Veterans Affairs Military Toxic Exposure Research Conference: Veteran-centric Approach and Community of Practice

Abstract

The U.S. Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act expands benefits and services to U.S. Veterans exposed to military and deployment-related toxicants. Open-air burn pits were used on military bases in the Middle East and Southwest Asia for trash disposal, exposing U.S. troops to numerous and profound health consequences. Research is underway to understand the scope of the health and wellness impacts from burn pit exposures and to establish care standards and meaningfully address the needs of Veterans and military personnel. A virtual plenary conference and a subsequent hybrid in-person/virtual conference were conducted to foster a cross-professional Community of Practice (CoP) approach to address knowledge and implementation gaps in research and clinical care. For the plenary conference, leading experts in Veteran health care advocacy, preclinical, clinical and implementation scientists, clinicians, Veterans, and their families were engaged to present information on the current state of knowledge and solicit feedback from attendees. Often, clinical trials and health care delivery enterprises function as separate entities, with siloed goals, infrastructure, and incentives. Consequently, trials can have less relevance and be less responsive to the needs of Veterans and those responsible for their care. The conference highlighted the need to support Veteran health systems learning, requiring continuous cooperation and a loop of basic and clinical knowledge generation and uptake, and how best to provide care under real-world conditions, not just in determining what interventions work, under what contexts, and also how best to ensure they are provided to Veterans who need them. The in-person/virtual hybrid conference was held to further discuss what was learned from the plenary conference and propose next steps in collaborative efforts to address unmet needs. The purpose of this publication is to disseminate information presented and discussed in the two conferences. Findings are summarized related to centering the Veteran voice and creating a novel, CoP approach for research and health care. U.S. Veteran health care and policy are strengthened and informed by collaborative scientific knowledge, research, and innovation generated by bringing together stakeholders for effective implementation and sustained improvement of Veterans' health.

Figure 1.. Summary of Veteran Affairs Military Toxic Exposure Conference (VA MTEC) outcomes.

A. VA MTEC Meeting Metrics. Left: The demographic distribution during the initial plenary conference held March 27, 2023, providing insights into participant affiliation. Percentage and number of attendees indicated. Right: The demographic composition from the subsequent in-person/virtual conference conducted October 31, 2023, highlighting any changes in participant affiliation. Percentage and number of attendees indicated. B. Social Drivers of Health Affecting Access to Care and Well-being. On the left is depicted an iceberg illustrating that there are many unseen root causes and barriers to Veteran health and care that prevent individuals from seeking, obtaining, or receiving necessary medical attention. On the right are listed the stakeholders necessary to enhance upstream factors and health outcomes by addressing disparities with a collaborative and holistic approach at the root of the Veteran Health ecosystem. C. Approach to Improving Veteran Military Toxic Exposure Outcomes. The VA Military Exposure Research Program (MERP) plan presents a systematic approach to improving health outcomes for veterans exposed to military toxins. Our group’s CoP Veteran-centric approach aligns with MERP goals. This approach integrates team science and community care within translational precision medicine, tailored to address military toxin exposures. Key components include fostering collaboration among VA and non-VA researchers, clinicians, and community stakeholders; implementing robust data handling practices; upholding ethical standards with a focus on protecting Veterans’ rights and well-being; and actively involving veterans in the research process, recognizing their insights as crucial to identifying health concerns and informing program goals. Our approach also emphasizes continual evaluation and adaptation to advancements in precision medicine and evolving Veteran health needs.