Research

Faculty associated with the Department of Health Policy, Management and Evaluation (HPME) are involved in a broad range of research activities with a variety of organizations. Success of the HPME Knowledge Transfer initiative is dependent on presenting our stakeholders with a unified, clear image of the depth and breadth of Departmental expertise. To promote greater internal awareness of the knowledge developed through HPME, faculty research profiles will be included as a regular feature of this newsletter.

In this issue we feature research profiles from Upton D. Allen and Ahmed Bayoumi:

• Upton D. Allen is an Associate Professor with HPME. He is also a staff physician with the Hospital for Sick Children and an Associate Scientist with the Hospital for Sick Children Research Institute. His research focuses on infections in immunocompromised children.
  
  
• Ahmed Bayoumi is an Assistant Professor with HPME. He is also a staff physician with St. Michael's Hospital; Scientist with the St. Michael's Inner City Health Research Unit; and Director of Science for the HIV Information Infrastructure Project at the Ontario HIV Treatment Network. His research focuses on health and health care utilization of the homeless and those living with HIV.

+ + PROFILES OF THE MONTH + +

Upton D. Allen, MBBS, MSc, FAAP, FRCPC

My research activities have focussed mainly on infections in immunocompromised patients. In this regard, the populations targeted by my research are pediatric HIV-infected patients and transplant recipients. I have employed medical decision analyses and clinical trials to answer important questions in infectious diseases. I have been instrumental in establishing and leading national and international collaborative networks to conduct research.

Education and Work Background

In 1981, I obtained my medical degree from the University of the West Indies, Kingston, Jamaica. I completed Royal College certification in pediatrics in 1987 and pediatric infectious diseases in 1989 following training in these disciplines at the Hospital for Sick Children, Toronto. I received the MSc degree in Design, Measurement and Evaluation from McMaster University in 1989. Following completion of additional research training at the Hospital for Sick Children in 1991, I was appointed Assistant Professor of Pediatrics at the University of Ottawa. In 1995, I returned to the Hospital for Sick Children, where I have been an Associate Professor since 1998. I am cross-appointed to HPME as an Associate Professor.

Research Activities

One of the main areas of research focus has been infections in immunocompromised hosts. I am the immediate past chair of the Canadian Pediatric AIDS Research Group. I have utilized medical decision analyses to evaluate several aspects of HIV care including occupational exposure to HIV, pneumocystis prophylaxis and the role of erythropoietin therapy in zidovudine-related anemia.

I have spearheaded national studies on zidovudine resistance among HIV-infected children and in 1999 was the Canadian PI for the first drug trial among HIV-infected children in Canada. In 1995, I unveiled a study design that would enable HIV-infected pediatric patients to be entered into clinical trials using a two-step randomization process that allows for two or more conventional study arms and a parallel track arm in which patients are managed at the discretion of their treating physicians.

My research over the past 5 years has shifted towards transplant-related infections. I have led local and national collaborative networks to conduct such research. A major focus has been the herpesvirus family of viruses [Epstein-Barr virus (EBV), cytomegalovirus (CMV), human herpes virus-6 and varicella-zoster virus]. One of the areas that I am currently pursuing is post-transplant lymphoproliferative disease (PTLD) caused by EBV, including the role of EBV viral load testing in the evaluation of patients with PTLD.

Work on CMV is proceeding in parallel with the EBV-related studies due to similarities in the approach to these two viruses in transplant recipients. I have evaluated the role of polymerase chain reaction (PCR) in the diagnosis and evaluation of syndromes due to HHV-6 infection among transplant recipients and I have conducted studies on varicella-zoster infections in transplant recipients. Besides the herpesviruses, my research has also targeted other viruses affecting transplant recipients. These include respiratory viruses such as respiratory syncytial virus. Other studies have investigated fungal infections with an emphasis on drug trials involving novel approaches to therapy.

Teaching and Supervisory Responsibilities

In addition to teaching and supervision at undergraduate and post-graduate levels, I have taught and co-supervised graduate students. I have been a tutor for different sessions in the Introduction to Clinical Epidemiology and Health Care Research and the Controlled Clinical Trials Courses. I continue to function as an important resource and role model for junior clinician investigators, particularly those in infectious diseases and related disciplines. I am currently chair of the Nucleus Group, Specialty Committee on Infectious Diseases training, Royal College of Physicians and Surgeons of Canada.

Future Research

My future research activities will build on the foundations established to date. The activities will focus mainly on infections in transplant and related immunocompromised patients. In this regard, I will continue efforts to maintain and expand national and international collaborative networks that will enable us to successfully conduct clinical trials in the above populations. One such study that is near completion is a multicentre trial on EBV prophylaxis among transplant patients. In early 2002, I will also be launching at least two vaccine trials involving transplant recipients. Overall, I expect that my research will continue to have a direct impact on patient care and will help to foster multidisciplinary research collaborations.

Ahmed Bayoumi, MD, MSc

My professional interests revolve around health services research related to those living with HIV and individuals who are socioeconomically disadvantaged.

Education and Work Background

My education includes a medical degree from the University of Toronto in 1989. I then obtained an MSc in Clinical Epidemiology from the University of Toronto in 1997 and a Fellowship in Health Services Research at Stanford University in California.

I also received specific clinical training in HIV medicine at the Wellesley Hospital.

Since July 1998 I have been a Staff Physician at St. Michael's Hospital in the Department of Medicine, Division of General Internal Medicine, and a Scientist in the Inner City Health Research Unit at St. Michael's Hospital.

More recently I was hired as the Director of Science of the HIV Information Infrastructure Project at the Ontario HIV Treatment Network (www.ohtn.on.ca).

I also hold the academic positions of Assistant Professor in both HPME and the Department of Medicine at the University of Toronto.

I teach in the Introduction to Clinical Epidemiology and Decision Analysis courses, directly supervise two graduate students, and mentor three students/residents.

Research Activities

I was recently appointed the Director of Science for the HIV Information Infrastructure Project (HIIP), an initiative of the Ontario HIV Treatment Network. The HIIP, with an annual budget of $3,000,000, aims to improve the care of individuals living with HIV in Ontario through information technology, including the implementation of a sophisticated electronic health record throughout the province. Consenting participants will have their data securely and confidentially downloaded in real time to a central database. As research director, I will set the research agenda for the project, spanning the research fields of health services research, observational database analysis, and health informatics.

The HIIP has also assumed responsibility for the HIV Ontario Observational Database, making it an extremely rich repository of research information. Current research projects include issues of access to care for viral load testing, genotypic resistance testing, and antiretroviral therapy as well as clinical questions relating to the effectiveness of genotypic resistance testing, the tolerability of antiretrovirals, and the discontinuation of prophylactic regimens by HIV-infected individuals.

With colleagues at St. Michael's Hospital's Inner City Health Research Unit, I am collaborating on several projects to examine barriers to care for individuals who are socioeconomically disadvantaged. This line of inquiry includes both studies of factors in office practice that influence decision making and innovative observational studies using databases from homeless shelters and food banks.

I have an interest in exploring the relationship between "psychometric" quality of life scales (which measure the psychological impact of several health domains) and "utility-based" measures (which measure individual preferences for health states). Current studies are extending this line of research in the setting of HIV infection.

I have developed a comprehensive natural history simulation model of HIV infection, which is currently being used to address several important questions relating to HIV care, including the cost effectiveness of HIV resistance testing, the optimal time to initiate therapy for asymptomatic HIV-positive adults, the most cost-effective method of improving adherence, and the cost-effectiveness of HIV screening. I am also collaborating in comprehensive meta-analyses, developed under the auspices of the Cochrane Collaboration to provide rich data for these models. Future research will examine the equity implications of using cost-effectiveness analyses in health policy decision-making.

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