Research grants
EPIX’s current research involves evaluating public health policies and gaps in health service delivery, with a focus on infectious diseases (syphilis, HIV/AIDS, and SARS-CoV-2) and chronic liver conditions (metabolic dysfunction-associated steatotic liver disease (MASLD) and hepatitis C).
Syphilis has reemerged as a serious public health concern in Canada, especially in rural, remote, and small urban communities. People who use drugs, take part in survival sex work, or do not have stable housing are at higher risk of infection and often face barriers to getting tested. While syphilis can be cured, delays in testing and treatment can cause serious health problems and allow the infection to spread further. Our team is working to solve this problem by bringing care directly to people who need it most. We use a new approach that combines rapid syphilis tests with public health outreach. Over the past two years, this outreach model of care has expanded across Ontario, with eight public health units partnering with 83 community-based organizations.
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Next, we want to learn two things: (1) how to grow this model to reach more people and places that need it most, and (2) whether the benefits of stopping new infections outweigh the costs. To achieve this, we are collecting data, listening to community members, and collaborating with individuals who have lived experience to ensure we are meeting their needs. Ultimately, our research will provide public health leaders with the evidence they need to reduce syphilis rates, understand potential cost savings, and promote health equity for underserved populations across Canada.
Congenital syphilis is increasing rapidly across Canada. This is when babies are born with syphilis infections because their mothers were infected during pregnancy, Early diagnosis and treatment in pregnant women can stop them from passing syphilis to their babies.
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Our study will investigate how well prenatal syphilis screening is followed across all public health units in Ontario. Next, we'll use the differences in recommendations between these units to see if increasing testing for all women is better at reaching those at the highest risk of syphilis compared to only testing based on risk factors. We will do this by using health administrative data and forming a new team with experts in public health, infectious diseases, and maternal and perinatal health. Our existing collaborations with public health units across Ontario will facilitate the timely completion of our research and allow our work to be implemented into practice. Overall, our research has the potential to evaluate equitable access to prenatal screening, which can ultimately reduce congenital syphilis and lay the groundwork for future syphilis research in Canada.
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Our community-centred implementation science research aims to improve the administration of point-of-care tests (POCT) and treatment to targeted underserved populations in non-urban communities experiencing some of the highest infectious syphilis rates in Ontario. Concurrently, we seek to address the rise in infectious syphilis cases by pairing POCT and treatment with existing public health outreach programs and to understand the community's preferences to maximize equitable access and adoption of POCTs in the future. Specific objectives include:
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O1: Expand and evaluate our pilot “POCT test and treat” model of care for underserved populations using the RE-AIM framework. We will expand our successful pilot to additional PHUs in Northern Ontario.
O2: Elicit the preferences for syphilis testing and treatment by conducting a discrete choice experiment from geographically diverse groups of underserved populations.
O3: Accelerate knowledge mobilization (KM) by creating a real-time exchange of information between community organizations, PHUs, and other relevant knowledge users to support decision-making.
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Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is caused by fat accumulating in the liver over time, causing inflammation and scarring. An estimated 1 in 4 Canadians has MASLD, but very few are aware. People with type 2 diabetes are at a high risk of advanced disease progression, making them an ideal population for screening. International experts recommend using a simple test called the Fibrosis-4 index (FIB-4) to screen for advanced liver fibrosis in high-risk groups like people with diabetes. However, there are currently no Canadian Diabetes guidelines for screening for fibrosis. And access to the necessary blood tests to calculate FIB-4 is not currently universally available.
We propose to describe the variability in screening strategies (different blood tests) and rates over time. We will then identify factors and subgroups of people with distinct screening patterns and examine how these patterns are associated with liver disease progression. Finally, we will evaluate which screening strategy is the most cost-effective. We will use data routinely collected from health records and advanced statistical methods to account for many of the biases found when using this type of data. Ultimately, the goal is to develop effective and equitable screening strategies to prevent liver disease progression in people with diabetes.
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