• Spittal, Patricia

    Titles

    Investigator, BC Children's Hospital
    Professor and Head, Division of Health in Populations, School of Population and Public Health, University of British Columbia
    Associate Director for Research, Centre for Excellence in Indigenous Health

    Degrees / Designations

    PhD

    Primary Area of Research
    Healthy Starts
    Secondary Area(s) of Research
    Phone
    604-875-2345 ext. 5944
    Fax
    Lab Phone
    Mailing Address
    Clinical Support Building

    Room V3-323
    950 W 28th Ave
    Vancouver BC  V5Z 4H4

    Affiliate Websites
    Research Areas
    • Young people
    • Global health
    • Indigenous health
    • Conflict-affected populations
    • HIV/AIDS
    • Hepatitis C
    • Infectious disease
    • Trauma and health
    • GendeI
    Summary

    Globally, Indigenous leaders remain concerned about elevated rates of HIV and blood-borned infections  among their young people, particularly those who use drugs and those affected by conflict. Further, addressing barriers to engagement in health care for these key populations remains an urgent global priority.

    The Cedar Project involves young Indigenous people in Canada who use drugs at risk of and living with HIV and Hepatitis C. The Cango Lyec Project involves Acholi people in Northern Uganda at risk of or living with HIV in the aftermath of a long rebel-led civil war. These two CIHR-funded studies trace clear links between multigenerational cycles of distress and trauma with current impacts on risk behaviour, morbidity and mortality including HIV and other explosive epidemics. This work has been and continues to be done in full partnership with the respective communities to ensure that the research is relevant and that the findings are implemented.

    Currently our team is focused on development of high-impact prevention and treatment approaches for those most adversely affected by HIV and other epidemics. These findings are expected to have significant impact on reducing health care inequities, with the ultimate aim of improving health care and outcomes in Canada and globally.

    Current Projects

    THE CEDAR PROJECT

    The Cedar Project uses a community-driven approach to respond to the crises of HIV and Hepatitis C infection and contribute to the health and healing of young Indigenous people who use drugs. Since its inception, The Cedar Project Partnership, an independent body of Indigenous Elders, leaders, and health/social service experts, and researchers, has governed the entire research process. The Partnership provides protection, leadership, support, and ensures that self-determining principles of Ownership, Control, Access and Possession (OCAP) and Indigenous knowledges are respected. To date, we have had 14 years of continuous funding from CIHR.

    We have recently initiated a new Cedar Project initiative to provide culturally-safe, strengths-based case management for the delivery of optimal Hepatitis C care and treatment among Indigenous people who use drugs in Vancouver and Prince George, British Columbia. Hepatitis C infection is a critical public health issue that disproportionately impacts Indigenous people who use drugs. Indigenous leaders, community service providers, and health experts are justifiably concerned about the complex barriers that impede Indigenous people’s access to life-saving HCV treatments. Recent advances in direct acting antiviral (DAA) therapies are dramatically changing the landscape of HCV treatment, as they offer shorter treatment durations, higher rates of sustained viral response, and greater tolerability. However, improving HCV treatment uptake among Indigenous people who use drugs will require care that acknowledges the impact of colonization and historical trauma and supports strength and survival in the face of complex adversities. We anticipate that this research will make essential contributions regarding the delivery of HCV treatments among Indigenous people who use drugs in Canada, including demonstrating feasibility and informing best practices.

    THE CANGO LYEC PROJECT

    The Cango Lyec study is a CIHR-funded cohort involving 2448 conflict-affected Acholi people aged 13-49 in Northern Uganda. It was initiated by Dr. Spittal and a team of Ugandan and Canadian collaborators in response to the need for evidence addressing war-related trauma and HIV vulnerability.

    A newly initiated Cango Lyec sister study focuses specifically experiences of girls and young women 13-24 years old. Girls and young women account for 71% of new HIV infections among young people in sub-Saharan Africa, with 380,000 young women newly infected each year. Lack of power, coerced first sex, early marriage, limited health services, extreme poverty, and sexual violence underpin the disproportionate burden of HIV among young women. In addition, they remain a key population experiencing multiple barriers to engagement in HIV care. Our goal is to investigate HIV vulnerability of young women in Northern Uganda and address the individual, socio-cultural, and structural factors associated with their resilience, psychological wellbeing, and barriers to engagement in HIV care. Findings will provide evidence for interventions that address HIV risk and support the strengths of young women experiencing complex adversities of war and its aftermath.

    Selected Publications

    Jongbloed K, Pearce ME, Pooyak S, Zamar D, Thomas V, Demerais L, Christian WM, Henderson E, Sharma R, Blair AH, Yoshida EM, Schechter MT, Spittal PM, For The Cedar Project Partnership. The Cedar Project: Mortality Among Young Indigenous People Who Use Drugs in British Columbia. Canadian Medical Association Journal. 2017, In press.

    Shahram SZ, Bottorff JL, Kurtz D, Oelke N, Thomas V, Spittal PM, For the Cedar Project Partnership. Understanding the life histories of pregnant-involved young Aboriginal women with substance use experiences in three Canadian Cities. Qualitative Health Research, 2017; 27(2):249-259.

    Malamba S, Muyinda H, Spittal PM, Ekwaru JP, Kiwanuka N, Ogwang DM, Odong P, Kitandwe PK, Kabamba A, Jongbloed K, Sewankambo NK, Kinyanda E, Blair A, Schechter MT. The Cango Lyec Project - Healing the Elephant: HIV related vulnerabilities of post-conflict affected populations aged 13–49 years living in three Mid-Northern Uganda districts. BMC Infectious Diseases. 2016; 16(1):690.

    Blair AH, Pearce ME, Katamba A, Malamba SS, Muyinda H, Schechter MT, Spittal PM. The Alcohol Use Disorders Identification Test (AUDIT): Exploring the Factor Structure and Cutoff Thresholds in a Representative Post-Conflict Population in Northern Uganda. Alcohol and Alcoholism. 2016.

    Pearce ME, Blair AH, Teegee M, Pan SW, Thomas V, Zhang H, Schechter MT, Spittal PM, For the Cedar Project Partnership. The Cedar Project: Historical Trauma and Vulnerability to Sexual Assault Among Young Aboriginal Women Who Use Illicit Drugs in Two Canadian Cities. Violence Against Women. 2015;21(3):313-29.

    Pearce ME, Jongbloed K, Richardson C, Henderson E, Pooyak S, Oviedo-Joekes E, Christian WM, Schechter MT, Spittal PM, For the Cedar Project Partnership. The Cedar Project: Resilience in the face of HIV vulnerability within a cohort study involving young Indigenous people who use drugs in three Canadian cities. BMC Public Health. 2015; 15(1): 1095-1106.

    Clarkson A, Christian W, Pearce ME, Jongbloed K, Caron NR, Teegee M, Moniruzzaman A, Schechter MT, Spittal PM, For the Cedar Project Partnership. The Cedar Project: Negative health outcomes associated with involvement in the child welfare system among young Aboriginal people who use injection and non-injection drugs in two Canadian cities. Canadian Journal of Public Health. 2015; 106(5): e265-70.

    Patel S, Schechter MT, Sewankambo NK, Atim S, Lakor S, Kiwanuka N, Spittal PM. War and HIV: Sex and gender differences in risk behavior among young men and women in post-conflict Gulu District, Northern Uganda. Global Public Health. 2014; 9(3): 325-341.

    Patel S, Schechter MT, Sewankambo NK, Atim S, Kiwanunka N, Spittal PM. Lost in transition: HIV prevalence and correlates of infection among young people living in post-emergency phase transit camps in Gulu District, Northern Uganda. PloS One. 2014; 9(2): e897686.

    Spittal PM, Pearce M, Chavoshi N, Christian W, Moniruzzaman A, Teegee M, Schechter MT. The Cedar Project: high incidence of HCV infections in a longitudinal study of young Aboriginal people who use drugs in two Canadian cities. BMC public health. 2012;12(1):632.

    Christian WM, Spittal PM. The Cedar Project: Acknowledging the pain of our children. Lancet. 2008; 372(9644): 1132-1133.

    Grants

    CIHR Project Grant (2017-2020): Designing targeted interventions to address HIV vulnerabilities and improve clinical outcomes among conflict affected adolescent girls and young women under 25 in Northern Uganda (PI: Spittal, Malamba, Muyinda, Sewankambo)

    CIHR Project Grant (2016-2019): The Cedar Project: Providing culturally-safe, strengths-based case management for the delivery of optimal hepatitis C care and treatment among Indigenous people who use drugs in Vancouver and Prince George, BC (PI: Spittal, Yoshida)

    CIHR Foundation Grant (2016-2022): Reducing HIV risk, increasing access to treatment and promoting resilience in Indigenous communities in Canada and globally (PI: Schechter)

    CIHR Planning and Dissemination (2015-2016): The Cedar Project: Sharing community wisdom about culturally-safe and trauma-informed care (PI: Spittal)

    CIHR Training Grant (2017–2021): Indigenous Mentorship Network Program - British Columbia (PI: Loppie, Clement, Caron, Greenwood, Reading)

    CIHR Collaborative Centres of HIV/AIDS Community-Based Research (2017-2021): Aboriginal HIV and AIDS Community-based Research Collaborative Centre 2.0 (PI: Masching, Clement, Cotnam Martin, Miller, Prentice, St. Denys, Benoit, Loppie)>/span>
    Honours & Awards

    UBC Faculty of Medicine Distinguished Achievement Award for Service to the University and Community (2017)

    Nominee, U.S. Embassy International Visitors Leadership Program on Indigenous Health (2016)

    Ranked First for meritorious activity among UBC School of Population and Public Health faculty (2015)

    CJG Mackenzie Prize for Excellence in Teaching (2010)

    Research Group Members
    • David Zamar, Data Scientist
    • Richa Sharma, PhD Candidate & Research Assistant
    • Anton Friedman, Research Assistant
    • Margo Pearce, Postdoctoral Fellow
    • April Mazzuca, PhD Student
    • Kate Jongbloed, PhD Candidate & Research Assistant