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October 26, 2021
Presenters: Erica Phipps
Sujane Kandasamy
Leigh McClarty
Facilitator: Emily Clark
Equity and Knowledge Translation: Insights from the 2021
Knowledge Translation Student Award Recipients
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Public Health+
Networking and
Outreach
Presenters
Erica Phipps Sujane Kandasamy Leigh McClarty
Queen’s University McMaster University University of Manitoba
A critical exploration into
Manitoba’s HIV care
cascade
“Culture Eats Strategy for
Breakfast:” An Academic
Journey toward Theory-
informed, Empirically-rooted,
and Co-developed
Knowledge Translation
Interventions for Priority
Populations
Investing in relational
knowledge practices and
‘reversing the gaze’ for
equity-focused intersectoral
action on housing and health
equity: The RentSafe EquIP
research in Owen Sound,
Ontario
Investing in relational knowledge
practices and ‘reversing the gaze’ for
equity-focused intersectoral action
on housing and health equity:
The RentSafe EquIP research in
Owen Sound, Ontario
Erica Phipps, MPH, PhD
Vanier Scholar, Centre for Environmental Health Equity, Queen’s University (graduated)
Postdoctoral Fellow, University of Ottawa
Executive Director, Canadian Partnership for Children’s Health & Environment; Director, RentSafe
National Collaborating Centres for Public Health
Webinar, 26 October 2021
RentSafe EquIP
Equity-focused Intersectoral Practice
for housing and health equity
in Owen Sound, Ontario
Aim: To catalyze and support interaction among
people from diverse sectors, amidst an
escalating housing crisis, to:
• Better understand the causes and
consequences of housing inadequacy
• Foster new ways of thinking about issues
and solutions
Research
overview
§ Community-based Participatory Action
Research (PAR); funded by CIHR Knowledge-
to-Action grant
§ Linked to CPCHE-led RentSafe initiative
§ Catalyzed by work on Equity-focused
Knowledge Translation (EqKT)
§ Explored the role of human relationships and
critical reflexivity in understanding →
deconstructing → transforming knowledge
practices among intersectoral actors
Masuda, Zupancic, Phipps et al (2014). Equity-focused Knowledge Translation: A
framework for ‘reasonable action’ on health inequities. IJPH 59(3).
https://doi.org/10.1007/s00038-013-0520-z
Phipps & Masuda (2018). Towards equity-focused intersectoral practice (EquIP) in
children’s environmental health and housing: the transformational story of RentSafe.
Can J Public Health. 109(379). https://doi.org/10.17269/s41997-018-0094-x
Phipps, & NCCDH (2018). Towards healthy homes for all: What the RentSafe findings
mean for public health in Canada..
http://nccdh.ca/images/uploads/comments/NCCDH_RentSafeSummary_-_EN.pdf
Grounded expertise
The knowledge and insights gained and
developed by those who have directly
experienced and lived with(in) a particular
issue, concern or injustice.
Research phase 1:
Learning
Exchanges
• 11 sessions
• 45 participants from
16 agencies/sectors
• Convened by co-
researchers with
grounded expertise
• Identifying issues and
gaps
• Reflecting on existing
practices and mindsets
• Creating new
understandings of the
problem and potential
solutions
• Four-day immersive ‘experiment’ in
building capacity for equity-focused
intersectoral practice
• ~30 participants from the
community and research team
Research phase 2:
Intersectoral
Retreat
Centering of Indigenous ways of
knowing, ceremony and teachings
Solidarity through shared
discomfort and problem-solving
Getting out of our comfort zones
Interacting as people and
neighbours rather than as ‘roles’
What we
heard
• Multiple, intersecting drivers of
housing-related inequities
• Some feel excluded from the
‘system,’ others feel trapped within it
• Inadequate knowledge and
understanding create tension and
feed the crisis
• Intersectoral collaboration is
important and can be improved
“...the complex lives of people are not
properly addressed in the support
services that we have...”
“The judgement I was put through.
I was already humiliated enough,
and sick enough.”
”We all run on this hamster wheel sometimes on our own. Until we pick up the phone
and say okay, here’s the real deal, here’s the red tape, how can we work together?”
“...and the guy [prospective tenant] gets
out of the cab and the owner goes ‘Oh,
he’s native. No, sorry. I was wrong. I
don’t have a unit.’”
“It is not only okay, it is
imperative to prioritize
relationships.”
“We need to start thinking of
relationships as a resource.”
Knowledge
mobilization and
community
momentum
• Report to the community: We are
all Neighbours
• Briefing to high-level intersectoral
table: Healthy Communities
Partnership
• RentSafe EquIP Roundtable
• RentSafe Owen Sound
Collaborative
• Intersectoral video: Housing
Issues? We’re here to help
What we
learned
RentSafe EquIP research identified
gaps/barriers and opportunities for
change in...
1. Structures
“It can be very discouraging ...somebody comes in and is
literally sleeping on the streets and they [say]... “I need
help.” And you make the calls and it’s about a 3 year
wait list.”
2. Knowledge, perceptions and beliefs
“.. Attitudes that ...people are poor 'cause they've
messed up their lives, they made bad choices, and they
deserve what they get, which is substandard housing
and no rights.”
3. Practices
“When somebody with mental health issues or is
scared... walks into an office and they say ‘Here, here’s a
phone number, give them a call.’ They’re not gonna
call.”
“[Agency staff] don’t like to be made uncomfortable. It’s
easier to keep the tunnel vision.”
With regard to protocols that screen people out from
receiving services: “Just don’t tick the box.”
Phipps, Butt, Desjardins, Schonauer, Schlonies & Masuda (2021). Lessons from a rural housing crisis: grounded insights for
intersectoral action on health inequities. Social Science & Medicine, https://doi.org/10.1016/j.socscimed.2020.113416
What we
learned
EquIP served as a catalyst for...
1. (Re)problematization
• “Housing isn’t just one silo. There are so many aspects...
It’s the determinants of health, it’s the poverty lens... It
is not just bricks and mortar.”
2. Reflexivity
• “What we usually don’t hear is the frustration with our
service and how they [community members] view the
people who are trying to help them. That’s probably
really good to hear.” – senior manager
• “I am now more aware of the boxes [the service
providers] are in, and the limitations they face.” - tenant
3. Rethinking individual and collective agency
• “I feel more empowered and determined to stand up
against barriers within my organization that feel
unethical/unfair.”
• “It is important to build relationships...for those warm
referrals. But it is more than that. It is about
accountability. It is more difficult to turn a blind eye to
someone you know. “
• “People [with grounded expertise] are having a say...
And [people in decision-making roles] are listening.”
Phipps, Bumstead, Butt, Crighton, Desjardins, Hart, Oickle, Sanchéz-Pimienta, Schonauer, Umbach & Masuda (forthcoming).
It doesn’t happen any other way: Relationship-building and critical reflexivity as groundwork for equity-focused intersectoral
practice (EquIP).
Equity-
focused
Intersectoral
Practice
(EquIP)
Equity-focused intersectoral practice means:
• Asking upstream ‘why’ questions
• Engaging in intersectoral knowledge practices
in ways that
– Prioritize human relationships
– Create non-hierarchical, safe and inclusive
spaces
– Foster shared understandings, respect and trust
– Prioritize grounded expertise as the lens for
examining systems, policies and practices.
• Shifting the gaze away from perceived deficits
in communities towards blind spots and
barriers in the institutionalized ‘system’ itself.
• Examining one’s own role and possibilities to
act.. And having the courage to do so.
Concluding thoughts:
Opportunities for
public health practice
• Centering grounded expertise
• Constituting intersectoral work in ways that
advance reconciliation (ex: Giiwe)
• Applying/adapting EquIP methods (e.g.,
Learning Exchanges, creation of relational
spaces)
• ‘Reflexive’ intersectoral projects, e.g., video
• Leveraging research
• Embracing public health’s role as a convenor
RentSafe.ca
LogementSain.ca
Thank you!
For more information:
ephipps@uottawa.ca RentSafe.ca/owen-sound
With gratitude for past and current funding support from:
• Canadian Institutes of Health Research KTA grant # RN 27777245
• Vanier Canada Graduate Scholarship
• GESTE -- pour la partage des connaissances fellowship
• CIHR-funded postdoctoral fellowship, uOttawa
• SSHRC-funded U de Montréal REGARD research collaboration
Our team acknowledges the history, spirituality, culture, and stewardship of the Indigenous peoples of the region where this research was carried out:
the Saugeen Ojibway Nation and the Three Fires Confederacy, namely the Odawa, Potawatomi, and Ojibway nations.
“CULTURE EATS STRATEGY FOR
BREAKFAST:”
AN EXAMPLE OF A THEORY-INFORMED,
EMPIRICALLY-ROOTED &
CO-DEVELOPED KT INTERVENTION FOR
A PRIORITY POPULATION
Sujane Kandasamy, MSc, PhD
McMaster University
KEY TOPICS
Set the stage:
Brief Introduction
Deep Dive:
Key Concepts
Key Lessons:
Learnings
Next Steps:
Future Directions
Click here to watch the Documentary-style film shown in this
presentation
Evidence
KT Tool
Evaluation
Community-facing
Knowledge Mobilization
Integrated KT
Summary &
Next Steps (Co-design, joint analysis/mobilization,
Iterate/innovate/scale)
Thankyou!
kandas3@mcmaster.ca
@NonPlainJane
A critical exploration
into Manitoba’s HIV
care cascade
Novel applications of equity-
focused data visualisation to
support knowledge translation
Leigh McClarty, PhD
Postdoctoral Fellow, Institute
for Global Public Health
Rady Faculty of Health
Sciences, University of
Manitoba
2 6 O C T O B E R 2 0 2 1
Background
& Context
• Relatively little research focusing on
HIV epidemiology in Manitoba
• In 2013, CIHR-funded program of
research – the LHIV Study – provided
support for the establishment of a
prospective clinical cohort of people
living with HIV in Manitoba
• First comprehensive source of HIV-
specific health data for the province
• Using cohort data, developed the first,
comprehensive HIV care cascade
model for Manitoba
2 6 O C T O B E R 2 0 2 1
26
McClarty LM, Kasper K, Ireland L, et al.
The HIV care cascade in Manitoba,
Canada: Methods, measures, and
estimates to meet local needs. J Clin
Epidemiol 2020; 132: 26-33.
McClarty LM, Cheuk E, Ireland L, et al.
Cohort profile: the LHIV-Manitoba
clinical cohort of people living with HIV
in Manitoba, Canada, BMJ Open 2020;
10(5): e034259.
Frameworks & approaches
P R O G R A M S C I E N C E
• A research and program framework for
improving the design and implementation
of public health programs through the
systematic application of theoretical and
empirical scientific knowledge (Blanchard
& Aral, 2011) that is embedded within a
public health program
I N T E G R A T E D K N O W L E D G E
T R A N S L A T I O N
• Active and ongoing partnerships with key
stakeholders in Manitoba
• Inform objectives
• Ensure relevance for policy and programs
6 J A N U A R Y 2 0 2 2
27
The HIV care
cascade: What
is it?
• A framework for examining individuals’
progress through the continuum of HIV-related
health services and outcomes
• A tool used for:
• Monitoring performance of HIV care
programs, health systems
• Identifying gaps and bottlenecks
in service provision and uptake
• Tracking progress toward meeting high-
level public health goals (e.g., UNAIDS
90-90-90 Initiative)
28
Gardner EM, et al. Clinical infectious diseases 2011; 52(6): 793-800.
Manitoba’s HIV care cascade
2 6 O C T O B E R 2 0 2 1
29
90.8%
86.2%
81.5%
74.4%
0%
20%
40%
60%
80%
100%
Alive and diagnosed In care Retained in care On treatment Virologically
suppressed
Percentage
of
participants
alive
and
diagnosed
n = 703 at alive and diagnosed step
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Equity analyses
Rationale & methods
• The Sustainable Development Goals are centred around the notion of leaving no one behind.
• Conventionally, cascades use aggregate data to illustrate population-level engagement in HIV care
• Relying on aggregate data hides underlying heterogeneity among individuals and sub-groups within a population
2 6 O C T O B E R 2 0 2 1
30
Identified relevant “equity variables” available within the cohort
• Age, sex, geography, ethnicity, immigration status, HIV exposure category
Disaggregated each cascade step indicator by each equity variables
Used equiplots to visualize inequalities between participant subgroups in each cascade step
• Exploratory, multivariable logistic regression analyses were then used to quantify inequalities
M
E
T
H
O
D
S
McClarty LM, Blanchard JF, Becker ML.
Leaving no one behind? An equity
analysis of the HIV care cascade among
a cohort of people living with HIV in
Manitoba, Canada. BMC Public Health
2021; 21(1): 281.
Inequalities across age groups
CASCADE
STEP
In care Retained in care On treatment
Virologically
suppressed
Total
participants
in cascade
step, N
638 606 573 523
AOR 95%CI AOR 95%CI AOR 95%CI AOR 95%CI
Age range, in years
18-29 Ref. - Ref. - Ref. - Ref. -
30-39 1.62 0.65-4.02 2.39 1.07-5.34 2.01 0.96-4.24 1.57 0.77-3.24
40-49 2.51 1.03-6.11 3.28 1.51-7.13 3.27 1.58-6.77 2.77 1.37-5.59
50-59 4.53 1.73-11.89 3.69 1.67-8.14 4.39 2.08-9.30 3.75 1.83-7.68
60+ 5.04 1.52-16.69 6.37 2.27-17.85 4.99 2.05-12.15 4.53 1.96-10.44
2 6 O C T O B E R 2 0 2 1
M
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2
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31
n = 703; adjusted for sex and ethnicity
Inequalities across geographies
2 6 O C T O B E R 2 0 2 1
32
CASCADE
STEP
In care Retained in care On treatment
Virologically
suppressed
Total
participants
in cascade
step, N
638 606 573 523
AOR 95%CI AOR 95%CI AOR 95%CI AOR 95%CI
Geography, by region
Winnipeg Ref. - Ref. - Ref. - Ref. -
Northern
Manitoba
0.64 0.17-2.35 1.23 0.35-4.41 1.37 0.44-4.26 1.06 0.42-2.70
Western
Manitoba
0.33 0.12-0.90 0.44 0.17-1.11 0.65 0.26-1.66 1.03 0.41-2.61
Eastern
Manitoba
3.04 0.40-23.04 1.91 0.56-6.48 2.27 0.77-6.64 3.82 1.31-11.17
Southern
Manitoba
0.64 0.18-2.35 0.95 0.31-2.95 0.92 0.35-2.45 0.55 0.24-1.27
n = 693; adjusted for age group, sex, and ethnicity
M
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2
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1
.
Summary:
Data visualisation as
knowledge translation
2 6 O C T O B E R 2 0 2 1
33
Equiplots are innovative
and critical knowledge
translation tools
Facilitates communication
of evidence with policy
makers, program
implementers, clinicians
Visualisation of data
through equiplots may be
more programmatically
useful than examining
logistic regression models
Thank you!
6 J A N U A R Y 2 0 2 2
34
Funding
Study sites &
implementation
support
Questions?
leigh.mcclarty@umanitoba.ca
Committee members
• James Blanchard, Professor & Director,
Institute for Global Public Health, U of
Manitoba
• Marissa Becker, Associate Prof, Institute for
Global Public Health, U of Manitoba
• Carla Loeppky, Director, Epi & Surveillance,
Manitoba Health
• Lawrie Deane, Professor & Senior Scholar,
Faculty of Social Work, U of Manitoba
• Robert Hogg, Distinguished Professor, Simon
Fraser University
Q&A
Share your story!
• Are you using EIDM in your practice? We want to hear about it!
• Email us: nccmt@mcmaster.ca
• Need support for EIDM? Contact us for help!
• Email us: nccmt@mcmaster.ca
• We typically respond within 24 business hours
36
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Equity and KT: Insights from the 2021 Knowledge Translation (KT) Student Award Recipients

  • 1. Welcome! • This webinar will be recorded. • Your microphone and camera will be turned off for the duration of the webinar. • To ensure accessibility, live captions can be enabled from the control panel.
  • 2. October 26, 2021 Presenters: Erica Phipps Sujane Kandasamy Leigh McClarty Facilitator: Emily Clark Equity and Knowledge Translation: Insights from the 2021 Knowledge Translation Student Award Recipients
  • 3. Housekeeping • Connection issues • We recommend using a wired Internet Connection • If you are experiencing technical issues please send a private message to Alanna Miller • Use the Q&A and chat to post questions and/or comments throughout the webinar • Post your questions in the Q&A • Send questions about technical difficulties in a private chat to Alanna Miller • Polling
  • 4. After Today After the webinar, access the recording (in English) at www.youtube.com/nccmt and slides in English and French at www.slideshare.net/NCCMT/presentations.
  • 5. Pre-webinar Polling Questions 1.How many people are watching today’s session with you? A) Just Me B) 2-3 C) 4-5 D) 6-10 E) >10 2. Have you visited the National Collaborating Centre for Methods and Tools’ website or used its resources before? A) Yes B) No 3. If you stated YES on the previous question, how many times have you used the NCCMT’s resources? A) Once B) 2-3 times C) 4-10 times D) 10+ times
  • 6.
  • 7. NCCMT Products and Services Registry of Methods and Tools Online Learning Opportunities Workshops Video Series Public Health+ Networking and Outreach
  • 8. Presenters Erica Phipps Sujane Kandasamy Leigh McClarty Queen’s University McMaster University University of Manitoba A critical exploration into Manitoba’s HIV care cascade “Culture Eats Strategy for Breakfast:” An Academic Journey toward Theory- informed, Empirically-rooted, and Co-developed Knowledge Translation Interventions for Priority Populations Investing in relational knowledge practices and ‘reversing the gaze’ for equity-focused intersectoral action on housing and health equity: The RentSafe EquIP research in Owen Sound, Ontario
  • 9. Investing in relational knowledge practices and ‘reversing the gaze’ for equity-focused intersectoral action on housing and health equity: The RentSafe EquIP research in Owen Sound, Ontario Erica Phipps, MPH, PhD Vanier Scholar, Centre for Environmental Health Equity, Queen’s University (graduated) Postdoctoral Fellow, University of Ottawa Executive Director, Canadian Partnership for Children’s Health & Environment; Director, RentSafe National Collaborating Centres for Public Health Webinar, 26 October 2021
  • 10. RentSafe EquIP Equity-focused Intersectoral Practice for housing and health equity in Owen Sound, Ontario Aim: To catalyze and support interaction among people from diverse sectors, amidst an escalating housing crisis, to: • Better understand the causes and consequences of housing inadequacy • Foster new ways of thinking about issues and solutions
  • 11. Research overview § Community-based Participatory Action Research (PAR); funded by CIHR Knowledge- to-Action grant § Linked to CPCHE-led RentSafe initiative § Catalyzed by work on Equity-focused Knowledge Translation (EqKT) § Explored the role of human relationships and critical reflexivity in understanding → deconstructing → transforming knowledge practices among intersectoral actors Masuda, Zupancic, Phipps et al (2014). Equity-focused Knowledge Translation: A framework for ‘reasonable action’ on health inequities. IJPH 59(3). https://doi.org/10.1007/s00038-013-0520-z Phipps & Masuda (2018). Towards equity-focused intersectoral practice (EquIP) in children’s environmental health and housing: the transformational story of RentSafe. Can J Public Health. 109(379). https://doi.org/10.17269/s41997-018-0094-x Phipps, & NCCDH (2018). Towards healthy homes for all: What the RentSafe findings mean for public health in Canada.. http://nccdh.ca/images/uploads/comments/NCCDH_RentSafeSummary_-_EN.pdf
  • 12. Grounded expertise The knowledge and insights gained and developed by those who have directly experienced and lived with(in) a particular issue, concern or injustice.
  • 13. Research phase 1: Learning Exchanges • 11 sessions • 45 participants from 16 agencies/sectors • Convened by co- researchers with grounded expertise • Identifying issues and gaps • Reflecting on existing practices and mindsets • Creating new understandings of the problem and potential solutions
  • 14. • Four-day immersive ‘experiment’ in building capacity for equity-focused intersectoral practice • ~30 participants from the community and research team Research phase 2: Intersectoral Retreat
  • 15. Centering of Indigenous ways of knowing, ceremony and teachings Solidarity through shared discomfort and problem-solving
  • 16. Getting out of our comfort zones Interacting as people and neighbours rather than as ‘roles’
  • 17. What we heard • Multiple, intersecting drivers of housing-related inequities • Some feel excluded from the ‘system,’ others feel trapped within it • Inadequate knowledge and understanding create tension and feed the crisis • Intersectoral collaboration is important and can be improved “...the complex lives of people are not properly addressed in the support services that we have...” “The judgement I was put through. I was already humiliated enough, and sick enough.” ”We all run on this hamster wheel sometimes on our own. Until we pick up the phone and say okay, here’s the real deal, here’s the red tape, how can we work together?” “...and the guy [prospective tenant] gets out of the cab and the owner goes ‘Oh, he’s native. No, sorry. I was wrong. I don’t have a unit.’”
  • 18. “It is not only okay, it is imperative to prioritize relationships.” “We need to start thinking of relationships as a resource.”
  • 19. Knowledge mobilization and community momentum • Report to the community: We are all Neighbours • Briefing to high-level intersectoral table: Healthy Communities Partnership • RentSafe EquIP Roundtable • RentSafe Owen Sound Collaborative • Intersectoral video: Housing Issues? We’re here to help
  • 20. What we learned RentSafe EquIP research identified gaps/barriers and opportunities for change in... 1. Structures “It can be very discouraging ...somebody comes in and is literally sleeping on the streets and they [say]... “I need help.” And you make the calls and it’s about a 3 year wait list.” 2. Knowledge, perceptions and beliefs “.. Attitudes that ...people are poor 'cause they've messed up their lives, they made bad choices, and they deserve what they get, which is substandard housing and no rights.” 3. Practices “When somebody with mental health issues or is scared... walks into an office and they say ‘Here, here’s a phone number, give them a call.’ They’re not gonna call.” “[Agency staff] don’t like to be made uncomfortable. It’s easier to keep the tunnel vision.” With regard to protocols that screen people out from receiving services: “Just don’t tick the box.” Phipps, Butt, Desjardins, Schonauer, Schlonies & Masuda (2021). Lessons from a rural housing crisis: grounded insights for intersectoral action on health inequities. Social Science & Medicine, https://doi.org/10.1016/j.socscimed.2020.113416
  • 21. What we learned EquIP served as a catalyst for... 1. (Re)problematization • “Housing isn’t just one silo. There are so many aspects... It’s the determinants of health, it’s the poverty lens... It is not just bricks and mortar.” 2. Reflexivity • “What we usually don’t hear is the frustration with our service and how they [community members] view the people who are trying to help them. That’s probably really good to hear.” – senior manager • “I am now more aware of the boxes [the service providers] are in, and the limitations they face.” - tenant 3. Rethinking individual and collective agency • “I feel more empowered and determined to stand up against barriers within my organization that feel unethical/unfair.” • “It is important to build relationships...for those warm referrals. But it is more than that. It is about accountability. It is more difficult to turn a blind eye to someone you know. “ • “People [with grounded expertise] are having a say... And [people in decision-making roles] are listening.” Phipps, Bumstead, Butt, Crighton, Desjardins, Hart, Oickle, Sanchéz-Pimienta, Schonauer, Umbach & Masuda (forthcoming). It doesn’t happen any other way: Relationship-building and critical reflexivity as groundwork for equity-focused intersectoral practice (EquIP).
  • 22. Equity- focused Intersectoral Practice (EquIP) Equity-focused intersectoral practice means: • Asking upstream ‘why’ questions • Engaging in intersectoral knowledge practices in ways that – Prioritize human relationships – Create non-hierarchical, safe and inclusive spaces – Foster shared understandings, respect and trust – Prioritize grounded expertise as the lens for examining systems, policies and practices. • Shifting the gaze away from perceived deficits in communities towards blind spots and barriers in the institutionalized ‘system’ itself. • Examining one’s own role and possibilities to act.. And having the courage to do so.
  • 23. Concluding thoughts: Opportunities for public health practice • Centering grounded expertise • Constituting intersectoral work in ways that advance reconciliation (ex: Giiwe) • Applying/adapting EquIP methods (e.g., Learning Exchanges, creation of relational spaces) • ‘Reflexive’ intersectoral projects, e.g., video • Leveraging research • Embracing public health’s role as a convenor
  • 24. RentSafe.ca LogementSain.ca Thank you! For more information: ephipps@uottawa.ca RentSafe.ca/owen-sound With gratitude for past and current funding support from: • Canadian Institutes of Health Research KTA grant # RN 27777245 • Vanier Canada Graduate Scholarship • GESTE -- pour la partage des connaissances fellowship • CIHR-funded postdoctoral fellowship, uOttawa • SSHRC-funded U de Montréal REGARD research collaboration Our team acknowledges the history, spirituality, culture, and stewardship of the Indigenous peoples of the region where this research was carried out: the Saugeen Ojibway Nation and the Three Fires Confederacy, namely the Odawa, Potawatomi, and Ojibway nations.
  • 25. “CULTURE EATS STRATEGY FOR BREAKFAST:” AN EXAMPLE OF A THEORY-INFORMED, EMPIRICALLY-ROOTED & CO-DEVELOPED KT INTERVENTION FOR A PRIORITY POPULATION Sujane Kandasamy, MSc, PhD McMaster University
  • 26. KEY TOPICS Set the stage: Brief Introduction Deep Dive: Key Concepts Key Lessons: Learnings Next Steps: Future Directions
  • 27.
  • 28. Click here to watch the Documentary-style film shown in this presentation
  • 29. Evidence KT Tool Evaluation Community-facing Knowledge Mobilization Integrated KT Summary & Next Steps (Co-design, joint analysis/mobilization, Iterate/innovate/scale)
  • 31. A critical exploration into Manitoba’s HIV care cascade Novel applications of equity- focused data visualisation to support knowledge translation Leigh McClarty, PhD Postdoctoral Fellow, Institute for Global Public Health Rady Faculty of Health Sciences, University of Manitoba 2 6 O C T O B E R 2 0 2 1
  • 32. Background & Context • Relatively little research focusing on HIV epidemiology in Manitoba • In 2013, CIHR-funded program of research – the LHIV Study – provided support for the establishment of a prospective clinical cohort of people living with HIV in Manitoba • First comprehensive source of HIV- specific health data for the province • Using cohort data, developed the first, comprehensive HIV care cascade model for Manitoba 2 6 O C T O B E R 2 0 2 1 26 McClarty LM, Kasper K, Ireland L, et al. The HIV care cascade in Manitoba, Canada: Methods, measures, and estimates to meet local needs. J Clin Epidemiol 2020; 132: 26-33. McClarty LM, Cheuk E, Ireland L, et al. Cohort profile: the LHIV-Manitoba clinical cohort of people living with HIV in Manitoba, Canada, BMJ Open 2020; 10(5): e034259.
  • 33. Frameworks & approaches P R O G R A M S C I E N C E • A research and program framework for improving the design and implementation of public health programs through the systematic application of theoretical and empirical scientific knowledge (Blanchard & Aral, 2011) that is embedded within a public health program I N T E G R A T E D K N O W L E D G E T R A N S L A T I O N • Active and ongoing partnerships with key stakeholders in Manitoba • Inform objectives • Ensure relevance for policy and programs 6 J A N U A R Y 2 0 2 2 27
  • 34. The HIV care cascade: What is it? • A framework for examining individuals’ progress through the continuum of HIV-related health services and outcomes • A tool used for: • Monitoring performance of HIV care programs, health systems • Identifying gaps and bottlenecks in service provision and uptake • Tracking progress toward meeting high- level public health goals (e.g., UNAIDS 90-90-90 Initiative) 28 Gardner EM, et al. Clinical infectious diseases 2011; 52(6): 793-800.
  • 35. Manitoba’s HIV care cascade 2 6 O C T O B E R 2 0 2 1 29 90.8% 86.2% 81.5% 74.4% 0% 20% 40% 60% 80% 100% Alive and diagnosed In care Retained in care On treatment Virologically suppressed Percentage of participants alive and diagnosed n = 703 at alive and diagnosed step M c C l a r t y L M , K a s p e r K , I r e l a n d L , L o e p p k y C , B l a n c h a r d J F , B e c k e r M B . T h e H I V C a r e C a s c a d e I n M a n i t o b a , C a n a d a : M e t h o d s , M e a s u r e s , A n d E s t i m a t e s T o M e e t L o c a l N e e d s . J C l i n E p i d e m i o l 2 0 2 0 ; 1 3 2 : 2 6 - 3 3 .
  • 36. Equity analyses Rationale & methods • The Sustainable Development Goals are centred around the notion of leaving no one behind. • Conventionally, cascades use aggregate data to illustrate population-level engagement in HIV care • Relying on aggregate data hides underlying heterogeneity among individuals and sub-groups within a population 2 6 O C T O B E R 2 0 2 1 30 Identified relevant “equity variables” available within the cohort • Age, sex, geography, ethnicity, immigration status, HIV exposure category Disaggregated each cascade step indicator by each equity variables Used equiplots to visualize inequalities between participant subgroups in each cascade step • Exploratory, multivariable logistic regression analyses were then used to quantify inequalities M E T H O D S McClarty LM, Blanchard JF, Becker ML. Leaving no one behind? An equity analysis of the HIV care cascade among a cohort of people living with HIV in Manitoba, Canada. BMC Public Health 2021; 21(1): 281.
  • 37. Inequalities across age groups CASCADE STEP In care Retained in care On treatment Virologically suppressed Total participants in cascade step, N 638 606 573 523 AOR 95%CI AOR 95%CI AOR 95%CI AOR 95%CI Age range, in years 18-29 Ref. - Ref. - Ref. - Ref. - 30-39 1.62 0.65-4.02 2.39 1.07-5.34 2.01 0.96-4.24 1.57 0.77-3.24 40-49 2.51 1.03-6.11 3.28 1.51-7.13 3.27 1.58-6.77 2.77 1.37-5.59 50-59 4.53 1.73-11.89 3.69 1.67-8.14 4.39 2.08-9.30 3.75 1.83-7.68 60+ 5.04 1.52-16.69 6.37 2.27-17.85 4.99 2.05-12.15 4.53 1.96-10.44 2 6 O C T O B E R 2 0 2 1 M c C l a r t y L M , B l a n c h a r d J F , B e c k e r M L . L e a v i n g n o o n e b e h i n d ? A n e q u i t y a n a l y s i s o f t h e H I V c a r e c a s c a d e a m o n g a c o h o r t o f p e o p l e l i v i n g w i t h H I V i n M a n i t o b a , C a n a d a . B M C P u b l i c H e a l t h 2 0 2 1 ; 2 1 ( 1 ) : 2 8 1 . 31 n = 703; adjusted for sex and ethnicity
  • 38. Inequalities across geographies 2 6 O C T O B E R 2 0 2 1 32 CASCADE STEP In care Retained in care On treatment Virologically suppressed Total participants in cascade step, N 638 606 573 523 AOR 95%CI AOR 95%CI AOR 95%CI AOR 95%CI Geography, by region Winnipeg Ref. - Ref. - Ref. - Ref. - Northern Manitoba 0.64 0.17-2.35 1.23 0.35-4.41 1.37 0.44-4.26 1.06 0.42-2.70 Western Manitoba 0.33 0.12-0.90 0.44 0.17-1.11 0.65 0.26-1.66 1.03 0.41-2.61 Eastern Manitoba 3.04 0.40-23.04 1.91 0.56-6.48 2.27 0.77-6.64 3.82 1.31-11.17 Southern Manitoba 0.64 0.18-2.35 0.95 0.31-2.95 0.92 0.35-2.45 0.55 0.24-1.27 n = 693; adjusted for age group, sex, and ethnicity M c C l a r t y L M , B l a n c h a r d J F , B e c k e r M L . L e a v i n g n o o n e b e h i n d ? A n e q u i t y a n a l y s i s o f t h e H I V c a r e c a s c a d e a m o n g a c o h o r t o f p e o p l e l i v i n g w i t h H I V i n M a n i t o b a , C a n a d a . B M C P u b l i c H e a l t h 2 0 2 1 ; 2 1 ( 1 ) : 2 8 1 .
  • 39. Summary: Data visualisation as knowledge translation 2 6 O C T O B E R 2 0 2 1 33 Equiplots are innovative and critical knowledge translation tools Facilitates communication of evidence with policy makers, program implementers, clinicians Visualisation of data through equiplots may be more programmatically useful than examining logistic regression models
  • 40. Thank you! 6 J A N U A R Y 2 0 2 2 34 Funding Study sites & implementation support Questions? leigh.mcclarty@umanitoba.ca Committee members • James Blanchard, Professor & Director, Institute for Global Public Health, U of Manitoba • Marissa Becker, Associate Prof, Institute for Global Public Health, U of Manitoba • Carla Loeppky, Director, Epi & Surveillance, Manitoba Health • Lawrie Deane, Professor & Senior Scholar, Faculty of Social Work, U of Manitoba • Robert Hogg, Distinguished Professor, Simon Fraser University
  • 41. Q&A
  • 42. Share your story! • Are you using EIDM in your practice? We want to hear about it! • Email us: nccmt@mcmaster.ca • Need support for EIDM? Contact us for help! • Email us: nccmt@mcmaster.ca • We typically respond within 24 business hours 36
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  • 44. Webinar Feedback Your responses will be kept anonymous. 4. Can we contact you in the future to discuss how the NCCMT can improve its webinar series? □ Yes □ No
  • 45. Webinars from the NCCMT Learn more about our webinars: http://www.nccmt.ca/capacity-development/webinars 39
  • 46. For more information: NCCMT website: www.nccmt.ca Contact: nccmt@mcmaster.ca