Patient Perspectives on the Implementation of Routinised Syphilis Screening With HIV Viral load Testing: Qualitative Process Evaluation of the Enhanced Syphilis Screening Among HIV-positive Men Trial

Abstract

Background: Syphilis infections have been on the rise, affecting men living with HIV in urban centres disproportionately. Since individuals in HIV care undergo routine blood testing, HIV clinics provide practical opportunities to conduct regular and frequent syphilis testing. Following the implementation of a routine syphilis testing intervention in HIV outpatient clinics, we conducted a qualitative process evaluation of patient experiences to measure patient acceptability, barriers to implementation, and facilitators of successful uptake. Methods: Upon completion of the trial, which took place at four HIV outpatient clinics in Toronto and Ottawa, Canada, we recruited male patients attending these clinics from November 2017 to April 2018. Interviews were conducted on-site and were audio-recorded and transcribed verbatim. All participants provided written informed consent. Interview data were analyzed using grounded theory, assessing qualitative modulators of effective uptake of routinised syphilis testing. Results: A total of 21 male patients were interviewed. Overall, interviewees found the clinical intervention acceptable, endorsing the practice of routinising syphilis testing alongside regular viral load bloodwork. Some men preferred, based on their self-assessment of syphilis risk, to opt out of testing; we considered this as a potential barrier to uptake of population-wide routinised syphilis testing. Interviewees also identified multiple facilitators of successful uptake, including the de-stigmatising of STI testing as a consequence of the universal nature of routinised testing. Participants recommended a routinised syphilis screening intervention to give patients peace of mind surrounding their sexual health. Participants identified HIV care clinics as comfortable and efficient locations to offer testing. Conclusions: Overall, most men were in support of implementing routinised syphilis testing as part of standard HIV care. From the patient perspective, HIV care clinics are convenient places to be tested for syphilis, and the routine approach was viewed to have a de-stigmatisng effect on syphilis testing. Trial registration: ClinicalTrials.gov NCT02019043; registered December 23, 2013.Trial registration: ClinicalTrials.gov NCT02019043; registered December 23, 2013.

The Intersection of HIV and Syphilis: Update on the Key Considerations in Testing and Management

“…In our HIV clinic, syphilis serology has become a part of the standard panel of bloodwork completed on patients during each visit since 2018 when our research demonstrated this to be an effective approach [84]. Previous studies have also indicated that in our context implementing routine syphilis testing is cost effective and supported by patients [85,86]. We diagnose and monitor patients for syphilis based on the 2015 Centre of Disease Control guidelines for syphilis management and have described that over 90% of our patients across all syphilis stages achieved an adequate serological response after appropriate treatment [57,86].…”

“…Social distancing and lockdown measures have led to decreased rates of diagnosis of syphilis in Rome and Madrid and syphilis and HIV in Taiwan compared to same time periods in previous years [76][77][78][79][80][81][82][83][84][85][86][87][88]. This phenomenon has also been noted in public health reports comparing 2020 data for HIV and syphilis in regions in Canada and in the USA [79,80].…”