned the evaluation in order to document program operations and impacts, as well as current and emerging needs. It also sought considerations and recommendations to increase the efficiency, positive impacts and outcomes of programming. The evaluation was informed by three key sources, including a review of key documents, an analysis of the program’s database, and key informant interviews with staff, clients and partners. The report will be officially released later in 2016..
Mainline Needle Exchange Evaluation
Team Lead: Dr. Susan Kirkland (Dalhousie University)
Completed: 2016 Beginning in the fall of 2015, the Atlantic Interdisciplinary Research Network for Social and Behavioural Issues in Hepatitis C and HIV/AIDS (AIRN) worked with a steering group of stakeholders to conduct an evaluation of Mainline Needle Exchange. Mainline commissioned the evaluation in order to document program operations and impacts, as well as current and emerging needs. It also sought considerations and recommendations to increase the efficiency, positive impacts and outcomes of programming. The evaluation was informed by three key sources, including a review of key documents, an analysis of the program’s database, and key informant interviews with staff, clients and partners.
Rethinking ASOs? Responding to the End of AIDS Exceptionalism through East-West Collaboration
Team Lead: E. Jones, S. Kirkland (Dalhousie University), Dr. Jacqueline Gahagan (Dalhousie University), et al.
Completed: 2015 Rethinking ASOS? Responding to the End of AIDS Exceptionalism through East-West Collaboration was a CIHR- funded planning grant that brought together members from British Columbia (led by the Pacific AIDS Network) and from Atlantic Canada. The two regions share common challenges in addressing HIV/AIDS, such as providing community-based services and supports in both rural and urban centres, and the bulk of operational and program funding coming from Federal funding for ASOs, etc. The goal for this project was to collaborate in sharing our understanding of the shifting roles of ASOs. Simultaneous meetings were held in each region and a report was drafted. Multiple webinars were held (some pre- and one post-workshop) with additional resources created to aid in the deliberative dialogue (literature review and policy map – all available by clicking below.
Surging ahead in community-based research in HIV/AIDS: Building on our collective knowledge to reduce harms and understand the impact of addiction on people at risk for or living with HIV/AIDS in Atlantic Canada
Team Lead: Dr. Susan Kirkland (Dalhousie University)
Completed: 2015 In our collective efforts to move evidence into action we conceived of this planning and dissemination event as a means to strategically build on our substantial body of work in the areas of harm reduction, mental health and addictions. The two day event “Surging ahead in community-based research in HIV/AIDS: Building on our collective knowledge to reduce harms and understand the impact of addiction on people at risk for or living with HIV/AIDS and HCV in Atlantic Canada” was informed by the findings from CIHR funded projects, two program evaluations, panel discussions and subsequent strategic planning and priority setting activities. Ultimately, we seek to maximize the use of this knowledge in practice/policy, and to inform the development of research to make a measureable difference in the lives of people living with and impacted by HIV and AIDS.
Spread the Word, Not the Virus
Team Lead: Carla Densmore (Hepatitis Nova Scotia)
Completed: 2015 Based on the Spread the Word, Not the Virus HIV and Hepatitis C (HCV) co-infection workshop developed in partnership with Direction 180 and AIRN (with funding from the Halifax Community Health Board`s Community Development Fund, this HepNS project delivered a 3 hour presentation or workshop to clients and members of community agencies serving people who live with HIV or HIV and HCV co-infection, people who use drugs, and or men who have sex with men. In addition to the base workshop, three different modules, specific to the needs of the three target populations (those living with HIV, men who have sex with men, and people who use or have used injection drugs) were developed (through focus groups) and delivered as workshop add-ons. Each module focused on prevention, healthy living or safety information addressing the needs as identified by the focus groups for that community. Local resource information was also be provided as well as follow up web-based and print materials for further self-discovery.
Exploring the Landscape of Communicable Diseases in Atlantic Canada
Team Lead: Dr. Susan Kirkland (Dalhousie University)
Completed: 2014 Exploring the Landscape of Communicable Diseases in Atlantic Canada was a collaborative and consultative investigation into the current state of HIV/AIDS, HCV and other sexually transmitted or blood-borne infections (STBBIs), affected populations, and associated service delivery needs in Atlantic Canada from the perspective of community-based organizations and the people who access their programs, services and supports. The objectives of the project were: (1) To identify the current and emerging needs, key issues, and gaps in the area of services provided to populations living with communicable diseases—specifically, HIV/AIDS, Hepatitis C, and other STBBIs—in Atlantic Canada; and (2) To generate evidence to guide decision-making concerning how organizations serving these populations might position themselves to provide effective and efficient services to those most affected in the region into the future.
Our Youth, Our Response: Building Capacity for Effective Policy and Programming Responses Across the Atlantic Region (OYOR)
Team Lead: Dr. Jacqueline Gahagan (Dalhousie University)
Completed: 2014 Our Youth, Our Response (OYOR ) was a three‐year interprovincial research study funded by the Nova Scotia Health Research Foundation (NSHRF). OYOR sought to investigate the current state of primary (eg. preventing the initial infection) and secondary (eg. preventing transmission) prevention policies for youth aged 15 to 24 across Atlantic Canada using population health and determinants of health frameworks. The overarching goal was to develop evidence-based recommendations for a variety of stakeholders within government, community and research sectors on strategic and innovative prevention policy and programming approaches needed to help mitigate the impact of these diseases.
Harm Reduction within Mainstream Services: What are the Challenges & Opportunities to Reducing the Harms for People Who Use Drugs?
Team Lead: Dr. Lois Jackson (Dalhousie University)
Completed: 2014 This project explored the opportunities and challenges to integrating harm reduction services and supports into emergency departments and emergency shelters. The research had two key objectives: (1) To understand the policies and practices (formal and informal) that currently guide the provision of services to drug users within emergency departments and emergency shelters across Atlantic Canada; and, (2) To conduct a series of workshops to discuss with a broad range of key stakeholders (e.g. physicians, nurses, police, community groups) the challenges and opportunities to integrating harm reduction services into emergency departments and emergency shelters.
Community and Provider Perspectives on Improving Treatment Adherence and Retention for Injection Drug Users Living with HIV/AIDS
Team Lead: Dr. Susan Kirkland (Dalhousie University), Dr. Jacqueline Gahagan (Dalhousie University) & Cynthia MacIsaac (Direction 180)
Completed: 2014 People who use injection drugs (IDUs) often have to cope with having multiple conditions that occur along with addiction, and those living with HIV/AIDS tend to have the poorest outcomes. Combining addiction care (methadone maintenance therapy, or MMT) and HIV care (highly active antiretroviral therapy, or HAART) in a community setting has the potential to improve short and long term outcomes for this population. However, key community members have identified that there remain considerable challenges to consistently taking medications and remaining on treatment. The purpose of the research was to obtain better understanding of what factors contribute to IDUs who are living with HIV/AIDS not taking their medications regularly and staying on treatment (MMT and HAART), and also what supports have contributed to successfully taking medications and staying on treatment.
Opioid-dependent users on methadone: A knowledge synthesis of formal interventions aimed at methadone retention & improved health
Team Lead: Dr. Lois Jackson (Dalhousie University) & Carolyn Davison (Nova Scotia Department of Health and Wellness)
Completed: 2014 Methadone’s effectiveness as a treatment to help stabilize individuals who are opioid-dependent, and to help them improve their health, has been well established. However, for many individuals, staying on methadone for a long enough period of time to obtain the benefits, and to address their varied physical, mental and social needs, can be challenging. These individuals require a variety of interventions (such as counseling, medical services, housing and vocational services) to assist them in continuing on methadone, and in improving their health so they can live productive lives. Our research will help in the development of evidence-informed interventions for individuals on methadone by: a) synthesizing the existing body of knowledge about interventions for this population; and, b) providing an explanation as to what types of interventions work best for the different sub-populations on methadone (e.g., women, men, youth, etc.), and under what conditions.
Spreading Information, Stopping Infection: Policies for Prevention of HIV/HCV in Youth in Atlantic Canada
Team Lead: Dr. Jacqueline Gahagan (Dalhousie University)
Completed: 2013 The Spreading Information, Stopping Infection workshop was held in Halifax, Nova Scotia from March 4 to 5, 2013. The purpose of the workshop was to bring together researchers, health educators, policymakers, health care workers, and youth to share knowledge about HIV and Hepatitis C (Hep C) prevention and harm reduction across Atlantic Canada. The workshop aimed to facilitate open communication and knowledge sharing around HIV and Hep C prevention and harm reduction issues, approaches and potential research and programming partnerships. The workshop was an extension of the Our Youth, Our Response (OYOR) research project, a three-year inter- provincial research study funded by the Nova Scotia Health Research Foundation (NSHRF).