Beth Payne The ASPIRE Mayuge trial is a pragmatic, sequential, cluster randomized trial, which began recruitment in August 2019 in Mayuge, Uganda. The objective of the trial is to compare effectiveness of two models of community-based self-collected HPV testing as a screening tool for cervical cancer in this rural low-resourced setting. Arm 1 involves door-to-door recruitment of women by community health workers (CHWs). 64 CHWs were trained and 6 nurses for facility-based VIA follow-up. Over 600 women of the Arm 1 target of 1066 have been enrolled to date, with an HPV incidence of 26.7% reflecting tremendous community support and need for screening.

Soha Sabeti, Chloé Xavier First Nations in BC have been disproportionately affected by the overdose crisis. In response to the Public Health Emergency, surveillance systems were established to identify trends in overdose. Existing systems contained minimal information on overdose among First Nations. Data linkage, sharing, and analysis processes that adhered to the principles of OCAP and TRC’s Calls to Action required development. In response to this need, the First Nations Health Authority, BCCDC, Provincial Health Officer, and MoH worked collaboratively to create new data linkage processes to identify First Nations persons in overdose data. This presentation will outline the data governance context, principles, and operational considerations of creating overdose surveillance systems for First Nations people in BC.

Sarah B. Henderson Since declaration of the provincial opioid public health emergency in 2016, British Columbia continues to see new adulterations to illicit drugs, changes in drug use habits, and increasing drug potency. Under these conditions the province is still experiencing an increase in annual deaths from illicit drug overdoses. We developed a syndromic surveillance system to detect opioid overdoses in data collected by the Drug and Poison Information Centre (DPIC) in near-real-time, potentially allowing rapid identification of dangerous changes in the drug supply. The system incorporates machine learning and free text mining to account for the evolving nature of public exposure to illicit opioids.

Zahara Mamdani The BC Take Home Naloxone (THN) program, established in 2012, provides naloxone to individuals at risk, or likely to witness, an opioid overdose, primarily through community-based organizations and harm reduction sites. In December 2017, the THN program expanded to selected community pharmacies across BC in order to further increase access of naloxone, specifically to those who may be reluctant to obtain it from traditional harm reduction sites. The evaluation of the THN program in community pharmacies was conducted to identify strengths and barriers to the implementation of the program, and inform its improvement.

Arina Zamanpour GetCheckedOnline (GCO) is an internet-based testing service for sexually transmitted and blood-borne infections in British Columbia that is highly accepted by clients. Using a matched case-control study, we compared treatment uptake, engagement in partner notification (PN), and PN outcomes between chlamydia and/or gonorrhea cases diagnosed through GCO and two provincially-operated sexually transmitted infection clinics. Using a cascade of care, PN outcomes were compared between partners of GCO and clinic cases. These findings will enable us to better understand differences between clients of internet-based testing services and clinic-based clients, as well as inform our PN strategies.

Tom Kosatsky Evidence suggests an increase in death by myocardial infarction (MI) on days with snowfall, but this had never been evaluated in the complex climate of British Columbia. We assessed the relationship between snowfall and MI mortality across the province from 2009-2017 using a case-crossover design. The odds ratio [95% confidence interval] on days with heavy snowfall (5 cm) was 1.34 [1.00, 1.80], but the effect was larger on warmer days, possibly due to heavier snow. We hypothesize that shoveling wet snow and travelling in slushy conditions may be important mechanisms underlying the link between snowfall and MI mortality.

Kamila Romanowski Tuberculosis (TB) is the leading cause of death from a single infectious agent worldwide. The World Health Organization estimates that, in 2017, 1.6 million deaths were due to TB. These TB-associated mortality estimates reflect the number of people with TB who die before starting, or during, TB treatment. Accumulating research, however, suggests that mortality post-TB treatment is high, but this data has not been comprehensively assessed. We conducted a systematic review and meta-analysis to estimate the post-treatment mortality among TB survivors, and examine differences in mortality risk by demographic and clinical characteristics.

Sydney Schwartz, Martin Cheung, Navdeep Chahil, Muhammad Morshed The Parasitology Public Health Laboratory was experiencing Plasmodium falciparum contamination issues with an in-house Malaria PCR assay therefore an investigation was deployed to find the source of the contamination. This investigation provides an insight to the work process around contamination troubleshooting and may be useful to PCR-centric laboratories.

TEAM: Tina Cheng, Mariana Brussoni, Christina Han, Fritha Munday, Megan Zeni Transmission of COVID is less likely outdoors and play outdoors is crucial for children’s healthy development. We conducted focus groups to examine early childhood educators’ challenges in promoting children’s outdoor play. Challenges ranged from individual-level concerns (e.g.,knowledge and skills), interpersonal and organizational concerns (e.g.,lack of shared understanding with parents and colleagues), and communal and societal concerns (e.g. societal impression of unstructured outdoor play and the associated risks). We present evidence-based strategies for change.

TEAM: Shelina Babul, Kate Turcotte, Samantha Bruin, Karen Sadler, Denise Beaton, Shazya Karmali Concussion is gaining wide recognition as a serious health issue. CATT is expanding to meet concussion education and resource needs of diverse audiences, including medical professions (pediatricians, physiotherapists, occupational therapists), parents, teachers, high performance athletes, workers and their workplaces, and those working with the survivors of intimate partner violence. Tailored eLearning modules are available along with Return to Sport, School, Work and Activity strategies. CATT has been piloted in Uganda to assess the effectiveness of eLearning to educate health professionals, coaches, and sport managers on the recognition and management of concussion in East Africa.

Kate McLeod, Jane A. Buxton, Ehsan Karim, Ruth Elwood Martin, Amanda Slaunwhite In the weeks after release from prison, people are at a greatly increased risk of non-fatal and fatal overdose. Disruptions in healthcare are common during this transition from prison to community. We are completing a retrospective cohort study in the Provincial Overdose Cohort to examine the relationship between use of outpatient healthcare services in the 30 days following release from provincial prison and risk of overdose in this same time period.

TEAM: Jimmy Liu, William Hsiao Over the course of long evolutionary histories, existing pathogens have adapted to various niches, establishing stable subpopulations that are dessimated globally. The designation of these subpopulations or subtyping is critical for risk assessments and longitudinal surveillance. To date, serotyping remains as the main method for Salmonella subtyping; however, it offers low discriminatory power due to the limited targets of comparison. We compared ~180,000 Salmonella whole genome sequences from 157 countries to differentiate Salmonella subtypes at a higher resolution. We described additional pitfalls of serotyping by revealing the discorrelation between antigenic and core genome variation.

TEAM: Alice X.T. Xu, Ihoghosa Iyamu, Oralia Gómez-Ramírez, Hsiu-Ju Chang, Mark Gilbert Despite the rapid development and implementation of digital health interventions in the last two decades, the scope and applications of digital technologies in public health is not well delineated. We conducted a scoping review aimed to determine how the scope of digital public health is described by public health researchers and practitioners within published and grey literature. A total of 211 articles were selected for in-depth analysis. Findings from this review on the intersection between public health domains and digital health technologies will inform the development of a conceptual framework of digital public health to inform future practice and research direction in the field.

A total of 207 SHINE mothers contributed 354 whole metagenome sequencing datasets (187 during pregnancy). The maternal microbiome did not appear to differ in pregnancy, by HIV-status, or SHINE WASH assignment. Abundance of resistant starch degrading bacteria was important in predicting infant birth weight, and to a lesser extent neonatal growth. Pathogen carriage was low. Capacity for environmental sensing, energy metabolism and vitamin B metabolism were important predictors of increased infant birth weight and neonatal growth; while bacterial functions related to biofilm formation, in response to nutrient restriction, predicted low birth weight. The pregnancy microbiome in rural Zimbabwe is characterized by diet-dependent resistant starch degrading members, which play a role in fetal growth. TEAM: Ethan K. Gough, Thaddeus J. Edens, Hyun Min Geum, Iman Baharmand, Sandeep K. Gill, Ruairi Robertson, Kuda Mutasa, Robert Ntozini, Bernard Chasekwa, Florence D. Majo, Naume V. Tavengwa, Batsirai Mutasa, Freddy Francis, Lynnea Carr, Laura E. Smith, Rebecca Stoltzfus, Lawrence H. Moulton, Andrew J. Prendergast, Jean H. Humphrey,Amee R. Manges and the SHINE Trial Team

TEAM: Max Xie, Drona Rasali, Caren Rose and Crystal Li The occurrence of chronic disease comorbidities in adults results in worse health outcomes, complex clinical management and higher health care costs. We analyzed the occurrence of comorbidities among a diabetes incident cohort of individuals aged =20 years in 2000/01 from BC’s Chronic Disease Registry, and followed them for 15 years to visualize the occurrence patterns of comorbidities. There were 19,884 (0.64%) individuals who were diagnosed with diabetes meeting its case definition in that fiscal year amongst those =20 years of age in the BC population. Heat maps showed that the development of 17 selected chronic conditions varied by age and sex post diagnosis. The most common chronic conditions occurring as a comorbidity were Hypertension, Ischemic Heart Disease and Osteoarthritis.

Emergency department (ED) buprenorphine may prevent overdose. Microdosing is a novel method not requiring withdrawal, a barrier to standard inductions. We aimed to evaluate the feasibility of an ED buprenorphine program providing standard dosing and microdosing take-home packages, and of randomizing to these interventions. We screened ED patients for opioid use disorder and provided 21 standard dosing and 25 microdosing packages. At least 24% (standard dosing) and 32% (microdosing) remained on opioid agonist therapy at 30 days. We conclude that ED standard dosing and microdosing buprenorphine programs are feasible, and a randomized controlled trial would be acceptable to our population.

TEAM Aaron Liu, Inna Sekirov, Danuta Skowronski, Jun Duan, Muhammad Morshed, Natalie Prystajecky, William Hsiao, Soren Gantt, Agatha Jassem Immunological imprinting by the first coronavirus (CoV) infection in childhood may explain the observed differences in COVID-19 severity. By this “original antigenic sin” hypothesis, infection or vaccination with SARS-CoV-2 may preferentially back-boost antibodies to the original infecting CoV to the detriment of SARS-CoV-2 immune response. We are validating two complementary methods for the comprehensive detection of CoV antibodies: a peptide array called VirScan-CoV and a protein-based immunoassay by Meso Scale Discovery. We will characterize SARS-CoV-2 and other CoV antibody profiles and link to COVID-19 outcomes using established cohorts.

TEAM Ran D. Goldman, Tyler D. Yan, Shashidhar R. Marneni Michelle Seiler, Cristina Parra: Cotanda, Julie C. Brown, Eileen J. Klein, Julia Hoeffe, Renana Gelernter, Jeanine E. Hall, Adrienne L. Davis, Mark A. Griffiths, Ahmed Mater, Sergio Manzano, Gianluca Gualco, Naoki Sh :imizu, Thomas L. Hurt, Sara Ahmed, Matt Hansen, David Sheridan, Samina Ali, Graham C. Thompson, Nathalie Gaucher, Georg Staubli The uptake of a COVID-19 vaccine among children will be instrumental in limiting the spread of the disease. Some vaccine candidates have gained fast-track status for regulatory approval, with the first Phase 3 trials beginning in July 2020. We conducted an international survey of caregivers arriving with their children to pediatric emergency departments across six countries in the midst of the pandemic and found that less than half are willing to accept abbreviated COVID-19 vaccine testing, though 65% intent to vaccinate their children. We identified certain child and caregiver factors as associated predictors and qualitatively evaluated commonly reported reasons for acceptance and refusal.

Gina Ogilvie & Manish Sadarangani COVID-19 RESPPONSE Survey Team: Lori Brotto, Angela Kaida, Liisa Galea, Arianne Albert, Laurie Smith, Amy Booth, Shanlea Gordon; BC Teachers’ Immunization Survey Team: C. Sarai Racey, Robine Donken, Imogen Porter, Julie Bettinger, Meena Dawar, Mike Gagel, Rakel Kling, Silvina Mema, Issy Aguiar, Ian Roe, Hana Mijovic To support COVID-19 vaccine implementation, we administered cross-sectional surveys to (i) a representative sample of the BC population and (ii) public and independent school teachers to explore intentions to receive COVID-19 vaccines. Of the 3,425 BC population respondents, 79.7% of respondents reported they were likely/very likely to receive the vaccine. 89.1% reported that the BC PHO’s recommendations were important to follow – the highest among potential influencers. 69.9% reported they intend to receive the flu vaccine in the fall, compared to 38% who said they received the flu vaccine in 2017-18. Teachers’ intentions to be vaccinated against COVID-19 were high: 89.6% of the 5,089 BC teachers reported they were likely/very likely to receive the vaccine, which may help with transmission control in schools.

TEAM: Chloé Xavier, Margot Kuo, Roshni Desai, Gemma Regan, Bin Zhao, Wen Qi Gan, Amanda K. Slaunwhite Case reports, community members, and media sources are increasingly identifying brain injury (BI) among people who had a drug-related overdose as a significant health issue with major implications for health and long-term care provision. The aim of this study was to examine the association between BI and illicit drug-related overdoses in BC between January 1, 2015 and December 31, 2017. This study is the first to estimate the prevalence ratio of BI among people who have had an overdose in a population based sample. Our findings demonstrate a significant association between BI and overdose, after adjusting for sex, age, mental illness and substance use disorder iagnoses, and income. This association highlights the potential devastating effect of the toxic drug supply on severe hypoxic and anoxic overdose events.