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The Evidence Speaks

The Evidence Speaks (July 2020)

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The Evidence Speaks Series is a recurring feature highlighting the latest in CHÉOS research. This series features summaries of select publications as well as in-depth features on the latest work from our investigators. The Series is designed to keep media and the research community up-to-date with CHÉOS’ current research results in the health outcomes field.

Romanowski K, Rose C, Cook VJ, Sekirov I, Morshed M, Djurdjev O, Levin A, Johnston JC. Effectiveness of Latent TB Screening and Treatment in People Initiating Dialysis in British Columbia, Canada. Can J Kidney Health Dis. 2020 Jul 2 epub ahead of print.

Tuberculosis (TB) is the leading cause of death from a single infectious disease worldwide, more than HIV/AIDS. In response, the WHO launched the EndTB Strategy, which aims to reduce the global TB burden by around 90 per cent by 2035. To reach this goal, programs that systematically screen and treat latent TB in high-risk groups are vital. People living with chronic kidney disease (CKD) are one such group, with rates of active TB up to 10 times higher than in the general population. To reduce the risk of active TB in people with CKD, B.C. began systematically screening and treating all people initiating chronic dialysis for latent TB in the province. In this study, CHÉOS Scientists Drs. Caren Rose and Adeera Levin collaborated with colleagues from around B.C. to compare active TB rate in people who initiated dialysis and were screened using an interferon-gamma release assay (IGRA) compared with those who were not screening during the same period. The retrospective cohort included 3190 people who started dialysis between 2012 and 2017. Of this cohort, 1790 were screened and, of these, 152 initiated latent TB treatment post-screening. During follow-up, active TB was diagnosed in six of the screened cohort versus 11 of the unscreened cohort. None of the 152 screened participants who received treatment for latent TB developed active TB. The researchers concluded that systematically screening and treating people starting dialysis can significantly decrease the rate of active TB in people with CKD. These results could go on to inform the scale-up of TB screening in dialysis programs in other low-incidence areas.

Carnide N, Hogg-Johnson S, Côté P, Koehoorn M, Furlan AD. Factors associated with early opioid dispensing compared with NSAID and muscle relaxant dispensing after a work-related low back injury. Occup Environ Med. 2020 Jul 7 epub ahead of print.

Over the past 20 years, North America has faced an opioid crisis, in part owing to opioid overprescribing to treat pain, such as lower back pain (LBP). A recent study, conducted by CHÉOS Scientist Dr. Mieke Koehoorn and a team in Ontario, set out to analyze a sample of workers’ compensation claims for LBP to determine the factors associated with receiving opioids at the first post-injury dispense versus non-steroidal anti-inflammatory drugs (NSAIDs) and skeletal muscle relaxants (SMRs). The researchers conducted a historical cohort analysis of workers’ compensation claimants in B.C. who filed a new short-term disability claim for an LBP-related injury from 1998 to 2009, a pivotal time in the opioid crisis when opioid prescribing was on the rise. The researchers analyzed data from 54,130 claimants and determined that most workers received NSAIDs or SMRs as the first postinjury medication within the first 8 weeks after injury. Factors that influenced the drug class included diagnosis, prescription history, pre-existing comorbidities, occupation, and sociodemographics. For example, claimants whose jobs were physically demanding were more likely to receive opioids with or without NSAIDs and/or SMRs than those with less physical jobs. The study concluded that, in this time period, early postinjury dispensing after LBP injury was multifactorial, with a number of elements being associated with receiving opioids. Variation in the prescriber’s drug class choice appeared to be especially important; however, the reasons for which were not explained by basic prescriber characteristics.

Makuza JD, Nisingizwe MP, Rwema JOT, Dushimiyimana D, Habimana DS, Umuraza S, Serumondo J, Ngwije A, Semakula M, Gupta N, Nsanzimana S, Janjua NZ. Role of unsafe medical practices and sexual behaviours in the hepatitis B and C syndemic and HIV co-infection in Rwanda: a cross-sectional study. BMJ Open. 2020 Jul 12;10:e036711.

July 28 is World Hepatitis Day. Earlier this month, CHÉOS Scientist Dr. Naveed Janjua joined an international team of researchers to publish their study on the burden of hepatitis B (HBV), C (HCV), and HIV co-infections and the associated risk factors in Rwanda. The viruses themselves are transmitted via the same routes and co-infection can occur depending on the presence of shared risk factors and community prevalence rates. The study analyzed data from 156,499 eligible participants from 60 health centres across six districts. It found that mono-infection with any of the three viruses was more common than co-infections; only 0.3% of individuals tested had double or triple coinfections with HIV/HBV, HIV/HCV, or HIV/HBV/HCV. The researchers also discovered that the patterns of risk factors varied for the different mono-infections and co-infections. HIV and related coinfections were associated with urbanicity, high-risk sexual behaviour, and health care exposures, whereas HCV and related co-infections were often associated with rural residence and unsafe medical practices. The findings from this study highlight the prevalence of mono- and co-infections of HIV, HBV, and HCV, alongside the risk factors for each, which could contribute to the design of effective care and prevention programs in Rwanda and beyond.

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