Title : SHIVER: A Syphilis/HIV ‘Test and Treat’ POCT intervention trial to reach rural/remote and underserved populations in Saskatchewan, Canada
Abstract:
Context: An alarming increase of infectious and congenital syphilis rates is being seen in Saskatchewan and the prairie provinces of Canada. According to the Public Health Agency of Canada, the national rate of infectious syphilis increased from 5.1 per 100,000 population in 2011 to 30 per 100,000 population in 2021, with the prairie provinces reporting the greatest relative increases from 2017 to 2021 (1346% in Saskatchewan and more than 400% in Alberta and Manitoba). Confirmed early congenital syphilis cases in Canada have considerably increased from prior years, with 50 cases reported in 2020 and 96 cases in 2021, compared with 7 cases in 2017. In 2020, Saskatchewan reported 10 confirmed cases of congenital syphilis, and two stillborn babies. In 2022, 67 congenital cases were reported. Syphilis carries serious life-threatening complications for the individual and the unborn child, if left untreated.
In March 2023, Wellness Wheel Clinic launched the Syphilis HIV Early Rapid Test (SHIVER) project, with the support of the REACH Nexus, collaborating First Nations communities and participating provincial sites, aimed to address the urgent need for faster testing and treatment, and reduce access barriers to treatment for rural/remote areas and underserved inner city groups.
Objective: To understand how point of care testing (POCT) options, along with culturally responsive care interventions, offer opportunities for immediate treatment and linkage to care for syphilis for undiagnosed individuals in inner city, remote, rural and underserved populations in Saskatchewan.
Research Question: How does the implementation of a “test and treat” model of POCT, delivered as a culturally informed and responsive interventional team approach, offer immediate treatment and linkage to care for syphilis, and reach those undiagnosed in sites across Saskatchewan?
Method: This project is a multiplex point-of-care “test and treat” intervention study based on a successful 2020 study in Alberta, Canada. The program demonstrated the clinical utility in diagnosing and linking underserved and hard to reach individuals into care. The SHIVER approach offers 3 rapid finger prick test options (syphilis only, HIV only, or syphilis and HIV) with education and participant experience survey. Additional blood is drawn for confirmatory results and screen for false positive/negative. In the event of a positive diagnosis, treatment, and linkage to care for follow-up is immediately carried out. The POCT device was found to be >98 per cent accurate in detecting active syphilis. Test kits provide a test result in under five minutes using a fingerstick blood specimen. Acting on the device’s instantaneous nature, connecting participants to care and early treatment was a key priority of the study. This initiative aims to enroll 1,500 individuals for testing of HIV and/or syphilis.
Results: As of November 2023, SHIVER has recruited 20 sites, including 10 First Nations on-reserve communities, 1 northern community health centre, 8 community organizations providing harm reduction care and support services to people living in inner-city settings, and the Saskatchewan Federal Penitentiary. Preliminary numbers report 443 participants have taken part in the project across the 9/10 participating sites. 71/443 participants testing positive for syphilis, and 14/71 also receiving a positive HIV diagnosis (co-infection). Within those testing positive, 35/71 were of male biological sex and 36/71 were female biological sex. Among those women with a positive syphilis result, 2 were pregnant. Biological sexed women, aged 18 to 39, had the highest diagnosis rate with 29/36 individuals being between ages of 18 and 39. Biological sexed men were older with 29/35 of the positive diagnoses being among those aged 30-49. No one over the age of 59 years had a positive result for either disease. 12 women and 12 men (total n=24) had a positive HIV result along with a negative syphilis result. Most POCT and positive results were among inner city harm reduction community organization cohorts. Efforts are underway to increase testing rate in communities through testing events and culturally tailored public awareness campaigns. Data reporting is ongoing and additional sites will be onboarded throughout 2024 to expand the POCT program.
