Sensitivity and specificity of two investigational Point of care tests for Syphilis and HIV (PoSH Study) for the diagnosis and treatment of infectious syphilis in Canada: a cross-sectional study

Singh, Ameeta E.; Ives, Noel; Gratrix, Jennifer; Vetland, Carla; Ferron, Leslie; Crawford, Megan; Hale-Balla, Lisa; Dong, Kathryn; Meyer, Garret; Smyczek, Petra; Galli, Rick; Rourke, Sean B.; Fonseca, Kevin; Doherty, Jenny; Cardinal, Nicole; Ahmad, Rabia; Rosenblum, Rebecca; Braun, Sheila; Wong, Tom; Yacoub, Wadieh

doi:10.1016/j.cmi.2023.02.015

Cited by 3 publications

(6 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…20 Despite this, when a concurrent diagnosis of HIV is made using rapid point of care HIV and syphilis testing, it may be reasonable to consider early treatment in these higher risk individuals given the high specificity of these tests and high prevalence of syphilis among PLWH in DC. 21,22 It is notable that among all stages of early syphilis there were significant rates of extended treatment "adequate plus," or treatment with regimens other than those recommended by the CDC guidelines (Table 2). 10 This may be reflective of treatment for concurrent STIs.…”

Section: Discussionmentioning

confidence: 99%

“…However, the risks and costs versus benefits of deciding whether or not to treat empirically or wait for confirmatory testing remains an area of clinical uncertainty and has not clearly been studied 20 . Despite this, when a concurrent diagnosis of HIV is made using rapid point of care HIV and syphilis testing, it may be reasonable to consider early treatment in these higher risk individuals given the high specificity of these tests and high prevalence of syphilis among PLWH in DC 21,22 …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The Tenacious Treponema: A Retrospective Examination of Syphilis Treatment Disparities in Washington, DC

Liroff,

Kassaye,

Spence

et al. 2023

Sexual Trans Dis

View full text Add to dashboard Cite

Background Since 2000 there have been rising rates of syphilis infections nationally with higher incidence among minorities and persons living with HIV (PLWH). The purpose of this study was to determine syphilis treatment adequacy and factors associated with treatment delay. Methods This was a retrospective academic-public health collaboration with the District of Columbia Department of Public Health reviewing surveillance data of all primary, secondary, and early latent syphilis cases diagnosed between 1/1/2015 and 12/31/2019. Data were analyzed using multivariable logistic regression to identify factors associated with delayed treatment >14 days from diagnosis. Results Among 1852 individuals diagnosed with early syphilis, 93% (1730/1852) were male; 48% (893/1852) were co-infected with HIV; 43% (n = 796/1852) were African American/Black, 27% (n = 492/1852) were White, and race/ethnicity was unknown for 17% (n = 318/1852) of cases. Among 679 PLWH for whom viral load (VL) was known, 41% (278/679) had a viral load (VL) < 20 copies/mL, and 18% (123/679) had VL >10,000 copies/mL. Treatment adequacy overall was 96.5%. Median time to syphilis treatment was 6 days [IQR = 4,7]. Factors associated with delay of treatment included refused/unknown race (aOR = 1.95; CI = 1.00, 3.79), reporting provider veterans/military (aOR = 5.26; (CI = 1.51-18.28),and HIV VL > 10,000 copies/mL (aOR = 1.97; CI = 1.08-3.58). Conclusions The factors we identified associated with delayed treatment may reflect systemic factors contributing to the increased rates of infection among key populations. This highlights the importance of targeted public health efforts with the goal of reducing transmission of both HIV and syphilis.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Tenacious Treponema: A Retrospective Examination of Syphilis Treatment Disparities in Washington, DC

Liroff,

Kassaye,

Spence

et al. 2023

Sexual Trans Dis

View full text Add to dashboard Cite

show abstract

“…While the INSTI® Multiplex POC product monograph reports 95-100% sensitivity (30), more real-world studies are needed to examine accuracy in a community setting and in populations with low RPR concentrations (<1:8 dilutions) (Figure 1). Expanding POC tests to non-healthcare settings is a crucial strategy to reach undiagnosed individuals, but few studies have evaluated the effectiveness and feasibility of this approach in various settings (31–33). Here we describe the methodology of the Syphilis Rapid Point-of-Care Testing and Immediate Treatment Evaluation (SPRITE) Study, wherein the overall goal is to evaluate the implementation and effectiveness of a community-based outreach model of care aimed at reducing barriers to timely testing and treatment of syphilis across PHUs in Ontario.…”

Section: Epidemiologymentioning

confidence: 99%

“…Results are read after the addition of the three vials is complete (~one minute) and not after five minutes following the addition of the clarifying solution. A reactive syphilis POC test will be considered a suspect case (30). Participating PHUs have each developed a medical directive allowing trained outreach nurses to immediately treat these suspect syphilis cases with a single dose of benzathine penicillin G (2.4 million units via intramuscular injection).…”

Section: Model Of Carementioning

confidence: 99%

See 1 more Smart Citation

The Syphilis Point of Care Rapid Testing and Immediate Treatment Evaluation (SPRITE) Study

Mackrell,

Carter,

Hoover

et al. 2024

Preprint

View full text Add to dashboard Cite

Background: In the last decade, the rates of infectious syphilis have increased by 505% in Ontario, Canada. Underserved populations (people who use drugs, un(der)housed individuals, and those living in rural and remote areas) face unique social and healthcare challenges that increase their vulnerability to syphilis infections and hinder their access to timely diagnosis and treatment. Given the shift in epidemiology and the geographic disparities in resources, there is no one-size-fits-all solution to this complex issue. Access to low-barrier diagnostics, such as point-of-care (POC) tests for HIV and hepatitis C, has been shown to be an effective strategy for reaching underserved people outside of traditional healthcare settings. However, there is a paucity of evidence regarding the effectiveness of POC tests for other sexually transmitted and blood-borne infections, particularly in non-urban, rural, and remote settings. Methods/Design: The Syphilis Rapid Point-of-Care Testing and Immediate Treatment Evaluation (SPRITE) Study includes nine Public Health Units (PHUs) in Ontario. The INSTI Multiplex HIV-1/HIV-2/Syphilis Antibody Test will be used to evaluate a rapid test and immediate treatment outreach model of care targeting people who are un(der)housed or who use drugs at multiple community-based settings anchored to their respective PHU. Implementation of the model of care will be evaluated using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) Framework, following a community-based participatory approach. Empirical results will inform network models to estimate the population-level impact of using POC test to curb transmission. Discussion: Urgent, tailored, and equitable action is needed to address the alarming rise in syphilis rates in Canada. This study assesses the real-world effectiveness of syphilis POC tests in breaking barriers and bringing services to the population at the highest risk. Results will inform future implementation, build capacity, and provide the evidence necessary for program decision-making.

show abstract

Rapid HIV Self-Testing

Mason¹,

Bailey²

2023

cjht

View full text Add to dashboard Cite

Self-testing has become recognizable to most people in Canada as a way to reduce the spread of infections. HIV self-testing has recently become available in Canada and is an approach to HIV screening intended to complement existing HIV testing currently offered in medical and community settings. Self-test kits can be used in the home, alone or in the presence of another person, and they may help overcome barriers to HIV diagnosis, and help Canada achieve its commitments to end the HIV and AIDS epidemics by 2030. HIV self-testing is recommended by the WHO, used in countries worldwide. The INSTI HIV-1/2 Antibody Self Test is the first HIV self-test available in Canada. It is a single-use HIV test kit that detects HIV-1 and HIV-2 antibodies from a drop of blood collected by a fingerstick. In 50% of people, the test can detect HIV infection about 22 days after exposure, and in 99% of people can detect HIV infection 12 weeks (3 months) after infection. As the INSTI HIV-1/2 Antibody Self Test is intended as a screening test, a positive result must be confirmed with a laboratory-based test. If the result is negative, no further action is required unless the tester has had a potential HIV exposure in the previous 3 months. In this case, a person should self-test at a later date or seek a laboratory-based HIV test that is able to detect HIV in a shorter window of time since potential exposure. While the comparability of the INSTI HIV-1/2 Antibody Self Test with traditional lab testing has already been established, when used in real-world settings in Canada, there is a higher than-expected rate of invalid test results (that is, when the test does not produce a result and therefore another test must be taken). Improvements to the content, design, or delivery of the test instructions and other resource materials provided to testers have been offered as possible solutions. This report outlines information related to the INSTI HIV-1/2 Antibody Self Test use in Canada and issues for consideration when implementing an HIV self-testing program including cost, support for testers, and providing test access to groups who have historically had lower testing rates.

show abstract

Sensitivity and specificity of two investigational Point of care tests for Syphilis and HIV (PoSH Study) for the diagnosis and treatment of infectious syphilis in Canada: a cross-sectional study

Cited by 3 publications

References 11 publications

The Tenacious Treponema: A Retrospective Examination of Syphilis Treatment Disparities in Washington, DC

The Tenacious Treponema: A Retrospective Examination of Syphilis Treatment Disparities in Washington, DC

The Syphilis Point of Care Rapid Testing and Immediate Treatment Evaluation (SPRITE) Study

Rapid HIV Self-Testing

Contact Info

Product

Resources

About