A national approach to addressing sexually transmitted and blood-borne infections (STBBIs) was recently articulated in the Public Health Agency of Canada’s new A Pan-Canadian Framework for Action: Reducing the health impact of sexually transmitted and blood-borne infections in Canada by 2030 . This Framework promotes an integrated approach, with a focus on the key populations that are affected by overlapping epidemics (i.e., syndemics). We advance the idea that integrating surveillance would be helpful in characterizing and understanding the populations, locations, risk behaviours and other drivers that contribute to STBBI syndemics. The creation of matched or linked data systems that would allow routine reporting of integrated data is challenged by the technical barriers of integrating data silos as well as by the privacy and ethical considerations of merging sensitive individual-level data. Lessons can be learned from jurisdictions where an improved understanding of syndemics, through integrated STBBI surveillance, has led to more efficient and effective operational, program and policy decisions. Emerging enablers include the development of data standards and guidelines, investment in resources to overcome technical challenges and community engagement to support the ethical and non-stigmatizing use of integrated data. The Framework’s call to action offers an opportunity for national discussion on priorities and resources needed to advance STBBI syndemic surveillance for local, regional and national reporting in Canada.

Setting Syndemics occur when two or more health conditions interact to increase morbidity and mortality and are exacerbated by social, economic, environmental, and political factors. Routine provincial surveillance in Ontario assesses and reports on the epidemiology of single infectious diseases separately. Therefore, we aimed to develop a method that allows disease overlaps to be examined routinely as a path to better understanding and addressing syndemics in Ontario. Intervention We extracted data for individuals with a record of chlamydia, gonorrhea, infectious syphilis, hepatitis B and C, HIV/ AIDS, invasive group A streptococcal disease (iGAS), or tuberculosis in Ontario's reportable disease database from 1990 to 2018. We transformed the data into a person-based integrated surveillance dataset retaining individuals (clients) with at least one record between 2006 and 2018. Outcomes The resulting dataset had 659,136 unique disease records among 470,673 unique clients. Of those clients, 23.1% had multiple disease records with 50 being the most for one client. We described the frequency of disease overlaps; for example, 34.7% of clients with a syphilis record had a gonorrhea record. We quantified known overlaps, finding 1274 clients had gonorrhea, infectious syphilis, and HIV/AIDS records, and potentially emerging overlaps, finding 59 clients had HIV/AIDS, hepatitis C, and iGAS records. Implications Our novel person-based integrated surveillance dataset represents a platform for ongoing in-depth assessment of disease overlaps such as the relative timing of disease records. It enables a more client-focused approach, is a step towards improved characterization of syndemics in Ontario, and could inform other jurisdictions interested in adopting similar approaches. Résumé Contexte Les syndémiques surviennent lorsque deux ou plusieurs affections interagissent de façon à augmenter la morbidité et la mortalité et sont exacerbées par des facteurs sociaux, économiques, environnementaux et politiques. En Ontario, les services provinciaux de surveillance de routine évaluent et communiquent séparément l'épidémiologie de chaque maladie infectieuse. Par conséquent, nous avons voulu élaborer une méthode permettant d'examiner de façon routinière les chevauchements de maladies comme moyen de mieux comprendre et traiter les syndémiques en Ontario. Intervention Nous avons extrait de la base de données ontarienne sur les maladies à déclaration obligatoire des données concernant des personnes dont le dossier mentionnait la chlamydia, la gonorrhée, la syphilis infectieuse, l'hépatite B et C, le VIH/sida, la maladie invasive à streptocoque du groupe A (SGA) ou la tuberculose de 1990 à 2018. Nous avons transformé les données en un ensemble de données de surveillance intégrée axé sur les personnes (les clients), en retenant celles ayant eu au moins un dossier de 2006 à 2018.