Mifepristone Implementation Research in Canada

This foundational research at the time of introduction for an innovative practice in Canada, will support advances for training programs and will inform health policy, system and service improvements to facilitate equitable access to medication abortion options for women throughout Canada.

Principal Investigator: Dr. Wendy Norman

Primary Contact: Sarah Munro, Post-doctoral Fellow, 604-875-2424 ext 4990, Sarah.Munro@ubc.ca

About the study: Mifepristone, approved by Health Canada, will be introduced in 2017. Currently 96% of Canadian abortions are surgical, largely concentrated in the largest cities close to the southern border. Overcoming barriers for provision of mifepristone abortion by current and new abortion providers could help to address this disparity. We are undertaking this national study to measure, and concurrently address, the facilitators and barriers for successful initiation and ongoing provision of medical abortion, and to measure changes to abortion access throughout Canada.

Why is this research important? This foundational research at the time of introduction for an innovative practice in Canada, will support advances for training programs and will inform health policy, system and service improvements to facilitate equitable access to medication abortion options for women throughout Canada.

What impact has this research had on policy? This study has involved close partnership with decision makers responsible for mifepristone policy in Canada. During the study period, our research-policy collaboration accelerated health system change through concurrent identification and mitigation of barriers to implementation of mifepristone. The research evidence contributed to removal of the federal requirements for observed dosing, practitioner training, practitioner registration, and physician-only prescribing and dispensing.

Study status: In the process of data collection and has begun preliminary analysis.

Who can participate? This study has three groups of participants: (1) physicians and pharmacists completing mifepristone training certification; (2) physicians and pharmacists who were eligible to provide mifepristone abortion services but did not complete certification; and (3) health service stakeholders who have an influential role in the health policy, system, and/or services that contribute to adoption and diffusion of abortion practice in Canada.

Co-Investigators: Drs. Tamil Kendall, Jan Christilaw, Edith Guilbert, Jennifer Blake, James Meuser, Philip Emberley, Rollin Brant,  Melissa Brooks, Stirling Bryan,  Dustin Costescu, Sheila Dunn, Angel Foster, Janusz Kaczorowski,  Sarah Munro, Regina Renner, Judith Soon, Eleni Stroulia, Flora Teng, Ashley Waddington, Marie-Soleil Wagner.

Funded by: CIHR, MSFHR, BC Women’s Hospital + Health Centre

Advances in Screening and Prevention in Reproductive Cancers (ASPIRE)

ASPIRE is a women’s health initiative using innovative models and technologies to improve access to reproductive health in low income settings.

Principal Investigator: Dr. Gina Ogilvie

Primary Contact: Heather Pedersen, Research Coordinator, 604-707-2424 x5473, Heather.pedersen@cw.bc.ca

About the study: ASPIRE is a women’s health initiative using innovative models and technologies to improve access to reproductive health in low income settings. Since 2007, ASPIRE has conducted various community-based cervical cancer screening initiatives in Kampala, Uganda using self collection-based HPV testing. The project takes an integrated health services approach to address cervical cancer along other reproductive health issues including sexually transmitted infections and HIV.

Why is this research important? Cervical cancer, despite being almost entirely preventable, remains a leading cause of death among women in low and middle income countries largely due to the absence of screening programs in these regions. Cost-effective and acceptable tools are needed to improve access in low income settings. By integrating cervical cancer and reproductive health screening with routine HIV services, the health of vulnerable women can be protected while most effectively utilizing resources.

Study Status: 1) Randomized controlled trial comparing HPV self collection vs VIA in Kampala: complete; 2) Integration of cervical cancer screening with HIV services: under development; 3) Reproductive health & pregnancy outcomes in adolescents: under development.

Study results/publications:

Moses E, Pedersen HN, Mitchell SM, Sekikubo M, Mwesigwa D, Singer J, Biryabarema C, Byamugisha JK, Money DM, Ogilvie GS. Uptake of community-based, self-collected HPV testing vs. visual inspection with acetic acid for cervical cancer screening in Kampala, Uganda: Preliminary results of a randomized controlled trial. Trop Med Int Health. 2015; 20(10):1355-67.

Teng FF, Mitchell SM, Sekikubo M, Biryabarema C, Byamugisha JK, Steinberg M, Money DM, Ogilvie GS. Understanding the role of embarrassment in gynaecological screening: a qualitative study from the ASPIRE cervical cancer screening project in Uganda. BMJ Open 2014;4:4 e004783.

Mitchell SM, Sekikubo M, Biryabarema C, Byamugisha JJ, Steinberg M, Jeronimo J, Money DM, Christilaw J, Ogilvie GS. Factors associated with high-risk HPV positivity in a low-resource setting in sub-Saharan Africa. Am J Obstet Gynecol 2014 Jan;210(1):81.e1-7.

Ogilvie G S, Mitchell S, Sekikubo M, Biryabarema C, Byamugisha J, Jeronimo J, Miller D, Steinberg M, Money D M. Results of a community-based cervical cancer screening pilot project using human papillomavirus self-sampling in Kampala, Uganda. Int J Gynaecol Obstet 2013; 122 (2): 118–123.

Mitchell S, Ogilvie G, Steinberg M, Sekikubo M, Biryabarema C, Money D. Assessing women’s willingness to collect their own cervical samples for HPV testing as part of the ASPIRE cervical cancer screening project in Uganda. Int J Gynaecol Obstet 2011;114(2):111-115.

Co-Investigators: Deborah Money, Jan Christilaw, Josaphat Byamugisha, Sheona Mitchell, Angela Kaida, Ashley Roberts, Curren Warf, Patricia Spittal

Funded by: CIHR, CFRI, BCCDC Foundation, UBC, BC Women’s Foundation

Partners: University of British Columbia, Makerere University, BCCDC

Websites:

http://www.aspireafrica.ca/aspire/

Does a Women’s Heart Center Change Clinical Outcomes?

It is not yet known whether specialized care centers like the Women’s Heart Center improves outcomes in women compared to usual care. Through this study we hope to better understand how gender specific care can impact the outcome for woman with a range of different cardiac conditions.

Principal Investigator: Dr. Tara Sedlak

Primary Contact: Dr. Tara Sedlack, Principle Investigator, VCH, 604-875-5487, Tara.Sedlak@vch.ca

About the study: This study has two aims: firstly, to create a database of patients attending the VGH/BCWH Women’s Heart Center (WHC) to facilitate the ability of future investigators to conduct research on a number of different of issues surrounding women and heart disease. The second aim is to examine whether attendance at a WHC improves outcomes of patients with heart disease or at risk for heart disease. We will collect clinical information and some basic demographic information and store this in a de-identified database. We will also ask participants to complete a total of 4 questionnaires over a 5 year period.

Why is this research important? It is not yet known whether specialized care centers like the Women’s Heart Center improves outcomes in women compared to usual care. Through this study we hope to better understand how gender specific care can impact the outcome for woman with a range of different cardiac conditions.

Study status: Ethics approval in progress.

Who can participate? Any woman who is being seen within the Women’s Heart Center at Vancouver General Hospital and/or BC Women’s Hospital will be invited to participate in this study who is fluent in English.

Co-Investigators: Natasha Prodan-Bhalla, Dr. Karin H. Humphries.

Impact of Timing of Surgical Management After Detection of Early Pregnancy Loss on Women’s Emotional Health study

This study will explore how the timing of having a dilatation and curettage (D&C) procedure for a miscarriage impacts a women’s emotional well-being.

Principal Investigator: Dr. Stephanie Fisher

Primary Contact: Emma Branch, Research Assistant, WHRI, 604-875-2424 ext 4796, Emma.Branch@cw.bc.ca 

About the study: We want to explore how the timing of having a dilatation and curettage (D&C) procedure for a miscarriage impacts a women’s emotional well-being. Dilatation and curettage (D&C) is a minor surgical procedure in which the cervix is gently opened (dilation) and the pregnancy is removed with a suction device or small curette (curettage). D&C is performed to clear the uterine lining after a miscarriage. This study is qualitative and exploratory. Women taking part in this study will be asked to participate in an interview. In addition, we will collect information about the D&C procedure and some demographic data.

Why is this research important? We hope that the findings in this study can be used to improve counseling for women who choose to undergo a D&C procedure for their early pregnancy loss (less than 12 weeks and 6 days).

Study status: No longer recruiting.

Who can participate: We want to hear from women who had a D&C procedure within 36 hours of their visit to the Early Pregnancy Assessment Clinic (EPAC) and from women who had a D&C procedure after 36 hours of their visit to EPAC.

Co-Investigators: Mariana Veiga, Caitlin Johnston, Dr. Stephanie Rhone, Edwina Houlihan.

Funded by: BC Women’s Hospital Nursing Research Grant

Tomosynthesis Mammographic Imaging Screening Trial (TMIST)

The TMIST study will help determine whether tomosynthesis results in fewer false-positive findings (reduced recall rate) than traditional 2D mammography.

Principal Investigator: Dr. Paula Gordon

Primary Contact: Melissa Watt, Research Coordinator, 604-875-2424 ext 4878, TMIST@cw.bc.ca

About the study: This study aims to enroll 3,000 women in the Vancouver area into a screening mammography trial. Each woman will be randomized either into a group that receives regular 2-dimensional screening or a new type of screening called Tomosynthesis, which has 3-dimensional capability. Both groups of woman will receive their respective screening mammography exams annually for three years.

Why is this research important? The findings from this study will help determine whether tomosynthesis results in fewer false-positive findings (reduced recall rate) than traditional 2D mammography.  This could result in less anxiety for women who receive abnormal results and lower economic burden of unnecessary follow-up on the health care system.

Study status: Recruiting

Who can participate? Women over the age of 50, fluent in English, Eligible for mammography screening at the Screening Mammography Program of British Columbia, Are able to return to the original sites (BC Women’s Hospital or X-Ray 505) for further screenings.

Co-Investigators: Dr. Linda Warren, Janette Sam, Dr. Andy Coldman, Dr. Joseph Yang.

Funded by: Gordon and Leslie Diamond family/BC Women’s Hospital & Health Centre Foundation

Partners: BC Women’s Hospital + Health Centre, BC Cancer Agency, Screening Mammography Program of BC, American College of Radiology (ACR), American College of Radiology Imaging Network (ACRIN)