Expanding syphilis testing: a scoping review of syphilis testing interventions among key populations

Abstract

Syphilis is an important sexually transmitted infection (STI). Despite inexpensive and effective treatment, few key populations receive syphilis testing. Innovative strategies are needed to increase syphilis testing among key populations. Areas covered: This scoping review focused on strategies to increase syphilis testing in key populations (men who have sex with men (MSM), sex workers, people who use drugs, transgender people, and incarcerated individuals). Expert commentary: We identified many promising syphilis testing strategies, particularly among MSM. These innovations are separated into diagnostic, clinic-based, and non-clinic based strategies. In terms of diagnostics, self-testing, dried blood spots, and point-of-care testing can decentralize syphilis testing. Effective syphilis self-testing pilots suggest the need for further attention and research. In terms of clinic-based strategies, modifying default clinical procedures can nudge physicians to more frequently recommend syphilis testing. In terms of non-clinic based strategies, venue-based screening (e.g. in correctional facilities, drug rehabilitation centres) and mobile testing units have been successfully implemented in a variety of settings. Integration of syphilis with HIV testing may facilitate implementation in settings where individuals have increased sexual risk. There is a strong need for further syphilis testing research and programs.

Syphilis Self-testing: A Nationwide Pragmatic Study Among Men Who Have Sex With Men in China

“…HIV self-testing has already created extensive infrastructure and public health pathways, including online testing programs, integration of public health and community-based organization programs, verification methods, and educational materials [29][30][31]. Given the syndemic of HIV and syphilis among MSM [32,33], our data suggest that syphilis self-testing could be integrated into existing HIV self-testing platforms, organizations, and projects [9]. Currently, there are 3 main ways of disseminating self-testing kits, including through community-based organizations, e-commerce platforms, and pharmacies.…”

“…Syphilis self-testing may help improve test uptake among key populations. Self-testing is the process whereby a person collects a specimen, performs the test, and interprets the result themselves [9]. HIV self-testing programs have already introduced the concept of self-testing to MSM in many countries, creating an infrastructure to distribute and measure uptake of self-testing [15,16].…”

Incidence of syphilis among HIV-infected men in Singapore, 2006–2017: temporal trends and associated risk factors

“…Moreover, increasing the frequency and coverage of syphilis screening in HIV-infected MSM receiving HIV care, relative to current standard of care, would be highly cost-effective 26. Many promising and novel interventions have been identified to boost frequency and coverage of syphilis testing, including modification of default clinical procedures, provision of self-testing and point-of-care testing, venue-based screening and community-based testing services via mobile testing units 27. In order to make voluntary HIV testing more accessible and convenient in Singapore, AfA launched the first Mobile Testing & Counselling Service on 7 December 2011, which provides anonymous HIV testing on wheels 28…”

Self-collection of samples as an additional approach to deliver testing services for sexually transmitted infections: a systematic review and meta-analysis

“…Follow-up in the case of positive test results requires a linkage with the health system. Research in high-income countries, where organised lab facilities and healthcare are available, shows that self-collected STI samples are as diagnostically accurate as clinician-collected samples13 and that self-collection interventions are feasible and acceptable in a variety of populations 14–23. Self-collection approaches also have the potential to address some common barriers to clinician-dependent and/or clinic-based diagnosis, such as concerns around autonomy, inconvenience, stigma and lack of privacy 5 24 25.…”