Research Highlights

1. Informing HIV treatment strategies: I have made several contributions to the development of HIV treatment strategies. In a first author paper that was fast-tracked for publication in the Lancet to coincide with the XIII International AIDS conference in Durban, South Africa, I described a statistical model demonstrating the population impact of low-level use of HIV treatments on preventing mother-to-child transmission of HIV in South Africa (Wood E et al., Extent to which low-level use of antiretroviral treatment could curb the AIDS epidemic in sub-Saharan Africa. Lancet, 2000; 355: 2095-2100 [Fast Track]). This publication led several pharmaceutical companies to offer free antiretrovirals to prevent mother-to-child transmission of HIV throughout Africa. I have also published high impact papers demonstrating the role of highly active antiretroviral therapy adherence in contributing to the survival of HIV-infected patients (e.g., Wood E et al., Effect of medication adherence on survival of HIV-infected adults who start highly active antiretroviral therapy when the CD4+ cell count is 0.200 to 0.350 x 109 cells/L. Annals of Internal Medicine, 2003; 139(10): 810-816). My overall body of work in this area resulted in an invited review paper from Lancet Infectious Diseases that was published to coincide with the 2005 International Conference on HIV Pathogenesis and Treatment (Wood E et al., When to initiate antiretroviral therapy in HIV-1-infected adults: a review for clinicians and patients. Lancet Infectious Diseases, 2005; 5(7): 407-414). Together these studies had a significant impact on the clinical care of HIV-infected patients locally, as they informed the province of British Columbia’s HIV Therapeutic Guidelines, and internationally, as they were noted in the various international HIV treatment guidelines.

2. Investigating & addressing HIV infection & other harms among injection drug users: In 2003, I successfully obtained a five-year operating grant from the Canadian Institutes of Health Research (CIHR) to support an ongoing prospective cohort study of injection drug users, known as the Vancouver Injection Drug Users Study (VIDUS). In 2004, I also obtained a five-year operating grant from the US National Institutes of Health (NIH) to expand this work. Together, this provided several million dollars in competitive peer-reviewed funding that enabled the creation of an infrastructure that has made major international research and educational contributions (please see the International Leadership section). The VIDUS study, along with the related work described below, had a high level of involvement with local and national policy-makers, as well as ongoing community engagement and consultation. The operation and management of the VIDUS study has involved oversight of a large research infrastructure involving more than 1,000 injection drug users who are followed every six months at a storefront research office in Vancouver’s Downtown Eastside. During each visit, participants answer a detailed study instrument and provide a blood sample for HIV and hepatitis C testing. Since 2003, the VIDUS study has provided a platform for the training of dozens of medical and graduate students and produced several hundred peer-reviewed publications. I am the first or senior author on the majority of these papers, several of which were published in very high impact publications, including the American Journal of Public Health, Journal of the American Medical Association, Canadian Medical Association Journal and other top medical and public health journals. Since Aboriginal health is among my clinical and research interests, I will describe one of these papers (Wood E et al., Burden of HIV infection among Aboriginal injection drug users in Vancouver, British Columbia. American Journal of Public Health, 2008; 98(3): 515-519). This paper demonstrated elevated rates of HIV infection among Aboriginal injection drug users in Vancouver’s Downtown Eastside, and I led an effort to reach out to Aboriginal community-based organizations in advance of the paper’s publication to raise awareness about this issue. This paper, which was published on February 1, 2007, resulted in an emergency debate in the Canadian House of Commons on February 7, 2007, bringing national attention to the health crisis among this population. In a separate paper, published in the Canadian Medical Association Journal, I reported on how elevated rates of HIV infection among Aboriginal persons may be due, in part, to lower access to addiction treatment (Wood E et al., Rate of methadone use among Aboriginal opioid injection drug users. Canadian Medical Association Journal, 2007; 177(1): 37-40). These papers have received widespread media attention and have been used for ongoing political advocacy by the Aboriginal community. In June 2011, I was invited to meetings with members of Canada’s Assembly of First Nations for the purpose of expanding these collaborations.

3. Evaluating innovative public health programs to address the harms of injection drug use: Through my research with the VIDUS study, I have been involved in evaluating a range of HIV prevention and other programs. Among the most well recognized contribution is my work evaluating Vancouver’s supervised injecting facility (SIF), known as Insite. Recent review papers have suggested that more than 65 SIFs exist internationally, and for many years there were debates about the potential value of an SIF in Vancouver—beginning soon after the Vancouver Health Board declared a public health emergency in Vancouver’s Downtown Eastside in the late 1990s. This debate was escalated in 2002, when I conducted a feasibility study for an SIF in Vancouver that was subsequently fast-tracked for publication (Wood E et al., Potential public health and community impacts of safer injecting facilities: evidence from a cohort of injecting drug users. Journal of Acquired Immune Deficiency Syndromes, 2003; 32: 2-8 [Fast Track]). This paper was the first to demonstrate the public health rationale and potential impact of SIFs for injecting drug users in Canada. The scientific support for these interventions provided by this research was cited by policy-makers as critical for the opening of Vancouver’s SIF, which opened in September 2003. As a result of my track record of research with the VIDUS study, I was awarded (as Principal Investigator) five-year funding from Health Canada to evaluate the Vancouver SIF after it opened. This research, known as the Scientific Evaluation of Supervised Injecting (SEOSI), involved the establishment and supervision of a prospective cohort study of more than 1,000 randomly recruited SIF users. The result has been first or last author manuscripts in the Canadian Medical Association Journal, British Medical Journal, Lancet and the New England Journal of Medicine. This research was summarized in a 2006 review paper (Wood E et al., Summary of findings from the evaluation of a pilot medically supervised safer injecting facility. Canadian Medical Association Journal, 2006; 175 (11): 1331-1337), which has been cited over 40 times. These papers illustrate the impact that Insite has had on SIF users: fewer overdose deaths, reduced HIV risk behaviour, less public disorder, and improved uptake of addiction treatment.