Literature Collection

BACKGROUND: Integrated care is a promising strategy to advance system transformation, care coordination, equity, and better health outcomes. Health services and policy research can drive evidence-informed health system improvements but is often underutilized. To optimize the relevance and impact of integrated care research as a transformative lever for better health and system outcomes, the Canadian Institutes of Health Research's Institute of Health Services and Policy Research (CIHR-IHSPR) designed a large-scale, evidence-informed, community-engaged research funding initiative. This paper outlines the approach and methods used by CIHR-IHSPR and describes how they informed the design and development of Transforming Health with Integrated Care (THINC), a large-scale, impact-oriented research funding initiative that promotes the adoption and proliferation of integrated care in Canada. METHODS: A multi-method qualitative, community-engaged approach was used to inform the design of a research funding strategy. Key features of the approach included multiple evidence inputs (retrospective and prospective information from primary [key informant interviews, focus groups, and a workshop] and secondary [CIHR funding data and literature review] sources), pan-Canadian reach of community engagement, involvement of diverse interest-holders, iterative data collection and analysis, and a commitment to identifying shared priorities through a community-engaged process. FINDINGS: There was consensus across the evidence inputs that implementing, adapting, and scaling evidence-informed integrated care interventions is crucial for real-world impact. Strategies found important for improved research relevance and impact include implementation science, rapid response, embedded research, and knowledge mobilization, along with key initiative design elements such as co-leadership, cross-jurisdictional and interdisciplinary teams, and a focus on the Quintuple Aim. Priority populations were also identified for maximizing the potential benefit and impact of the research. These findings informed the design of THINC, resulting in a multi-program initiative aligned to a shared goal of evidence-informed integrated care transformation. A collaborative design approach fostered shared objectives, commitment from multiple partner organizations, and resources to increase the initiative's size and scope. CONCLUSIONS: The study demonstrates the feasibility of using an evidence-informed, community-engaged approach and the influence and benefits of the approach in designing a large-scale research funding initiative that aims to be transformational and impactful.

As treatment expansion in the opioid epidemic continues, it is important to examine how the makeup of individuals with opioid use disorder (OUD) is evolving. Treatment programs are increasingly utilizing buprenorphine, an effective OUD medication. This exploratory study examines sex and gender differences in psychosocial, clinical and substance use treatment characteristics of a clinical population in outpatient medication treatment for OUD with buprenorphine. This is a secondary data analysis from a cross-sectional survey study with retrospective medical record review conducted with patients recruited from an office-based opioid treatment clinic between July-September 2019. Participants on buprenorphine for at least 28 days at time of survey completion were included (n=133). Differences between men and women were explored with Pearson χ(2) and Fisher's Exact Tests for categorical variables and T-Tests for continuous variables. The sample was 55.6% women and nearly three-fourths Black (70.7%). Mean days in current treatment episode was 431.6 (SD=244.82). Women were younger and more likely to be unemployed, identify as a sexual minority, and live alone with children than men. More women than men had a psychiatric comorbidity. Women reported more prescription opioid misuse while men had more heroin only opioid use. More men reported comorbid alcohol use and a history of drug overdose. One-third of participants reported recent discrimination in a healthcare setting due to substance use. As buprenorphine-based outpatient treatment programs continue to expand, present study findings support evaluation of the unique needs of men and women in order to better tailor OUD-related services and improve treatment outcomes.

Men who have sex with men (MSM) continue to be the largest risk group for HIV infections in the U.S., where crystal methamphetamine abuse heightens risk for HIV infection through greater engagement in condomless anal sex (CAS). Existing treatments lack attention to replacement activities or the role of depressed mood. Behavioral activation (BA) is an evidence-based approach for depression that involves identifying and participating in pleasurable, goal-directed activities. We hypothesize, for MSM abusing crystal methamphetamine, re-learning how to engage in non-drug-using aspects of life would facilitate their ability to benefit from sexual risk reduction (SRR) counseling. Project IMPACT was a pilot randomized-controlled-trial. Forty-six MSM at sexual risk of acquiring HIV who met DSM-IV criteria for crystal methamphetamine dependence were enrolled. Of those MSM, 41 were randomized: 21 were assigned to the intervention, two sessions of SRR, ten sessions of BA with SRR, and one session of relapse prevention; 20 participants were assigned to a control condition (two sessions of SRR). At the acute post-intervention visit, intervention participants reported an average of 3.2 CAS acts with men who were HIV-infected or whose status they did not know, compared to 4.5 among control participants (β = -0.36; 95% CI: -0.69, -0.02; p = 0.035). At the 6-month post-intervention visit, intervention participants reported 1.1 CAS acts with men who were HIV-infected or whose status they did not know compared to 2.8 among control participants (β = -0.95; 95% CI: -1.44, -0.46; p < 0.0001). Similarly, intervention participants reported 1.0 CAS acts under the influence of crystal methamphetamine with men who were HIV-infected or whose status they did not know compared to 2.5 among control participants (β = -0.87; 95% CI: -1.38, -0.36; p = 0.0005). Lastly, intervention participants reported more continuous days abstaining from crystal methamphetamine compared to control (50.1 vs. 39.0, respectively) (β = 0.25; 95% CI: 0.16, 0.34; p < 0.0001). Findings are encouraging, provide evidence of feasibility and acceptability, and demonstrate initial efficacy for reducing sexual risk for HIV and crystal methamphetamine use.