Syphilis is on the rise among HIV-positive men who have sex with men in Ontario. Untreated syphilis may lead to serious problems such as neurosyphilis, can be spread to sexual partners, and can increase the likelihood of spreading HIV from one person to another. Early treatment, on the other hand, is simple, effective and inexpensive.
A solution to make it easier for HIV-positive men to get tested for syphilis.
We are working with four Ontario clinics to see opt-out syphilis testing incorporated whenever men in HIV care undergo HIV viral load testing, which typically occurs every three to six months. ‘Opt-out’ means that the test is a routine part of the patient’s clinic visit, unless a patient requests otherwise. The goal of this solution is to ensure that more HIV-positive men get screened for syphilis more often, increasing the chances of better outcomes through early treatment.
We used a cluster-randomized, stepped-wedge design to introduce the testing strategy across four urban HIV clinics in Toronto and Ottawa, and then analyzed the data from participating patients’ lab results, medical charts and information. Over 30 months, enhanced screening will be applied to roughly 3,100 patients
Our program-science approach involving researchers and knowledge users will guide policy and practice decisions regarding scale-up in these and other HIV clinics in Ontario. Our results will also be important addition to the literature on what kinds of policies, practices and strategies really work to control the spread of syphilis among men who have sex with men, and prevent serious syphilis-related disease. Our learnings may also be applicable to other sexually transmitted and blood-borne infections that pose risk for HIV-positive men.