Social and structural barriers and facilitators to HIV healthcare and harm reduction services for people experiencing syndemics in Manitoba: study protocol.

INTRODUCTION: In Manitoba, Canada, there has been an increase in the number of people newly diagnosed with HIV and those not returning for regular HIV care. The COVID-19 pandemic resulted in increased sex and gender disparities in disease risk and mortalities, decreased harm reduction services and reduced access to healthcare. These health crises intersect with increased drug use and drug poisoning deaths, houselessness and other structural and social factors most acutely among historically underserved groups. We aim to explore the social and structural barriers and facilitators to HIV care and harm reduction services experienced by people living with HIV (PLHIV) in Manitoba. METHODS AND ANALYSIS: Our study draws on participatory action research design. Guiding the methodological design are the lived experiences of PLHIV. In-depth semi-structured face-to-face interviews and quantitative questionnaires will be conducted with two groups: (1) persons aged ≥18 years living or newly diagnosed with HIV and (2) service providers who work with PLHIV. Data collection will include sex, gender, sociodemographic information, income and housing, experiences with the criminal justice system, sexual practices, substance use practices and harm reduction access, experiences with violence and support, HIV care journey (since diagnosis until present), childhood trauma and a decision-making questionnaire. Data will be analysed intersectionally, employing grounded theory for thematic analysis, sex-based and gender-based analysis and social determinants of health and syndemic framework to understand the experiences of PLHIV in Manitoba. ETHICS AND DISSEMINATION: We received approval from the University of Manitoba Health Ethics Research Board (HS25572; H2022:218), First Nations Health and Social Secretariat of Manitoba, Nine Circles Community Health Centre, Shared Health Manitoba (SH2022:194) and 7th Street Health Access Centre. Findings will be disseminated using community-focused knowledge translation strategies identified by participants, peers, community members and organisations, and reported in conferences, peer-reviewed journals and a website (www.alltogether4ideas.org).

Saying it out loud: explicit equity prompts for public health organization resilience.

Introduction: In the early days of the COVID-19 pandemic there were numerous stories of health equity work being put "on hold" as public health staff were deployed to the many urgent tasks of responding to the emergency. Losing track of health equity work is not new and relates in part to the need to transfer tacit knowledge to explicit articulation of an organization's commitment to health equity, by encoding the commitment and making it visible and sustainable in policy documents, protocols and processes. Methods: We adopted a Theory of Change framework to develop training for public health personnel to articulate where and how health equity is or can be embedded in their emergency preparedness processes and documents. Results: Over four sessions, participants reviewed how well their understanding of disadvantaged populations were represented in emergency preparedness, response and mitigation protocols. Using equity prompts, participants developed a heat map depicting where more work was needed to explicitly involve community partners in a sustained manner. Participants were challenged at times by questions of scope and authority, but it became clear that the explicit health equity prompts facilitated conversations that moved beyond the idea of health equity to something that could be codified and later measured. Over four sessions, participants reviewed how well their understanding of disadvantaged populations were represented in emergency preparedness, response and mitigation protocols. Using equity prompts, participants developed a heat map depicting where more work was needed to explicitly involve community partners in a sustained manner. Participants were challenged at times by questions of scope and authority, but it became clear that the explicit health equity prompts facilitated conversations that moved beyond the idea of health equity to something that could be codified and later measured. Discussion: Using the indicators and prompts enabled the leadership and staff to articulate what they do and do not know about their community partners, including how to sustain their involvement, and where there was need for action. Saying out loud where there is - and is not - sustained commitment to achieving health equity can help public health organizations move from theory to true preparedness and resilience.

Impact of non-pharmaceutical interventions and vaccination on COVID-19 outbreaks in Nunavut, Canada: a Canadian Immunization Research Network (CIRN) study.

BACKGROUND: Nunavut, the northernmost Arctic territory of Canada, experienced three community outbreaks of the coronavirus disease 2019 (COVID-19) from early November 2020 to mid-June 2021. We sought to investigate how non-pharmaceutical interventions (NPIs) and vaccination affected the course of these outbreaks. METHODS: We used an agent-based model of disease transmission to simulate COVID-19 outbreaks in Nunavut. The model encapsulated demographics and household structure of the population, the effect of NPIs, and daily number of vaccine doses administered. We fitted the model to inferred, back-calculated infections from incidence data reported from October 2020 to June 2021. We then compared the fit of the scenario based on case count data with several counterfactual scenarios without the effect of NPIs, without vaccination, and with a hypothetical accelerated vaccination program whereby 98% of the vaccine supply was administered to eligible individuals. RESULTS: We found that, without a territory-wide lockdown during the first COVID-19 outbreak in November 2020, the peak of infections would have been 4.7 times higher with a total of 5,404 (95% CrI: 5,015-5,798) infections before the start of vaccination on January 6, 2021. Without effective NPIs, we estimated a total of 4,290 (95% CrI: 3,880-4,708) infections during the second outbreak under the pace of vaccination administered in Nunavut. In a hypothetical accelerated vaccine rollout, the total infections during the second Nunavut outbreak would have been 58% lower, to 1,812 (95% CrI: 1,593-2,039) infections. Vaccination was estimated to have the largest impact during the outbreak in April 2021, averting 15,196 (95% CrI: 14,798-15,591) infections if the disease had spread through Nunavut communities. Accelerated vaccination would have further reduced the total infections to 243 (95% CrI: 222-265) even in the absence of NPIs. CONCLUSIONS: NPIs have been essential in mitigating pandemic outbreaks in this large, geographically distanced and remote territory. While vaccination has the greatest impact to prevent infection and severe outcomes, public health implementation of NPIs play an essential role in the short term before attaining high levels of immunity in the population.

Integrated surveillance of antimicrobial resistance and antimicrobial use: Evaluation of the status in Canada (2014-2019).

OBJECTIVE: Integrated surveillance of antimicrobial resistance (AMR) and antimicrobial use (AMU) across One Health sectors is critically important for effective, evidence-based policy, stewardship, and control of AMR. Our objective was to evaluate progress towards achieving comprehensive, integrated AMR/AMU surveillance in Canada. MATERIALS AND METHODS: Based on an environmental scan, interviews of subject matter experts, and reports from the 2014 National Collaborating Centre for Infectious Diseases and the 2016 Canadian Council of Chief Veterinary Officers, we identified 8 core surveillance requirements and their specific components; the latter were assessed using a 2-way classification matrix, with 7 common elements ranked according to development stage. RESULTS: Components that mapped to requirements of a comprehensive, fully integrated AMR/AMU surveillance system were mostly in the lowest stages of development (Exploration or Program Adoption). However, both the establishment of the Canadian AMR Surveillance System integrated reporting and expansion of existing components under the Canadian Nosocomial Infection Surveillance Program and the Canadian Integrated Program for AMR Surveillance are improvements. Regardless, obvious gaps in Canadian AMR/AMU surveillance prevent this from being a comprehensive and integrated One Health program. CONCLUSION: Action is needed in 3 crucial areas: i) development of a complete, integrated AMR/AMU surveillance program, based on current success; ii) changes in Federal/Provincial/Territorial policies to require standardized AMR/AMU reporting; and iii) more resources for AMR/AMU surveillance (dedicated persons, funding, and enabling structures and policy). There is an urgent need for prioritization by Federal/Provincial/Territorial governments to address governance, leadership, and funding to create surveillance systems that inform stewardship and policy.

OBJECTIF: La surveillance intégrée de la résistance aux antimicrobiens (RAM) et de l'utilisation des antimicrobiens (UAM) dans les secteurs Une seule santé est d'une importance cruciale pour une politique, une gestion et une maitrise efficaces et fondées sur des preuves de la résistance aux antimicrobiens. Notre objectif était d'évaluer les progrès vers la réalisation d'une surveillance complète et intégrée de la RAM/UAM au Canada. MÉTHODES: Sur la base d'une analyse de l'environnement, d'entrevues d'experts en la matière et de rapports du Centre de collaboration nationale des maladies infectieuses de 2014 et du Conseil canadien des chefs vétérinaires de 2016, nous avons identifié huit exigences de surveillance de base et leurs composantes spécifiques ; ces derniers ont été évalués à l'aide d'une matrice de classification à deux voies, avec sept éléments communs classés selon le stade de développement. RÉSULTATS: Les composants correspondant aux exigences d'un système de surveillance de la RAM/UAM complet et entièrement intégré en étaient pour la plupart aux stades les plus bas de développement (Exploration ou Adoption de programme). Cependant, l'établissement du Système canadien de surveillance de la RAM et l'expansion des éléments existants dans le cadre du Programme canadien de surveillance des infections nosocomiales et du Programme intégré canadien de surveillance de la RAM constituent des améliorations. Quoi qu'il en soit, des lacunes évidentes dans la surveillance canadienne de la RAM/UAM l'empêchent d'être un programme Une seule santé complet et intégré. CONCLUSION: Des actions sont nécessaires dans trois domaines cruciaux : 1) le développement d'un programme de surveillance complet et intégré de la RAM/AMU, basé sur le succès actuel; 2) des changements aux politiques fédéralesprovinciales-territoriales pour exiger des rapports normalisés sur la RAM/UAM; et 3) davantage de ressources pour la surveillance de la RAM/UAM (personnes dédiées, financement, structures et politiques habilitantes). Il est urgent que les gouvernements fédéral-provincial-territorial établissent des priorités pour aborder la gouvernance, le leadership et le financement afin de créer des systèmes de surveillance qui éclairent la gouvernance et les politiques.(Traduit par Dr Serge Messier).

Integrated surveillance of antimicrobial resistance and antimicrobial use: Evaluation of the status in Canada (2014-2019).

OBJECTIVE: Integrated surveillance of antimicrobial resistance (AMR) and antimicrobial use (AMU) across One Health sectors is critically important for effective, evidence-based policy, stewardship, and control of AMR. Our objective was to evaluate progress towards achieving comprehensive, integrated AMR/AMU surveillance in Canada. MATERIALS AND METHODS: Based on an environmental scan, interviews of subject matter experts, and reports from the 2014 National Collaborating Centre for Infectious Diseases and the 2016 Canadian Council of Chief Veterinary Officers, we identified 8 core surveillance requirements and their specific components; the latter were assessed using a 2-way classification matrix, with 7 common elements ranked according to development stage. RESULTS: Components that mapped to requirements of a comprehensive, fully integrated AMR/AMU surveillance system were mostly in the lowest stages of development (Exploration or Program Adoption). However, both the establishment of the Canadian AMR Surveillance System integrated reporting and expansion of existing components under the Canadian Nosocomial Infection Surveillance Program and the Canadian Integrated Program for AMR Surveillance are improvements. Regardless, obvious gaps in Canadian AMR/AMU surveillance prevent this from being a comprehensive and integrated One Health program. CONCLUSION: Action is needed in 3 crucial areas: i) development of a complete, integrated AMR/AMU surveillance program, based on current success; ii) changes in Federal/Provincial/Territorial policies to require standardized AMR/AMU reporting; and iii) more resources for AMR/AMU surveillance (dedicated persons, funding, and enabling structures and policy). There is an urgent need for prioritization by Federal/Provincial/Territorial governments to address governance, leadership, and funding to create surveillance systems that inform stewardship and policy.

RéSUMé: OBJECTIF: La surveillance intégrée de la résistance aux antimicrobiens (RAM) et de l'utilisation des antimicrobiens (UAM) dans les secteurs Une seule santé est d'une importance cruciale pour une politique, une gestion et une maitrise efficaces et fondées sur des preuves de la résistance aux antimicrobiens. Notre objectif était d'évaluer les progrès vers la réalisation d'une surveillance complète et intégrée de la RAM/UAM au Canada. MéTHODES: Sur la base d'une analyse de l'environnement, d'entrevues d'experts en la matière et de rapports du Centre de collaboration nationale des maladies infectieuses de 2014 et du Conseil canadien des chefs vétérinaires de 2016, nous avons identifié huit exigences de surveillance de base et leurs composantes spécifiques; ces derniers ont été évalués à l'aide d'une matrice de classification à deux voies, avec sept éléments communs classés selon le stade de développement. RéSULTATS: Les composants correspondant aux exigences d'un système de surveillance de la RAM/UAM complet et entièrement intégré en étaient pour la plupart aux stades les plus bas de développement (Exploration ou Adoption de programme). Cependant, l'établissement du Système canadien de surveillance de la RAM et l'expansion des éléments existants dans le cadre du Programme canadien de surveillance des infections nosocomiales et du Programme intégré canadien de surveillance de la RAM constituent des améliorations. Quoi qu'il en soit, des lacunes évidentes dans la surveillance canadienne de la RAM/UAM l'empêchent d'être un programme Une seule santé complet et intégré. CONCLUSION: Des actions sont nécessaires dans trois domaines cruciaux : 1) le développement d'un programme de surveillance complet et intégré de la RAM/AMU, basé sur le succès actuel; 2) des changements aux politiques fédérales/provinciales/territoriales pour exiger des rapports normalisés sur la RAM/UAM; et 3) davantage de ressources pour la surveillance de la RAM/UAM (personnes dédiées, financement, structures et politiques habilitantes). Il est urgent que les gouvernements fédéral/provincial/territorial établissent des priorités pour aborder la gouvernance, le leadership et le financement afin de créer des systèmes de surveillance qui éclairent la gouvernance et les politiques.

Introduction of short course treatment for latent tuberculosis infection at a primary care facility for refugees in Winnipeg, Canada: A mixed methods evaluation.

Background: The World Health Organization (WHO) End TB strategy document 'Toward tuberculosis elimination: an action framework for low incidence countries'-like Canada- identifies screening and treatment of latent tuberculosis infection (LTBI) for groups at increased risk for TB disease as a priority, including newcomers from endemic countries. In 2015, the clients-centered model offered at a primary care facility for refugees, BridgeCare Clinic, Winnipeg, Canada was evaluated. The model included LTBI screening, assessment, and treatment, and originally offered 9-months of isoniazid as treatment. This mixed methods evaluation investigates LTBI program outcomes since the introduction of two short-course treatment regimens: 4-months of rifampin, and 3-months of isoniazid and rifapentine. Methods: This study combined a retrospective analysis of program administrative data with structured interviews of clinic staff. We included LTBI treatment eligibility, the treatment regimen offered, treatment initiation, and completed treatment from January 1, 2015 to August 6, 2020. Results: Seven hundred and one people were screened, and infection rates varied from 34.1% in 2015 to 53.3% in 2020. Most people living with LTBI came from high TB burden countries in Africa and South-East Asia WHO regions and were younger than 45 years old. Treatment eligibility increased 9% (75% in 2015 to 86% in 2016-2020) and most people diagnosed with LTBI took the short course treatments offered. There was an increase of 14.5% in treatment initiation (75.6 vs. 90.1%), and an increase of 8% in treatment completion (82.4 vs. 90.4%) after short-course regimens were introduced. The final model showed that the treatment regimen tends to affect the frequency of treatment completion, but there are other factors that influence this outcome, in this population. With the new treatments, BridgeCare Clinic achieved the 90% of treatment coverage, and the 90% treatment completion rate targets recommended in the End TB Strategy. Qualitative interviews with clinic staff further affirm the higher acceptability of the new treatments. Conclusion: While these results are limited to government-sponsored refugees in Winnipeg, they highlight the acceptability and value of short-course LTBI treatment as a possibility for reaching End TB targets in primary care settings.

Slipping through: mobility's influence on infectious disease risks for justice-involved women in Canada.

BACKGROUND: The relationship between incarceration and women's vulnerability to sexually transmitted and blood-borne infections (STBBI) is understudied in Canada, despite numerous studies showing that justice-involved women experience very high rates of infection. Justice-involved women in Canada are highly mobile, as a result of high rates of incarceration and extremely short sentences. From a public health perspective, it is productive to understand how the mobility of justice-involved women shapes their vulnerability to STBBI. RESULTS: This narrative review demonstrates that mobility between incarceration facilities and communities drives sexually transmitted and blood-borne disease risk for justice-involved women in Canada. Associations and interactions between epidemics of gender-based and intimate partner violence, substance use, and STBBIs shape the experiences of justice-involved women in Canada. In correctional facilities, the pre-existing vulnerability of justice-involved women is compounded by a lack of comprehensive STBBI care and limited harm reduction services. On release, unstable housing, disruptions to social support networks, interruptions in medical care, and relapse to or continuation of substance use, significantly increase individual disease risk and the likelihood of community transmission. High rates of incarceration for short periods perpetuate this cycle and complicate the delivery of healthcare. CONCLUSIONS: The review provides evidence of the need for stronger gender-transformative public health planning and responses for incarcerated women, in both federal and provincial corrections settings in Canada. A supportive, evidence-based approach to STBBI identification and treatment for incarcerated women - one that that removes stigma, maintains privacy and improves access, combined with structural policies to prevent incarceration - could decrease STBBI incidence and interrupt the cycle of incarceration and poor health outcomes. A coordinated and accountable program of reintegration that facilitates continuity of public health interventions for STBBI, as well as safe housing, harm reduction and other supports, can improve outcomes as well. Lastly, metrics to measure performance of STBBI management during incarceration and upon release would help to identify gaps and improve outcomes for justice-involved women in the Canadian context.

One Health Evaluation of Antimicrobial Use and Resistance Surveillance: A Novel Tool for Evaluating Integrated, One Health Antimicrobial Resistance and Antimicrobial Use Surveillance Programs.

We describe the development, application and utility of our novel, One Health Evaluation of Antimicrobial Use and Resistance Surveillance (OHE-AMURS) tool that we created to evaluate progress toward integrated, One Health surveillance of antimicrobial resistance (AMR) and antimicrobial use (AMU) as a complex system in Canada. We conducted a qualitative inquiry into the current state of policy and programs for integrated AMR/AMU surveillance using explicit and tacit knowledge. To assess the "messy" state of public health surveillance program development, we synthesized recommendations from previous reports by the National Collaborating Centre for Infectious Diseases and the Canadian Council of Chief Veterinary Officers; conducted an environmental scan to find all federal, provincial, and territorial AMR/AMU surveillance programs in Canada; and conducted semi-structured interviews with Canadian subject matter experts. To integrate evidence from these different sources we adapted two published tools to create a new evaluation matrix, deriving 36 components of the ideal integrated AMR/AMU surveillance system. Our two-way matrix tool allowed us to examine seven common, foundational elements of sustainable programs for each component, and assign a stage of development/sustainability ranking for each component according to the matrix definitions. Our adaptable novel tool allowed for granular and repeatable assessment of the many components of a complex surveillance system. The assessment proved robust and exacting to ensure transparency in our methods and results. The matrix allows flexible assignment of program components based on program principles, and stages can be adapted to evaluate any aspect of an AMR/AMU surveillance or other multi-faceted, multi-jurisdictional system. Future refinement should include an assessment of the scope of surveillance components.

Knowledge brokering on infectious diseases for public health.

The National Collaborating Centres (NCCs) for Public Health (NCCPH) were established in 2005 as part of the federal government's commitment to renew and strengthen public health following the severe acute respiratory syndrome (SARS) epidemic. They were set up to support knowledge translation for more timely use of scientific research and other knowledges in public health practice, programs and policies in Canada. Six centres comprise the NCCPH, including the National Collaborating Centre for Infectious Diseases (NCCID). The NCCID works with public health practitioners to find, understand and use research and evidence on infectious diseases and related determinants of health. The NCCID has a mandate to forge connections between those who generate and those who use infectious diseases knowledge. As the first article in a series on the NCCPH, we describe our role in knowledge brokering and the numerous methods and products that we have developed. In addition, we illustrate how NCCID has been able to work with public health to generate and share knowledge during the coronavirus disease 2019 (COVID-19) pandemic.

Changes in the incidence of seasonal influenza in response to COVID-19 social distancing measures: an observational study based on Canada's national influenza surveillance system.

OBJECTIVES: Seasonal influenza is an acute respiratory infection that presents a significant annual burden to Canadians and the Canadian healthcare system. Social distancing measures that were implemented to control the 2019-2020 novel coronavirus outbreak were investigated for their ability to lessen the incident cases of seasonal influenza. METHODS: We conducted an ecological study using data from Canada's national influenza surveillance system to investigate whether social distancing measures to control COVID-19 reduced the incident cases of seasonal influenza. Data taken from three separate time frames facilitated analysis of the 2019-2020 influenza season prior to, during, and following the implementation of COVID-19-related measures and enabled comparisons with the same time periods during three preceding flu seasons. The incidence, which referred to the number of laboratory-confirmed cases of specific influenza strains, was of primary focus. Further analysis determined the number of new laboratory-confirmed influenza or influenza-like illness outbreaks. RESULTS: Our results indicate a premature end to the 2019-2020 influenza season, with significantly fewer cases and outbreaks being recorded following the enactment of many COVID-19 social distancing policies. The incidence of influenza strains A (H3N2), A (unsubtyped), and B were all significantly lower at the tail end of the 2019-2020 influenza season as compared with preceding seasons (p = 0.0003, p = 0.0007, p = 0.0019). CONCLUSION: Specific social distancing measures and behaviours may serve as effective tools to limit the spread of influenza transmission moving forward, as they become more familiar.

RéSUMé: OBJECTIFS: La grippe saisonnière est une infection aiguë des voies respiratoires qui représente un important fardeau annuel pour la population et pour le système de soins de santé du Canada. Nous avons cherché à déterminer si les mesures de distanciation sociale appliquées pour contrôler l'éclosion du nouveau coronavirus en 2019­2020 ont pu atténuer les cas incidents de grippe saisonnière. MéTHODES: Nous avons mené une étude écologique à l'aide des données du système national de surveillance de l'activité grippale au Canada pour déterminer si les mesures de distanciation sociale appliquées pour contrôler la COVID-19 ont réduit les cas incidents de grippe saisonnière. Des données provenant de trois périodes distinctes ont facilité l'analyse de la saison grippale 2019­2020 avant, pendant et après l'application des mesures liées à la COVID-19 et permis des comparaisons avec les mêmes intervalles durant trois saisons grippales antérieures. L'incidence, c'est-à-dire le nombre de cas confirmés en laboratoire de souches grippales particulières, était notre principal objectif. Des analyses plus poussées ont permis de déterminer le nombre de nouvelles éclosions de syndrome grippal ou de grippe confirmée en laboratoire. RéSULTATS: Selon nos résultats, la saison grippale 2019­2020 a connu une fin prématurée; un nombre sensiblement moins élevé de cas et d'éclosions ont été enregistrés après la mise en place des nombreuses politiques de distanciation sociale liées à la COVID-19. L'incidence des souches grippales A (H3N2), A (non sous-typée) et B a été sensiblement moins élevée vers la fin de la saison grippale 2019­2020 comparativement aux saisons précédentes (p = 0,0003, p = 0,0007, p = 0,0019). CONCLUSION: Des mesures et des comportements de distanciation sociale particuliers peuvent être des outils efficaces pour limiter la propagation de la grippe maintenant qu'ils sont plus familiers.

Ten years of Pan-InfORM: modelling research for public health in Canada.

Modelling and simulation methods can play an important role in guiding public health responses to infectious diseases and emerging health threats by projecting the plausible outcomes of decisions and interventions. The 2003 SARS epidemic marked a new chapter in disease modelling in Canada as it triggered a national discussion on the utility and uptake of modelling research in local and pandemic outbreaks. However, integration and application of model-based outcomes in public health requires knowledge translation and contextualization. We reviewed the history and performance of Pan-InfORM (Pandemic Influenza Outbreak Research Modelling), which created a national infrastructure in Canada with a mandate to develop innovative knowledge translation methodologies to inform policy makers through modelling frameworks that bridge the gaps between theory, policy, and practice. This review demonstrates the importance of a collaborative infrastructure as a "Community of Practice" to guide public health responses, especially in the context of emerging diseases with substantial uncertainty, such as the COVID-19 pandemic. Dedicated resources to modelling and knowledge translation activities can help create synergistic strategies at the global scale and optimize public health responses to protect at-risk populations and quell socioeconomic and health burden.

Nimble, efficient and evolving: the rapid response of the National Collaborating Centres to COVID-19 in Canada. / Agiles, efficients et en évolution : la réponse rapide des Centres de collaboration nationale à la COVID-19 au Canada.

Since December 2019, there has been a global explosion of research on COVID-19. In Canada, the six National Collaborating Centres (NCCs) for Public Health form one of the central pillars supporting evidence-informed decision making by gathering, synthesizing and translating emerging findings. Funded by the Public Health Agency of Canada and located across Canada, the six NCCs promote and support the use of scientific research and other knowledges to strengthen public health practice, programs and policies. This paper offers an overview of the NCCs as an example of public health knowledge mobilization in Canada and showcases the NCCs' contribution to the COVID-19 response while reflecting on the numerous challenges encountered.

The explosion of research on COVID-19 in Canada and around the world called for an improved capacity to support evidence-informed decision making (EIDM). Canada is fostering various mechanisms to achieve this goal; the National Collaborating Centres (NCCs) for Public Health are central to supporting EIDM during the pandemic. The NCCs, a network of networks anchored on six unique knowledge hubs, are well connected to provincial, territorial, local and international partners. In response to COVID-19, the NCCs are making an important contribution to building knowledge, skills and capacity in the public health sector, and to supporting public health professionals in synthesizing and using evidence-informed knowledge in policy and practice.

L'explosion de la recherche menée sur la COVID-19 au Canada et ailleurs dans le monde a nécessité une augmentation de la capacité à soutenir la prise de décisions informées par les données probantes. Parmi les divers mécanismes préconisés par le Canada pour atteindre cet objectif, les Centres de collaboration nationale (CCN) en santé publique jouent un rôle essentiel pendant la pandémie pour soutenir la prise de décisions informées par les données probantes. Les CCN, qui constituent un réseau de réseaux s'appuyant sur six centres de connaissances, ont des liens étroits avec plusieurs partenaires provinciaux, territoriaux, locaux et internationaux. Pour lutter contre la COVID-19, les CCN renforcent de façon significative les connaissances, les compétences et les capacités en santé publique et soutiennent les professionnels en santé publique en synthétisant des connaissances fondées sur des données probantes pour leur intégration aux politiques et aux pratiques.

Simulating the effect of school closure during COVID-19 outbreaks in Ontario, Canada.

BACKGROUND: The province of Ontario, Canada, has instituted indefinite school closures (SC) as well as other social distancing measures to mitigate the impact of the novel coronavirus disease 2019 (COVID-19) pandemic. We sought to evaluate the effect of SC on reducing attack rate and the need for critical care during COVID-19 outbreaks, while considering scenarios with concurrent implementation of self-isolation (SI) of symptomatic cases. METHODS: We developed an age-structured agent-based simulation model and parameterized it with the demographics of Ontario stratified by age and the latest estimates of COVID-19 epidemiologic characteristics. Disease transmission was simulated within and between different age groups by considering inter- and intra-group contact patterns. The effect of SC of varying durations on the overall attack rate, magnitude and peak time of the outbreak, and requirement for intensive care unit (ICU) admission in the population was estimated. Secondly, the effect of concurrent community-based voluntary SI of symptomatic COVID-19 cases was assessed. RESULTS: SC reduced attack rates in the range of 7.2-12.7% when the duration of SC increased from 3 to 16 weeks, when contacts among school children were restricted by 60-80%, and in the absence of SI by mildly symptomatic persons. Depending on the scenario, the overall reduction in ICU admissions attributed to SC throughout the outbreak ranged from 3.3 to 6.7%. When SI of mildly symptomatic persons was included and practiced by 20%, the reduction of attack rate and ICU admissions exceeded 6.3% and 9.1% (on average), respectively, in the corresponding scenarios. CONCLUSION: Our results indicate that SC may have limited impact on reducing the burden of COVID-19 without measures to interrupt the chain of transmission during both pre-symptomatic and symptomatic stages. While highlighting the importance of SI, our findings indicate the need for better understanding of the epidemiologic characteristics of emerging diseases on the effectiveness of social distancing measures.

Review of Evidence for Using Chest X-Rays for Active Tuberculosis Screening in Long-Term Care in Canada.

Background: People living in long-term care facilities (LTCF) are at high risk to develop active tuberculosis primarily as a result of reactivation of a latent TB infection, or endemic transmission between residents. Current national guidelines in Canada are to use a posterior-anterior and lateral chest X-ray to screen for TB for those over 65 years old, upon admission to a LTCF. Objective: To assess the available evidence for cost benefits of universal chest X-ray screening for new LTCF residents. Methodology: We conducted a search for all articles published until September 2018, in PubMed and WorlCat databases, in English, using a combination of key words: chest X-ray, chest radiography or CXR, long-term care, elderly, screening, and tuberculosis. We also reviewed publicly available guidelines for screening new residents to LTCF from across Canada. We report on a qualitative synthesis of the evidence in the documents retrieved. Results: The final review yielded four cost-effectiveness studies (2 of 4 conducted in countries with low incidence), one systematic review, one recommendation/editorial, and one cohort study. We found that in a tuberculosis low-incidence country the CXR cost per identified case was $672,298 CAD. Enacting a more targeted screening program, perhaps one that tests only those who previously had TB, or other high-risk medical conditions may enhance the cost-effectiveness. Recommendations: We suggest reviewing the screening policy for active TB in people entering LTCF, which is based on a CXR. The results indicate that a targeted search for active TB in people with symptoms or other high-risk medical conditions may be more cost-effective.

Delivering Midwifery: A Scoping Review of Employment Models in Canada.

The majority of Canadian Provinces have regulated and publicly funded midwifery. No comprehensive review has summarized and compared the various types of employment models, practice organizations, and compensation for midwives across Canada. The aim of this scoping review was to gain an understanding of evidence related to funding models, organization of practice models, and compensation for midwives. The Arksey and O'Malley five-stage framework for conducting scoping reviews guided our methodology. The constructs of interest for inquiry related to Canadian midwifery were the following: (1) employment models, (2) organization of practice, and (3) compensation. The study selection was an iterative search process. After duplicates were removed from both database and grey literature sources, a total of 1540 records were initially screened. After final screening was complete, a total of 111 records were included that contained content related to constructs of interest. Currently, midwifery services are publicly funded in Alberta, British Columbia, Manitoba, Ontario, Québec, Nunavut, Nova Scotia, Northwest Territories, and Saskatchewan. The four types of employment models in which midwives work are private practice, private fee for service (deemed as course of care), course of care, and salaried. Compensation varies by province depending on the model of employment. This review of publicly available literature illustrates the range of employment, practice models, and compensation of regulated midwifery across Canada, as well as the evolution of the profession in the past 27 years. This type of information is relevant to inform health workforce planning for midwifery services across the country (Canadian Task Force Classification III).

Integrated Care for Latent Tuberculosis Infection (LTBI) at a Primary Health Care Facility for Refugees in Winnipeg, Canada: A Mixed-Methods Evaluation.

Although Canada has one of the lowest tuberculosis incidence rates in the world, certain groups are disproportionately affected, including foreign born people from high incidence countries. The Winnipeg Regional Health Authority has initiated a process to decentralize latent tuberculosis infection (LTBI) management at primary care clinics in Winnipeg. One of these clinics is BridgeCare Clinic which provides services to government-assisted refugees. The present study describes the BridgeCare Clinic LTBI program and reviews program outcomes from January 2015 to October 2016. Refugees at BridgeCare Clinic receive comprehensive care, including LTBI screening and treatment. The LTBI program is managed by physicians, nurse practitioners, and primary care nurses under a patient-centered model of care. An accessible interpretation service, education to clients, and laboratory sampling at the clinic with free IGRA testing are important components of the program. Anonymized data on client outcomes were statistically analyzed and qualitative interviews were conducted with senior staff. During the study period, 274 IGRA tests were ordered with 158 negative results (57.7%) and 101 positive results (36.9%). Of 45 clients eligible (from January to December 2015) for LTBI treatment, 11 (24.4%) declined to receive treatment and 34 (75.6%) started treatment. Twenty-seven (79.4%) clients completed treatment, 3 (8.8%) clients moved out of province, and 4 (11.8%) did not complete treatment. The most recent World Health Organization strategy for tuberculosis control calls for integrated, patient-centered care and prevention. Aligned with these WHO recommendations, our experience suggests that LTBI care and treatment can be delivered effectively in a primary care setting using an integrated patient-centered approach.

Looking for Evidence of Public Health's Role for Long-Term Evacuees.

Many Canadians have had personal experience of a major emergency or disaster at some point in their lifetime and close to a third of those affected were evacuated from their homes or communities. Most evacuations have lasted less than 2 weeks, but in some instances, people have been displaced for months or years. For example, hundreds of residents evacuated following flooding in Lake St. Martin, Manitoba in 2011, remain displaced today. In order to learn more about the roles and responses of public health for long-term evacuees (LTEs) in Canada, we conducted a narrative review of published English-language documents, beginning with literature specific to Canada and then expanding to include literature on other high-income countries. We found that while researchers have explored public health considerations in emergency preparedness, acute disaster management, and resettlement in these contexts there is a dearth of published evidence regarding the public health implications of prolonged evacuation and the public health responses to long-term evacuation in Canada and in other high-income countries. Because the public health needs of diverse populations of LTEs have not been fully investigated, it is likely that they are neither well-understood nor adequately addressed in public health policy and practice.

The value of program science to optimize knowledge brokering on infectious diseases for public health.

BACKGROUND: Knowledge translation (KT) and related terms have variously been defined as process and as products. In this paper we contribute to debates on effective KT, specifically knowledge brokering, by describing an adaptation of Program Science that aligns with the real-world of public health activities. We describe an adaptation of the Program Science framework to our knowledge translation and brokering planning and projects at the National Collaborating Centre for Infectious Diseases. The systematic approach allows for layering of knowledge year to year and translating knowledge from one infectious disease content area to another. Using a recent forum on syphilis outbreaks as an example, we also demonstrate the value of using Program Science to shape the design and delivery of the knowledge brokering event. CONCLUSION: The use of scientific knowledge to improve public health program design, implementation and evaluation forms the basis for the program science framework. Providing the right public health information to the right audience at the right time can foster long-term outcomes of networks and new partnerships which can potentially improve delivery of public health services.