Dual Syphilis and HIV Point of Care Testing (POCT) to Improve Access to Testing Among Inner City, Remote, Rural and Hard to Reach Populations in Alberta

Purpose:

In the context of resurgent syphilis in Alberta (Canada), the investigators will evaluate the performance of two dual HIV/syphilis POCT. Their utility in the point of care treatment for syphilis among populations who access outreach or acute care services and in rural/remote areas will also be assessed.

Justification:

Syphilis is an important sexually transmitted infection (STI) caused by the bacterium Treponema pallidum which if left untreated, can result in serious complications and can be transmitted from mother to child during pregnancy resulting in severe consequences (Singh, 1999). Alberta is currently in the midst of an outbreak of infectious syphilis, with rates not reported since 1948 (AH, 2019). Many syphilis cases in this outbreak have occurred among high risk populations, such as street-involved persons, who are difficult to reach through standard health care services and are also at high-risk for HIV infection. Cases are also occurring in rural and remote areas where access to services is also limited and may result in delays in treatment.

Point of care testing (POCT) for syphilis is widely available for diagnostic use and point of care treatment in many countries. There are more than a dozen commercially available tests internationally, but none are approved for use in Canada. In contrast, HIV POCT has been available in Canada since 2006. With the current syphilis outbreak in Alberta, POCT for syphilis and HIV offers the opportunity for immediate and rapid access to testing and results. For syphilis, POCT also provides the opportunity to provide immediate treatment in remote/rural communities and in non-traditional venues. Immediate treatment can prevent complications of syphilis in the infected individual and limit the spread of syphilis, as well as reduce the demand on limited healthcare resources by allowing treatment to occur at the time of testing, thus reducing the need for an additional visit by the client. In addition, a scoping review found that between 81-97% of Canadians prefer POCT to traditional testing and 96-100% were highly satisfied with the testing process (Minichiello, 2017). Studies using POCT for HIV in British Columbia and Ontario have also demonstrated that POCT is effective in reaching the undiagnosed (Fielden, 2013, Sullivan, 2013).